Direct Medical Costs of Hospitalized Patients with Idiopathic Pulmonary Fibrosis in a Tertiary Hospital in China
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease characterized by the scarring of lung tissue, leading to a decline in lung function and, ultimately, respiratory failure. The incidence of IPF varies significantly across different regions of the world. In North America and Europe, the incidence ranges from 3 to 9 cases per 100,000 inhabitants annually, while in South America and Asia, the incidence is lower, ranging from 1.2 to 4.16 cases per 100,000 inhabitants per year. As the incidence of IPF continues to rise, the economic burden associated with the disease is becoming increasingly significant. Studies from the United States and Spain have estimated the annual direct medical costs of IPF to be $26,378 and €26,435 per patient, respectively. However, there is a lack of data on the economic burden of IPF in China. This study aimed to address this gap by examining the direct medical costs of hospitalized patients with IPF in a tertiary hospital in China and identifying the factors contributing to these costs.
Study Design and Methodology
This study was a retrospective cross-sectional analysis conducted at the Beijing Chao-Yang Hospital, a tertiary hospital in China. The study included 219 hospitalized patients diagnosed with IPF between 2012 and 2015. The diagnosis of IPF was made in accordance with the guidelines set forth by the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax. Data were collected from the hospital’s case statistics management system, which included information on patient characteristics, comorbid conditions, and treatment costs.
The direct medical costs analyzed in this study were categorized into three main groups: auxiliary testing fees, drug fees, and other fees. Auxiliary testing fees included costs for laboratory diagnosis, radiography, ultrasonic imaging, pathological diagnosis, and clinical diagnosis. Drug fees covered antibiotics, western medicine, Chinese patent medicine, Chinese herbal medicine, and blood products. Other fees included treatment, anesthesia, rehabilitation, general medical expenses, nurse fees, monitoring and auxiliary equipment, oxygen, and accommodation. All costs were reported in Chinese yuan (CNY), with an exchange rate of 1 USD ≈ 6.2 CNY in 2015.
Statistical analysis was performed using SPSS version 22.0. Continuous data were presented as median values with interquartile ranges (Q1, Q3), while categorical data were presented as numbers and proportions. The distribution of continuous variables was tested for normality using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used to compare differences in continuous variables. Univariate and multivariate linear regression analyses were conducted to identify factors significantly associated with direct medical costs. A p-value of less than 0.05 was considered statistically significant.
Patient Characteristics
The study included 219 patients with a mean age of 65 years, ranging from 41 to 88 years. The majority of the patients (91.3%) were male, and nearly half (48.9%) were residents of Beijing. The average length of hospital stay was 10.1 days, with a standard deviation of 8.0 days. Among the patients, 13 (5.9%) required invasive or non-invasive ventilation, and 3 (1.4%) were admitted to the intensive care unit (ICU).
Direct Medical Costs
The median direct medical cost per patient per admission was 9,378.3 CNY (7,366.9, 12,122.8 CNY). The largest proportion of these costs was attributed to auxiliary testing fees, which accounted for 5,745.8 CNY (4,105.4, 7,043.7 CNY) per patient. Within the auxiliary testing fees, laboratory costs were the highest, with a median of 3,687.5 CNY (2,525.5, 4,556.5 CNY). Drug costs were significantly lower, with a median of 1,347.0 CNY (624.9, 3,809.9 CNY) per patient.
Factors Influencing Direct Medical Costs
Several factors were found to significantly influence the direct medical costs of hospitalized patients with IPF. These included the use of intensive care, ventilator use, and the patient’s place of residence. Patients who required intensive care had significantly higher costs, with a median of 81,452.5 CNY (63,117.9, 100,048.5 CNY) compared to 9,294.9 CNY (7,344.2, 12,057.8 CNY) for those who did not require intensive care. Similarly, patients who required ventilator support had a median cost of 29,869.7 CNY (10,121.8, 72,415.4 CNY), compared to 9,242.5 CNY (7,322.8, 11,897.7 CNY) for those who did not. Additionally, Beijing residents had slightly higher median costs (9,516.5 CNY) compared to non-residents (9,171.9 CNY).
Comorbid conditions also played a significant role in increasing direct medical costs. Patients with pulmonary infection had a median cost of 11,023.4 CNY (8,347.4, 19,849.6 CNY), compared to 8,789.3 CNY (6,810.5, 11,209.4 CNY) for those without pulmonary infection. Similarly, patients with respiratory failure had a median cost of 16,456.9 CNY (9,265.8, 29,350.6 CNY), compared to 8,806.8 CNY (6,938.3, 11,147.5 CNY) for those without respiratory failure. Pulmonary arterial hypertension (PAH) was another significant factor, with patients suffering from PAH incurring a median cost of 12,122.7 CNY (8,123.3, 19,011.5 CNY), compared to 9,212.6 CNY (7,046.1, 11,626.3 CNY) for those without PAH.
Regression Analysis
Univariate linear regression analysis revealed that the length of hospital stay, place of birth, reimbursement status, ventilator use, intensive care, pulmonary infection, respiratory failure, and PAH were significantly associated with higher direct medical costs. Multivariate linear regression analysis further identified the length of hospital stay, intensive care, pulmonary infection, and respiratory failure as independent predictors of high direct medical costs. Among these factors, intensive care had the greatest impact on costs.
Discussion
This study provides valuable insights into the direct medical costs of hospitalized patients with IPF in China. The median direct medical cost per patient per admission was 9,378.3 CNY, with auxiliary testing fees constituting the largest proportion of these costs. This is likely due to the fact that most patients were first diagnosed with IPF during hospitalization, necessitating extensive diagnostic testing. Drug costs were relatively low, which may be attributed to the limited availability of anti-fibrotic drugs such as pirfenidone and nintedanib in China at the time of the study.
The findings of this study highlight the significant economic burden of IPF, particularly for patients who require intensive care, ventilator support, or who suffer from comorbid conditions such as pulmonary infection, respiratory failure, and PAH. These results are consistent with previous studies conducted in Europe and the United States, which have also found that the treatment of acute exacerbations and comorbid conditions significantly increases the overall cost of care for IPF patients.
The study underscores the importance of controlling the progression of IPF and adhering to clinical guidelines for inpatients. Early diagnosis and appropriate management of comorbid conditions could potentially reduce the economic burden of the disease. Furthermore, the availability of anti-fibrotic drugs in China could have a significant impact on the treatment and cost of IPF in the future.
Conclusion
This study is the first to investigate the direct medical costs of hospitalized patients with IPF in China. The findings reveal that the median direct medical cost per patient per admission is 9,378.3 CNY, with auxiliary testing fees accounting for the largest proportion of these costs. Factors such as intensive care, ventilator use, pulmonary infection, and respiratory failure were found to significantly increase the direct medical costs of IPF patients. These results highlight the need for further research and policy interventions to reduce the clinical and economic burden of IPF in China.
doi.org/10.1097/CM9.0000000000001089
Was this helpful?
0 / 0