1. Puyang Municipal Center for Disease Control and Prevention, Puyang, Henan 457000, China; 2. The People’s Hospital of Puyang City, Puyang, Henan 457000, China; 3. The Henan Provincial Committee of Jiusan Society, Zhengzhou, Henan 450000, China
Abstract：Objective To investigate the direct, indirect and total costs due to artificial hip joint replacement in patients with hip joint disease in Puyang City, and to explore the possible influencing factors. Methods The time-phase cluster sampling method was used to conduct a face-to-face questionnaire survey on patients undergoing artificial hip replacement surgery in the People’s Hospital of Puyang City from January 2018 to December 2019. All the patients’ hospitalization records were checked within 3 days after discharge, and the hospitalization expenses and related information were recorded. The patients’ total costs included direct and indirect costs. The direct costs were further divided into direct medical costs and direct non-medical costs. The human capital method was employed to evaluate the indirect costs. Multiple linear regression analysis was conducted to identify the influencing factors linked to the direct, indirect and total costs. Results A total of 258 patients were investigated and analyzed, with the response rate of 95.20%. The total cost of the patients undergoing artificial hip replacement surgery was RMB 55,163.03 Yuan, among which, the direct cost was 51,514.42 Yuan (accounting for 93.39%), the indirect cost was 3,486.61 Yuan (accounting for 6.61%), and the ratio of the direct cost to the indirect cost was 14.12∶1. The direct medical cost was much higher than the direct non-medical cost (68.01∶1),and the hospitalization expenses accounted for 99.64% of the direct medical expenses.The patients’ total cost accounted for 484.24% of the patients’ average annual income and 42.09% of their households’ average annual income, of which the direct cost accounted for 452.21% of the patients’ average annual income and 39.31% of their households’ average annual income.The patients’ indirect cost was 1,831.24 Yuan, the indirect cost for caregivers was 1,817.37 Yuan, and the corresponding work-loss days were 16.14 d and 14.47 d, respectively. The results of univariate analysis showed that there were statistically significant differences in the total cost and thedirect cost between genders and among different ages, marital status,main diagnosis of discharge, the unilateral or bilateral and prosthetic material (Z=3.078, Z=3.190; χ2=69.410, χ2=72.459; Z=2.491, Z=2.629; Z=64.599, Z=68.392; Z=178.679, Z=181.249, all P<0.05) as well as in the indirect cost among different occupations, medical insurance and main diagnosis of discharge (Z=3.676, Z=3.027, χ2=8.558, P<0.05). Multiple linear regression analysis revealed that the unilateral or bilateral (β=45,502.603, β=45,350.504, 95%CI: 39,723.378-51,281.828, 95%CI: 39,828.956-50,872.051) and prosthetic material (β=6,837.012, β=6,853.304, 95%CI: 5,036.419-8,637.606, 95%CI: 5,132.993-8,573.615) were the common factors influencing the total cost and the direct cost (t=15.507, t=16.176, t=7.478, t=7.846, P<0.05), while occupations (β=-1,091.337, 95%CI:-1,568.287--614.387) and medical insurance (β=3,564.858, 95%CI: 2,196.003-4,933.713) were the factors influencing the indirect cost (t=-4.506, t=5.129, P<0.05). Conclusions Economic burden of the patients and families undergoing artificial hip arthroplasty is very heavy. The direct cost is higher than the indirect cost, and the direct medical cost is much higher than the direct non-medical cost, among which, other expenses (artificial hip prostheses) account for the highest proportion, which are the main factor affecting thefinancial burden of the patients.
2021, Vol. 28 
