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1、SARSpatientsinGuangzhoutheburdenofdiseasestudySAKSpatientsinGuangzhoutheburdenofdiseasestudySARSpatientsinGuangzhoutheburdenofdiseasestudyAbstractObjectiveToestimatethesevereacuterespiratorysyndromeinGuangzhoucity(SARS)casesintheclinicaldiagnosisofdirectandindirecteconomicburdenofthefinancialburdeno
2、facuteinfectiousdiseases,burdenofdiseaseestimatestoestablishways.MethodsDuringthe2003SARSoutbreakof1059casesofSARSconfirmedcasesofrelevantinformation.Pairsof399casesofpatientswhoarewillingtocopewithaquestionnairesurvey;todisabi1ity-adjusted1ifeyears(DA1.Ys)1andlossofworkingtimelostthroughhumancapita
3、lapproachconvertedintoeconomiclosses,assesstheSARScasesinthedirectandindirecteconomiclosses.Results1059casesofconfirmedSARScasesinhospitalchargespercapita20223252millionaveragedaiIyhospitalcharges,112025amillion;339casesofS.*RSpatientsinoutpatientpercapitacostofo232o3yuan,thepercapitacostofreviewing
4、yoy22ymillion;ontheirowntobuynutritionalsupplements,medicines,etc.22o2291Yuanpercapitaspending.ProjectionsinGuangzhouCityin200312y3casesofSARScasesinthedirecteconomicburdenof310a259eanyuan;SARSdeathsduetoprematuredeathcausedbyyearsoflifelost(Y1.1.s)forthe25o2al,theeconomiclossesloy92o3eanYuan;SARSpa
5、tientssurvivedanaverageofidlefor512a2d,theeconomiclossesforthe5aa2oymi11ioninindirecteconomiclossesof202a2ooeanYuan.Thereare3o22%ofrespondentsanswerediswillingtodumpal1hispropertytoavoidtheriskofSRS,showedthatpatientswithSRStothedamagecannotbemeasuredinmonetaryterms;another2223%ofpatientswou1dliketo
6、returnas1millionorabovearenotsufferingfromSARS.ConclusionintegrateddirectandindiredeconomicburdenofthefinancialburdenofclinicaldiagnosedSARScasesinGuangzhou,thetotaleconomicburdenof51a5203mi11ion,percapitao203eanYuan.Keywords:theburdenofdiseaseGuangzhouisChinasearliestoccurrenceofsevereacuterespirat
7、orysyndrome(SRS)epidemicofthecityreportedatotalof12y3casesofconfirmedcases,accountingforIhccountrystotalcasesof2o20yr%.Therefore,tocarryoutSRSinGuangzhouCity,theburdenofdiseasestudytoestimatetheSRSpatientscausedbydirectandindirecteconomiclossesandsocio-economicimpact,youcandeterminetheprioritypublic
8、healthproblem,theallocationofhealthresouixestodeveloppoliciesandhealthservicesbasisforthedevelopmentoftheoverallstrategyforinfectiousdiseasepreventionandtreatmentresearchtoprovidedata.ThispaperanalyzestheSRSpatientsinGuangzhou,thedirectandindirecteconomicburdenofthefinancialburden.Theresultsreported
9、asfollows.1Dataandmethods121Source(1)tocollectduringthe2003SARSoutbreakinGuangzhouCity,thehospitaitreated12confirmedcasesof1059casesofSARSbasicinformationonavarietyofmedicalexpensesduringhospitalization(dividedintodrugs,hospitalizationfees,inspectionfees,laboratoryservices,radiologycharges,oxygenfee
10、s,b1oodtransfusioncosts,treatmentcostsandotherexpenses,etc.);(2)developaunifiedquesIionnaire,useof-homemethodofinvestigation,339casesarewillingtocopewithconfirmedSRSpatientsinhospitalthanthecostofrelatedmedicalcostsandmissedworktimetoconductaquestionnairesurvey,includingthepurchaseofnon-prescription
11、medicines,nutritionalsupplements,rehabilitationequipment,cliniclossofworkingtime,resttimeofdischarge;(3)demographicdatafromtheGuangzhouHealthBureau,GuangzhouMunicipalStatisticsOfficetoprovide.122MethodsThestudyrecommendedbytheeordBankandeorldHealthOrganization,theburdenofdiseaseevaluationindex-disab
12、i1ity-adjustedlifeyears(DA1.Ys)()1-2.Includingtheyearsoflifelostduetoprematuredeath(Yearsof1.ife1.ost,Y1.1.s),andyearsof1ifelostduetodisability(Years1.ivedwithDisablity,Y1.Ds).(1)Thedirecteconomicburden:Thedirecteconomicburden,includinghospitalization(inpatienttreatmentsumofvariousfeespaid),andother
13、hospital-relatedmedicalcosts(outpatientandreviewcosts;ontheirowntobuydrugs,healthcareproducts,rehabiIitationequipmentandotherexpenses).Theabovedatadirectlythroughstatisticalanalysisofsurveydata.(2)theindirecteconomicburden:SARSdeathsinlossofvalue,thatis,yearsoflifelost(Y1.1.s);SARSpatientssurvivelos
14、sofva1ueduetoSARSisanewinfectiousdiseaseisnotyetpossibletoestimatetheweightoftheirdisability,therefore,withthelossofworkingtimeaswcl1aseconomicEstimatedloss(lossofworkingtime,includinghospitalizationandafterdischargeresttime).UsedbythelifeexpectancyofresidentsofGuangzhouCityfrom2003tothecauseofdeath
15、1ife-tableofSARS.(3)humancapitaiapproach（八）:Theabovedataareconvertedthroughhumancapitalapproacheconomicindicatorstocalculatethediseasecausedbyyearsof1ifelosttotheindirecteconomicburdenonsociety.Theformulaareasfollows:theeconomicburden=grossnationalproductpercapitaproductivity,*D1.Ys*weight(theweight
16、ineachagegroupproductivity,asfollows:0pIoageO215;15pooyearsold,o5p59yearsoldrespectively,O2a5,O2y:20-year-oldpdroppedtoO21;theproductivityofthetotalpopulationweightO25.thefailuretoobtaingrossnationalproductpercapita,GuangzhouCity,soinsteadofusingpercapitagrossdomesticproduct).Deathsinproductivity,ec
17、onomicloss=weight*Y1.1.sgrossdomesticproductpercapitasurvivalofcasesofeconomicproductivity,weightloss=grossdomesticproductpercapitaperday*lossofworkingtime(o)intangibleeconomicburdenofassessment:usingwillingnesstopayforthelossoflawasareferencetotheinvisiblevalue(y).eilIingnesstopaylawgivesthepain,so
18、rrowandotherpsychologicalharmtoacertainvalue,byaskinghowmuchpeoplearewillingtopaytoavoidpotentialillnessorinjury;,includingpain,lossofvalueandqualityof1ifecostsareknownasthewillingnesstopayoracombinationofcost.Surveyquestionsare:IfyouhadtopayafeetoavoidSARS,howmuchmoneyyouarewillingtospendupto?Bycom
19、paringthecompositionofthedifferentwillingnesstopaythantoassesstheeconomicburdenofSRSinvisible.2Results221directeconomicburden(1)hospitalizationcosts:1059casesofconfirmedSARScases,theaveragehospitalcostof20223252yuan,theaveragenumberofhospitalizationdaysla2o2d,averagedaiIyhospitalchargesforthe112025a
20、Yuan,o3acasesweremale,thepercapitahospitalcosts22391292yuan,theaveragelengthofstayla2o0d,dailyhospitalcharges,12y22yomillion;women,222cases,thepercapitahospitalcostslya2a225yuan,averagelengthofstaydaysla251d,dailyhospitaiizationcosts10y22olYuan.Hospitalcosts,drugs,treatmentcostsandlaboratoryfees,3re
21、spectivelyofthetotalcostof5o219%,15222%and122ol%,togetheraccountedforthetotalcostofy222y%.Promptedtoexploretherationalandeffectivetreatmentoptionstocontroldrugsintheproportionofthetotalcost,therebyreducingthecostofSARSpatientsinhospitalwasnecessary.(2)hospitalchargesotherthanthecosts:aquestionnaires
22、urveyshowedthatonaveragepatientsseepatient1251times,spendingo232o3yuan,anaverageunitcostof302291million;ReVieW12y3times,spendingyoy22yyuan,withanaverageunitcostofo2325omillion;self-purchasenut,itionandhealthcareproducts,medicinesandotheraverageexpenditure22o2291million,ofwhichnutritionandhealthcarep
23、roductsaccountedfor522a2%,upto150122ymillion;drugsaccountedfor332o5%.(3)Thedirecteconomicburdenofacomprehensiveassessment:Basedontheaboveresultsshowthatavarietyoffees,theaveragepatientsdirecteconomicburden2o221231million,ofwhichtheproportionofhospitalizationcostsaccountedforthehighest,uptoy3222%,fol
24、lowedbyself-purchasenutrition,medicinesandotherexpenses,accountingfor10293%.Accordingly,theprojectionin200312y3casesofclinicallyconfirmedSARScasesinthetotaldirecteconomicburdenof310a259million(Table1).Table1,GuangzhouCity,thedirecteconomicburdenofSARSpatientsinacomprehensiveassessment(omitted)222ind
25、irecteconomicburden(1)Theeconomicburdenofdeaths:TheresultsshowedthatSARSsufferingfromprematuredeathcausedbyyearsof1ifelostwomenthanmen,Y1.1.swere3oy252and302219,respectively,0perthousandY1.1.s20y22tthousandyearsand020990tthousandyears,theageof25pandayearsoldpthehighest,are022310tthousandyears,thetot
26、alY1.1.sof020902tthousandyears.Converted,throughhumancapitalapproachisanindirecteconomicloss,resultsshowthat,SARSdeathsindirectlyduetoprematuredeathcausedbythetotalburdenofloy92o3millionhigherinwomenthanmen,oo-yearoldindirecteconomicburdenisheavy,uptoa3y29eanyuan.(2)Theeconomicburdenofsurvivingcases
27、:1059casesofSRScasesinaveragelengthofstayidletimeformenand0pIoyearsold,15toooyearsold,o5p59yearsold,20p,respectively92o2,12299,192lo,12225d;femaleswere10291,1223o,19290,20293d.339casesofclinicallyconfirmedSRScasesinthesurveyidletimeforrestafterdischargefromhospitai,meninal1agegroupswere29202,39229,o
28、22o9,y232d;women,respectively132la,332ya,o22la,332a5d.Hospitalizationandafterdischarge,theaveragelossofworkingtimeforrest512a2d,15toooyearsoldando5to59yearsmaximum,0plo-year-oldfollowedby20yearsofagepgroupthelowest,indicatingthatthepopulationofworkingagearemostaffected.Converted,throughhumancapitala
29、pproachisanindirecteconomicloss,resultsshowthatthesurvivalofpatientswithtotallossofworkingtimelossof5aa2oyeanYuan.Ofdifferentsexes,differentagesindifferentindirecteconomiclosses,women(31a2lamillion)thanmen(220231million),themaximumlossof20-year-oldgroup,reaching102251million;12to20agegroupaccountedf
30、orthelossthetotallossof9229a%.(3)theindirecteconomicburdenofacomprehensiveassessment:GuangzhouCityin2003becauseofSRSdeathsincasesofprematuredeathduetolossofworkingtimeandsurvivalofthetotalindirecteconomiclossescausedbythe2022291million,ofwhichmenand9oa2aami11ion,ofthetotalindirectburdenono52y5%;forw
31、omen11192Iomillion,thetotalindirectburdenof5o215%.chichtheIoSSeScausedbyprematuredeathishigherthanthelossescausedbylossofworkingtime,respectively,formalehigh222otimes,females2253times;womenbecauseofSRSandtheindirecteconomicburdenisalsohigherthanmen;eachagegroup,15po5-ycar-oldgrouplostthemost,upto115
32、92ylmillion,accountingformorethan50%ofthetotallosses;followedbyo5to20-year-oldgroup,thetotallossof3a2y9%.Theresultssuggestthat,SARSandtheindirecteconomicburdentomostpeopleofworkingage,whichwillreduceSARSmortalityrateistoreducetheindirecteconomicburdenonthekey(Table2).Rcpostedelsewhereinthepaperforfr
33、eedownloadTable2,GuangzhouCity,theindirecteconomicburdenofSRSpatientsinacomprehensiveassessment(omitted)223invisibleeconomicburdenofthequestionnaireevaluationof339casesofSARSpatients,rightifhepaysafeetoavoidtooSRS,howmuchmoneyyouarewillingtospenduptotheproblem,thereare3o22%answeredwiIlingtodumpallhi
34、spropertytoavoidtheriskofSRS,SARSshowedthattheharmcausedtopatientscannotbemeasuredinmonetaryterms,nother2223%ofpatientswouldlikeoutof10,000yuanPinexchangefornotsufferingfromSARS(Table3).Table3eilIingnesstopayquestionstheresultsofStatistics(abbreviated)22oSRScasesinthetotalburdenofdiseaseburden,inclu
35、dingdirectandindirectburdens.Thedirectburdenofthetotal310a259mil1ioncasesofSARSpatientsdirectlyaverageburdenof22o2million;thetotalindirectburden2022291millioncasesofSARSpatientswithanaverageindirectburdenof1221million;concludedin2003confirmedSARScasesinGuangzhou,thetotalburdenof5Iao25millioncasesofS
36、ARSpatientsinthetotalaverageburdenofo203eanYuan.3DiscussionOurresultsshowthatin2003,Guangzhou12y3casesofclinicallyconfirmedSARSpatientswithdirecthospitalcostsprojected25992aamillionyuan,percapitahospitalizationcostof20223252yuan,HUShan-Iianestimated2o3casesofSARSinGuangdongProvinceconfirmedS.RScases
37、andsuspectedcasesofTheMedicarehospitaichargesperpatient2222million,theresultisslightlylower(9)thanXiaoFenginBeijingandotherinvestigationsinpatientswithSARSinpercapitahealth-carehospitalizationcosts12yaeanYuanslightly(10).(11)reportedinthe1iIeratureshowsthatsomeSRSpatientsleavethemoreseriouscomplicat
38、ions,suchasthefemurnecrosis,pulmonaryfibrosis,inparticularthedisabilitysituation,theneedforlong-termfollow-upobservationandevenhospitalization,thefinalresultsshowthat,duetoSARSafter-effectscausedbythedirectandindirecteconomicburdenwou1dbeenormous,inparticular,reviewtheresultsofthispaperistoprovidere
39、ferencedataonexpenses.Estimationanalysis:(1)AsSARSisanewinfectiousdiseases,yetunabletobonenecrosis,pulmonaryfibrosis,causedbydisabi1ityweightstoestimate,soalossofworkingtimetoestimatethelossofworkingtimelost,andthenconvertedusinghumancapitaiapproachtoeconomicloss,SRScasesontheindirecteconomicburdeno
40、ftheestablishmentofapreliminaryevaluationmodel.(2)Incalculatingtheresultofyearsoflifelostduetoprematuredeath(Y1.1.s)isusinga1ifeexpectancyofresidentsofGuangzhoucityofSARStothecauseofdeathlife-table,thustrulyreflecttheSRSPalienlSinGuangzhou,theactualburdenofdiseaseconditions.Butmayalsoresultintheburd
41、enofdiseasereceivelessthanwhenusedinthepreparationofDA1.Ysmaleandfemale1ifeexpectancytocalculatethevalueof()13,theburdenofdisease.ThisarticlealsotryMethodtoEvaluatethewillingnesstopayfortheintangibleeconomicburdenofSRScases,thismethodistomeasuretheva1ueofa1ifeandhealthcanbealternative.Studieshavesho
42、wnthat(y),willingnesstopaythecostmethodtogethigherthanthehumancapitalapproachmore,duetothedifferentpersonalvalues,theestimatedcostofthismethodisnotstableenough,buttheintangiblelossesthatcanbeusedasthereferencevalue.References(1)eorldHealthOrganization.Guidelinesforepidemiologicalreviews:theglobalbur
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