肝細胞癌における合併症と治療を考慮した医療費推定の試み  [in Japanese] Estimation of Inpatient Cost for Hepatocellular Carcinoma with its Complications and the Specific Treatments  [in Japanese]

Access this Article

Search this Article

Author(s)

    • 石田 博 ISHIDA H
    • 山口大学医学部附属病院医療情報部 Department of Medical Informatics and Decision Sciences, Yamaguchi University Hospital
    • 井上 裕二 INOUE Y
    • 山口大学医学部附属病院医療情報部 Department of Medical Informatics and Decision Sciences, Yamaguchi University Hospital
    • 黒川 典枝 KUROKAWA F
    • 山口大学医学部第一内科 Department of Gastroenterology and Hepatology, School of Medicine, Yamaguchi University
    • 日野 啓輔 HINO K
    • 山口大学医学部保健学科 Department of Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University
    • 沖田 極 OKITA K
    • 山口大学医学部第一内科 Department of Gastroenterology and Hepatology, School of Medicine, Yamaguchi University

Abstract

合併症を起こしやすい肝硬変症を基礎疾患とする肝細胞癌患者を対象として医療費変動の主要な説明要因および医療費推定の検討を行った.<br/> 肝細胞癌で入院した患者を対象に,レセプト請求データから入院期間,実施された診療行為および診療報酬請求額を抽出した.肝硬変症の非代償性合併症および肝細胞癌への治療の種別とその実施の有無を関連する診療行為から判定し,診療報酬請求額を目的変数とした単変量解析および多変量解析を行った.<br/> 単変量解析から合併症や治療の有無により入院日数および診療報酬請求額に有意な差が見られ,さらに,それぞれの要因で分けた診療報酬請求額と入院日数の間に有意な相関が見られた.そのため,得られた医療費の重回帰モデルでは入院期間が最も有意な変数で,以下,肝細胞癌治療,非代償性合併症の順で有意であった.検証用データにおいてもモデルによる予測額と実際額との相関係数(Spearman)は0.89と良好であった.<br/> 今回のような診療報酬請求データをもとにした統計モデルによって合併症などの病態や治療による医療費の主たる変動要因を明らかにし,それらの組み合わせの医療費を推定することが可能と考えられた.

Appropriate estimation of inpatient cost is difficult especially among the complicated cases with several complications or combination of specific treatments. We made a regression model to estimate inpatient cost per admission for hepatocellular carcinoma(HCC) with or without decompensated complications. 260 patients hospitalized due to HCC in our hospital were tracked retrospectively. For each case, the period of hospitalization and records of underwent specific medical interventions during it were extracted from the insurance claim data.<br/> Relationship between the total costs(insurance reimbursement) included basic hospital charge and each 0-1 variable corresponding to execution of the specific medical interventions for each complication or HCC therapy(resection, percutaneous ethanol injection, Chemo-lipiodol therapy or parental anticancer agent injection, etc.) was investigated using univariate and multivariate analysis.<br/> As a result of multivariate analysis, a model consisted of several variables of medical intervention: resection, Chemo-lipiodol therapy and parental anticancer agent injection, and complication: ascites and edema, and variceal bleeding in addition to the period of hospitalization was obtained. It predicted total inpatient cost with the high correlation coefficient(0.89) among HCC cases of separated data set for validation.<br/> This study suggested that the model consisted of several specific medical interventions corresponding to each complication or treatment obtained from insurance claim data can reveal significant factors causing considerable variance of costs and predict more precisely cost of the complicated disease status.

Journal

  • Japan Journal of Medical Informatics

    Japan Journal of Medical Informatics 24(6), 667-674, 2005-07-05

    Japan Association for Medical Informatics

References:  6

Codes

  • NII Article ID (NAID)
    10025685104
  • NII NACSIS-CAT ID (NCID)
    AN10024228
  • Text Lang
    JPN
  • Article Type
    SHO
  • ISSN
    02898055
  • Data Source
    CJP  J-STAGE 
Page Top