Abstract:

Objective Analyze and evaluate the economic burden of rabies exposure population in Zhejiang province, so as to provide a quantitative basis for health administrative departments to develop disease prevention strategies. Methods Literature retrieval and questionnaire collection were used to get the general features of the 1 471 cases of dog hurt exposure in dog hurt outpatient service from February to May, 2012. The direct medical costs, the direct medical costs and delays indirect economic burden were analyzed. Through DALY and human resources to estimate the dog hurt exposed economic burden. Results Median direct medical costs was RMB 220.42 Yuan, and the direct non-medical costs was RMB 16.24 Yuan, which transportation costs accounted 76.10% was the highest. The indirect economic burden due to the loss caused by per capita was RMB 135.96 Yuan, and particularly 72.73% of all was the families delay loss. In Zhejiang province total population, the indirect economic burden of post-exposure of rabies was RMB 77 487 000 Yuan (Delay work loss). According to the weight of different age groups, calculated the Zhejiang rabies death all the population average indirect economic burden for RMB 15 767 614.70 Yuan, which 45-60 years (46.51%) and 15-45 years (46.43%) old group were the highest percentage. Economic burden of post-exposure of rabies in Zhejiang province was RMB 400.34 Yuan per capita, of which the direct medical cost of total economic burden ratio of 59.12%, followed by the indirect economic burden caused by delays, accounted for 33.97%. If the grade Ⅲ exposures to accept human rabies immunoglobulin, so will the economic burden for the 4%-20%. Economic burden was overwhelmed. Conclusion Transportation accounts for direct and has the highest percentage of medical costs, should be reasonable to layout dog injury outpatient services, which location and quantity should satisfy a range of services. The family cost (direct economic costs and delays indirect economic burden) was higher than the social cost (death indirect economic burden). Direct economic burden, especially direct medical costs was the main source of the economic burden of post-exposure of rabies. The government should formulate relevant policies to help low-income people in cost, improve the clinic proportion, improve grade Ⅲ exposure rate of immunoglobulin injections.

Key words: Rabies, Disease burden, The direct economic burden, The indirect economic burden

摘要：

目的 综合分析和评价浙江省狂犬病暴露人群的经济负担，为卫生行政部门制定疾病防制策略提供量化依据。方法 2012年2-5月，通过文献调研和问卷调查等方法，收集浙江省40家犬伤门诊1 471份有效调查问卷，对犬伤暴露就诊者的一般特征进行描述性分析，并获得直接医疗费用、直接非医疗费用和误工间接经济负担。利用全省狂犬病疫情数据和统计年鉴，通过伤残调整生命年（DALY）结合人力资本的方法估算因早死引起的社会间接经济负担。结果 狂犬病暴露人群直接医疗费用和直接非医疗费用的中位数分别为220.42元和16.24元（3%贴现率修正），直接非医疗费用中交通费所占比例最高，占76.10%；因误工引起的间接经济负担人均为135.96元（3%贴现率修正），其中家属误工损失占72.73%；因误工引起的浙江省狂犬病暴露后间接经济负担（全人口）约为7 748.70万元；因早死引起的浙江省狂犬病暴露后死亡间接经济负担（全人口）为1 576.76万元，其中45~和15~岁年龄组所占比例最高。平均每例狂犬病暴露后总经济负担为400.34元，其中直接医疗费用占总经济负担比例的59.12%，其次是误工引起的间接经济负担占33.97%。若Ⅲ级暴露后注射免疫球蛋白，经济负担将占到年收入的4%~20%，经济负担沉重。结论 交通费所占直接非医疗费用比例最高，应合理布局犬伤门诊，其开设地点和数量应满足一定服务范围。家庭成本高于社会成本，直接经济负担特别是直接医疗费用是犬伤暴露后疾病经济负担的主要来源。有关部门应制定相关政策，帮助中低收入人群承担相关处置费用，提高就诊率，提高Ⅲ级暴露免疫球蛋白注射率。

关键词: 狂犬病, 疾病负担, 直接经济负担, 间接经济负担