中国临床药学杂志

目的 探究肿瘤患者中成药费用与疾病诊断相关分组（DRG）超支的相关性，为提高合理用药水平提供依据。方法 收集四川省绵阳市某三级甲等医疗机构2022年1月至12月进入RE1A病组恶性增生性疾患的化学治疗和/或其他治疗，伴严重或一般并发症与合并症的病例1 729例，采用多因素Logistic回归、限制性立方样条（RCS）和分段式Logistic回归分析10种中成药（百令胶囊、地榆升白片、复方苦参注射液、活力苏口服液、康复新液、生血宝合剂、苏黄止咳胶囊、鸦胆子油乳注射液、益血生胶囊及谷红注射液）费用与DRG超支的相关性。以性别、年龄、医保类型、出院科室、肿瘤类型为分层变量，对中成药费用与DRG超支的相关性进行亚组分析。结果 1 729例病例中有431例出现DRG超支。单因素分析和多因素Logistic回归分析结果表明，中成药费用是DRG超支的独立危险因素（P<0.05）;10种中成药中，复方苦参注射液和康复新液的费用是DRG超支的独立影响因素（P<0.05）。RCS和阈值效应分析结果表明，中成药费用与DRG超支存在曲线关系（P<0.001），当中成药费用≥125元时，中成药费用与DRG超支呈正相关（P<0.05）。各亚组中，中成药费用均能够增加DRG超支风险。结论 中成药费用与肿瘤患者DRG超支间存在相关性，当中成药费用≥125元时，中成药费用与DRG超支呈正相关。复方苦参注射液和康复新液费用是DRG超支的独立危险因素。临床应加强中成药在肿瘤患者中的合理使用，以降低医疗成本，促进临床合理用药。

AIM To explore the association between the cost of Chinese patent medicine and diagnosis-related group(DRG) overruns in cancer patients. METHODS The multivariable logistic regression, restricted cubic spline(RCS),and two-piecewise logistic regression were used to analyze the association between Chinese patent medicines(Bailing capsules, Diyu Shengbai tablets, compound Kushen injection, Huolisu oral liquid, Kangfuxin liquid, Shengxuebao agent,Suhuang Zhike capsule, Brucea javanica oil emulsion injection, Yixue Sheng capsule and Guhong injection). A total of1 729 patients who received chemotherapy and/or other treatments for malignant proliferative disorders and with severe or general complications and comorbidities entering the RElA disease group from January to December 2022 in a tertiary medical institution in Mianyang City, Sichuan Province, were used as the study data. Subgroup analyses of the association between the use of Chinese patent medicine and DRG overruns were stratified by gender, age, type of participation,admission department and tumor type. RESULTS A total of 1 729 patients were included in the study and 431 patients presented with DRG overruns. The results of multivariable and univariable Logistic regression analyses indicated a significant association between Chinese patent medicine and DRG overruns(P<0.05). Among the 10 Chinese patent medicines, the cost of compound Kushen injection and Kangfuxin injection was the independent factor that could increase the risk of DRG overruns(P<0.05). The RCS and threshold effect analysis showed a curvilinear relationship between Chinese patent medicine and DRG overruns(P<0.001). When the cost of Chinese patent medicine exceeded 125 yuan,it was positively associated with DRG overruns(P<0.05). In all subgroups, the cost of Chinese patent medicines could increase the risk of DRG overruns. CONCLUSION Chinese patent medicines were associated with DRG overruns. When the cost of Chinese patent medicine exceeds 125 yuan, it is positively associated with DRG overruns(P<0.05). Compound Kushen injection and Kangfuxin injection were independently associated with DRG overruns(P<0.05). The rational use of Chinese patent medicines in cancer patients should be enhanced in clinical practice to reduce the cost of drugs and promote rational drug use.