基于倾向性评分匹配和限制性立方样条研究血细胞刺激因子与肿瘤患者DRG超支之间的相关性<sup>★</sup>

doi:10.3969/j.issn.2095-1264.2025.04.17

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基于倾向性评分匹配和限制性立方样条研究血细胞刺激因子与肿瘤患者DRG超支之间的相关性★
DOI:
                        10.3969/j.issn.2095-1264.2025.04.17
                    
作者:
                        
                        
                    
作者单位:绵阳市第三人民医院/四川省精神卫生中心 临床药学科，四川 绵阳，621000
作者简介:赵德华，男，硕士，主管药师，研究方向为临床药学与医保管理。
通讯作者:
中图分类号:R730.6;R973
基金项目:北京医药卫生经济研究会药物经济学&真实世界研究&药政管理专项科研促进项目（BJHE2023-PRP-008）。

Association between hemocyte stimulating factors and DRG overspending in cancer patients based on propensity score matching and restricted cubic spline^★

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Affiliation:

Department of Clinical Pharmacy, the Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang, 621000, Sichuan, China

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摘要:

目的研究血细胞刺激因子（HSF）使用金额与疾病诊断相关分组（DRG）超支之间的相关性，为药品管控提供依据。方法以四川省绵阳市某三级甲等医疗机构2022年1月—12月进入RE1A病组的患者为研究资料。利用倾向性评分匹配（PSM）法对两组患者进行1∶1匹配，匹配后利用Wilcoxon秩和检验比较两组间HSFs使用金额的差异性。利用限制性立方样条（RCS）和分段式多因素Logistic回归探讨HSFs使用金额与DRG超支间的剂量-效应关系和阈值效应。采用匹配前数据，利用多因素Logistic回归模型进行敏感性分析。结果研究共纳入1 729例患者，431例（24.93%）患者出现DRG超支。匹配后，两组各348例患者，两组间各基线变量的SMD值均小于0.1。Wilcoxon秩和检验结果表明两组间HSFs使用金额有显著差异（P<0.001）。RCS结果表明HSFs使用金额与DRG超支呈曲线关系，当HSFs使用金额≥1 261.80元时，使用金额与DRG超支风险呈正相关（OR=1.001， 95% CI： 1.001~1.002， P=0.001）；当HSFs使用金额<1 261.80元时，二者不相关（P=0.389）。多因素Logistic回归分析结果表明，HSFs使用金额与DRG超支显著相关（OR=1.16， 95% CI： 1.10~1.22， P<0.001）。结论 HSFs使用金额与DRG超支呈曲线关系，当HSFs使用金额≥1 261.80元时，HSFs与肿瘤患者DRG超支呈正相关。故临床应加强HSFs的合理应用，降低药品成本，从而降低DRG超支风险。

Abstract:

Objective To explore the association between hemocyte stimulating factors (HSFs) and diagnosis related group (DRG) overspending in cancer patients, providing a basis for drug control.Methods Patients entering the RE1A disease group from January to December 2022 in a tertiary medical institution in Mianyang City, Sichuan Province, were used as the study data. The patients were divided into DRG overspending group and DRG not overspending group. Patients in the two groups were matched 1∶1 using propensity score matching (PSM), and the difference in the use of HSFs between the two groups was compared using the Wilcoxon rank sum test. Restricted cubic spline (RCS) and segmented multivariable Logistic regression models were employed for examining the dose-effect relationship and threshold effect between HSFs and DRG overrun. Sensitivity analyses were performed using the multivariable Logistic regression model with pre-matching data.Results A total of 1 729 patients were included in the study and 431 patients (24.93%) presented with DRG overspending. After matching, there were 348 cases in each of the two groups, which were balanced at baseline between the two groups, and the SMD values for each baseline variable were less than 0.1. The Wilcoxon rank sum test showed a statistical difference in the amount of HSFs between the two groups (P<0.001). RCS model indicated a nonlinear relationship between HSFs and DRG overrun. When the expense of HSFs was ≥1 261.80 yuan, HSFs were positively associated with the risk of DRG overrun (OR=1.001, 95% CI: 1.001~1.002, P=0.001). When the expense of HSFs was <1 261.80 yuan, no correlation existed between HSFs and the risk of DRG overrun (P=0.389). The results of the multivariable logistic regression model showed that the amount of HSFs was associated with DRG overspending (OR=1.16, 95% CI: 1.10~1.22, P<0.001).Conclusion A nonlinear relationship exists between HSFs and DRG overrun in tumor patients. When the expense of HSFs was ≥1 261.80 yuan, HSFs are positively associated with DRG overrun. Therefore, clinics should strengthen the rational use of HSFs to reduce drug costs, thus reducing the risk of DRG overspending.