Kırım-Kongo Kanamalı Ateşinin Etkisi: Bir Maliyet Analizi

Abstract

Kırım-Kongo kanamalı ateşi (KKKA), Türkiye’de endemik olup kırsal bölgelerde yaşayanlar ve tarım çalışanları arasında yaygın olarak görülmektedir. Nisan ve Ekim ayları arasında kliniklere yoğun başvuru olması, Türkiye ve benzer ülkeler için ek bir maliyet oluşturmaktadır. Bu çalışmada, 2013-2015 yılları arasında Sivas Cumhuriyet Üniversitesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Klinik Servisi’nde KKKA nedeniyle takip edilen 260 hastanın doğrudan tedavi maliyetleri incelenmiştir. Hastalar, daha önce tanımlanmış olan hastalık şiddet skorlama sistemine göre düşük, orta ve yüksek ölüm riski olmak üzere üç gruba ayrılmıştır. Bu hastalık şiddet skoru, farklı risk grupları arasındaki ilişkiyi anlamak ve grupların hastane maliyetlerini tahmin etmek amacıyla değerlendirilmiş ve diğer çalışmalarla karşılaştırılmıştır. Çalışmaya dahil edilen hastaların ortalama yaşının 50 (sınırlar) (36-63) yıl olduğu ve klinikte ortalama 6 (4-8) gün kaldıkları belirlenmiştir. Hastaların düşük ve orta/yüksek risk gruplarındaki yaş dağılımları arasındaki fark istatistiksel olarak anlamlı bulunmamıştır (p=0,103). Benzer şekilde, risk gruplarına göre hastanede yatış süresi açısından da anlamlı fark saptanmamıştır (p=0,279). Düşük risk grubundaki hastaların kişi başı maliyetinin 189 ABD doları, orta ve yüksek risk grubundaki hastaların kişi başı maliyetinin 488 ABD doları olduğu ve hastaların kişi başı ortanca/medyan maliyetinin 240 ABD doları olarak hesaplandığı görülmüştür. Hastaların doğrudan tedavi maliyetleri açısından gruplar arasındaki fark istatistiksel olarak anlamlı bulunmuştur (p<0,001). Çalışmaya dahil edilen tüm hastaların mortalite oranı %6,9 olarak hesaplanmış; bu oran düşük risk grubunda %2,92, orta-yüksek risk grubunda ise %14,6 olarak bulunmuştur (p<0,001). Grupların mortalite oranları arasında anlamlı fark saptanmıştır. Çalışma sonucunda, Kırım-Kongo Kanamalı Ateşi hastalarının ciddi bir maliyete neden olduğu ve bu maliyet kalemlerinin nelerden oluştuğu belirlenmiştir. Daha önce tanımlanmış olan Kırım-Kongo Kanamalı Ateşi hastalık şiddet skorlama sisteminin, hastalık şiddetini ve sağlık maliyetlerini tahmin edebileceği düşünülmüştür.

Keywords

• Kırım-Kongo kanamalı ateşi
• maliyet analizi
• doğrudan tedavi maliyeti
• hastalık şiddet skoru
• sağlık hizmetleri yükü

Ethical Statement

Bu retrospektif çalışma, Cumhuriyet Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu onayı (Onay No: 2016-10/18, Tarih: 21 Ekim 2016) sonrasında gerçekleştirilmiştir. Etik onay ve uygulama, Helsinki Bildirgesi'nde belirtilen ilkelere uygun olarak yapılmıştır.

The impact of Crimean-Congo Hemorrhagic Fever: A cost analysis

Abstract

Crimean-Congo hemorrhagic fever (CCHF) is endemic to Türkiye and is commonly seen among rural residents and agricultural workers. An intense application to clinics between April and October creates an additional cost for Türkiye and similar countries. This study examined the direct treatment costs of 260 patients who were followed up for CCHF in Sivas Cumhuriyet University, Infectious Diseases and Clinical Microbiology Clinical Service between 2013 and 2015. The patients were divided into three groups: low, intermediate, and high risk of death according to the severity grading score defined previously. This severity grading score was evaluated and compared with other studies to understand the relationship between different risk groups and estimate the hospital costs of the groups. It was determined that the mean age of the patients included in the study was 50 (limits) (36-63) years, and they stayed in the clinic for an average of 6 (4-8) days. The difference between the age distributions of the patients' low and intermediate/high-risk groups was insignificant (p=0.103). Similarly, there was no significant difference between the duration of hospital stay according to risk groups (p=0.279). It was seen that low-risk group patients cost 189 USD per person, intermediate and high-risk group patients 488 USD per person, and the median cost per person of patients was calculated as 240 USD. The difference between the groups was significant in terms of direct treatment costs of the patients (p<0.001). The mortality rate of all patients included in the study was calculated as 6.9%, and it was found to be 2.92% in the low-risk group and 14.6% in the intermediate-high-risk group (p<0.001). A significant difference was found between the mortality rates of the groups. As a result of the study, it was determined that Crimean-Congo Hemorrhagic Fever patients cause a severe cost and what these cost items consist of. It was thought that the Crimean-Congo Hemorrhagic Fever severity grading score, which was defined previously, could estimate disease severity and health costs.

Keywords

• Crimean-Congo hemorrhagic fever
• cost analysis
• direct treatment cost
• severity grading score
• healthcare burden

Ethical Statement

This retrospective study was conducted after obtaining approval from the Cumhuriyet University Non-Interventional Clinical Research Ethics Committee (Approval No: 2016-10/18, Date: October 21, 2016). Ethical approval and study procedures were carried out in accordance with the principles of the Declaration of Helsinki.

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