目的:探讨抗肿瘤药物使用金额与疾病诊断相关分组((diagnosis related group，DRG)超支之间的相关性，为控制药品使用和合理用药提供依据。方法:以绵阳市第三人民医院2022年1月至12月进入RE1A病组的患者为研究资料，分别采用多因素logistic回归模型、限制性立方样条(restricted cubic spline，RCS)模型和分段式多因素logistic回归模型分析抗肿瘤药物使用金额与DRG超支之间的相关性、剂量-效应关系以及阈值效应。以性别、年龄(＜60岁和≥60岁)、入住科室、参保类型、肿瘤类型和肿瘤分期为分层变量探讨抗肿瘤药物使用金额与DRG超支在不同亚组中的相关性。结果:研究共纳入1 729例患者，431例患者出现DRG超支。多因素logistic回归分析结果表明抗肿瘤药物与DRG超支之间存在相关性(OR=1。06，95％CI:1。05～1。07，P＜0。01)。RCS模型结果表明抗肿瘤药物使用金额与DRG超支呈曲线关系，当抗肿瘤药物使用金额≥1 140元时，使用金与DRG超支风险呈正相关(OR=1。11，95％CI:1。09～1。13，P＜0。01);当抗肿瘤药物使用金额＜1 140元时，两者不相关(P=0。42)。各亚组中，抗肿瘤药物的使用金额与DRG超支均呈正相关。结论:抗肿瘤药物与肿瘤患者DRG超支之间呈J型曲线关系。当抗肿瘤药物使用金额≥1 140元时，抗肿瘤药物与肿瘤患者DRG超支之间呈正相关。
Association between antineoplastic drugs use and DRG overrun in cancer patients based upon restricted cubic spline
OBJECTIVE To explore the association between antineoplastic drug dosing and diagnosis related group(DRG)overrun and provide rationales for rationale usage in cancer patients.METHODS From January to December 2022,1 729 patients of RE1A disease group were selected as study subjects.Multivariable logistic regression,restricted cubic spline(RCS)and segmented multivariable logistic regression models were employed for examining the correlation,dose-effect relationship and threshold effect between antineoplastic drug dosing and DRG overrun.Subgroup analyses of association between antineoplastic drug dosing and DRG overrun were stratified by gender,age,type of participation,admission department and tumor stage/type.RESULTS Among them,431 patients presented with DRG overrun.Multivariable logistic regression analyses revealed a signifi-cant association between antineoplastic drug dosing and DRG overrun(OR=1.06,95％CI:1.05-1.07,P＜0.01).RCS model indicated a curvilinear relationship between antineoplastic drug dosing and DRG overrun.When the expense of chemotherapy was ≥1 140 yuan,antineoplastic drugs were positively associated with the risk of DRG overrun(OR=1.11,95％CI:1.09-1.13,P＜0.01).When the expense of chemotherapy was＜1 140 yuan,no correlation existed between antineoplastic drug dosing and the risk of DRG overrun(P=0.42).In all subgroups,there was a positive trend(OR＞1)between antineoplastic drugs and DRG overrun.CONCLUSION J-shaped relationship exists between antineoplastic drug dosing and DRG overrun in tumor patients.When the expense of chemotherapy was ≥1 140 yuan,antineoplastic drugs are associated positively with the risk of DRG overrun.
cancer patientantineoplastic drugsDRG overrunRCSmultivariable logistic regression
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