Patients with hepatitis B often have this experience: at first, due to lack of experience and understanding, the treatment took many detours, trusting advertisements and "remedies" and "prescriptions", spending thousands of dollars in individual hospitals or clinics, but finally getting nothing. Later, he was transferred to other hospitals, but a large number of examination items and expensive treatment costs made the patients unbearable. Some patients use conventional combined antiviral therapy: interferon combined with lamivudine. After a course of treatment, more than 20 thousand medical expenses were spent, but the effect was not ideal. Long-term diagnosis and treatment of hepatitis B patients can make them poor and bankrupt due to illness; The diagnosis and treatment of hepatitis B is faced with the continuous renovation of diagnostic items, the endless stream of therapeutic drugs and the rising cost of patients' diagnosis and treatment. 10 years ago, at best, patients underwent some "two and a half" hepatitis B examinations and B-ultrasound examinations, and there were only a few therapeutic drugs, and the cost was relatively low. However, there are many kinds of examination items and drugs used today, but the curative effect has hardly changed. Infectious disease practitioners have to reflect on the phenomenon of "excessive diagnosis and treatment" in the process of hepatitis B diagnosis and treatment.
In recent years, there is a wrong practice and statement in the "market" of hepatitis B diagnosis and treatment, that is, to encourage patients to frequently check the HBV DNA quantification, and HBV DNA detection has sprung up everywhere, saying that infectivity and therapeutic effect can be known through quantitative examination. At present, the frequent use of PCR to detect HBV DNA has become a fashion, and many places and hospitals are scrambling to carry out this work. The detection of HBV DNA is called the "golden index" to judge infectivity and therapeutic effect. A hepatitis B virus DNA test needs about 200 yuan RMB. Some patients have to test hepatitis B virus dozens of times a year, and repeatedly observe the changes of DNA value of hepatitis B virus, trying to find something from it. ...
Liu Shijin, a doctor of medicine in seven departments of infection in 302 Hospital of the People's Liberation Army, said that so far, there are still many immature things in HBV DNA, which are not suitable for wide clinical use. It is actually a waste for hepatitis B patients to have random examinations.
■ Excessive diagnosis and treatment of hepatitis B is more common.
The so-called "over-diagnosis and treatment" refers to the over-use of diagnosis and treatment means beyond the basic needs of disease diagnosis and treatment, compulsory examination, compulsory use of unnecessary drugs and selective diagnosis and treatment items, all of which belong to "over-diagnosis and treatment".
According to Dr. Liu, China spends more than 50 billion yuan on the diagnosis and treatment of hepatitis B every year. According to incomplete statistics, about 20% of them belong to "over-diagnosis and treatment", which makes patients suffer huge economic losses, complicates the treatment of diseases and may make the condition worse. According to some data, the incidence of adverse drug reactions in hospitalized patients is 10%~20%, and overdose is one of the main causes of adverse drug reactions. It is estimated that a patient with hepatitis B will generally spend more than 1 1,000 yuan per person in a tertiary first-class hospital, which is about 500 yuan every day. The average cost of a diagnosis and treatment for hepatitis B patients in outpatient department is 650 yuan. Patients with hepatitis B have been treated for a long time and have been treated for many years. Among these expenses, there is no lack of "excessive diagnosis and treatment".
■ The manifestations of "excessive diagnosis and treatment" of hepatitis B.
First, there are more and more inspection items, and the inspection items are getting more and more detailed. There are more than 20 hepatitis B virus indicators (including hepatitis B virus genotyping and genetic variation, etc. ), liver fibrosis index more than 5, liver function series 10 or more, immune function index 10 or more, as well as protein electrophoresis, blood routine, B-ultrasound, CT and other imaging examinations. When hospitalized patients are admitted to the hospital, they also need to routinely check AIDS, sexually transmitted diseases and other indicators to prevent some diseases from being transmitted outside the hospital. If all these projects are to be done, it will cost several thousand yuan. In fact, not every patient needs to re-do these indicators, nor do patients need to re-examine every time they return to the clinic. Instead, the necessary examinations should be selected according to the actual situation of each patient. Unfortunately, in actual clinical practice, there are indeed many patients who have suffered some extra burdens for many years and do not need regular laboratory tests. Generally speaking, if patients do not receive special antiviral treatment, there is no need to frequently check hepatitis B virus indicators and virus variation indicators.
Second, some immature diagnosis and treatment projects are used in clinic, while some mature and effective diagnosis and treatment methods are ignored. It is recognized that hepatitis B vaccine is used to treat hepatitis B, but many places are mobilizing patients to try hepatitis B vaccine combined with other drugs, such as dipyridamole, to treat hepatitis B virus carriers and patients. These attempts have little practical clinical value.
Third, blindly pursue heights, preciseness and sharpness. Many patients with hepatitis B are in stable condition and have no special discomfort, but they have been mobilized for CT and MRI examination. Sometimes CT examination becomes a routine examination item for chronic hepatitis and liver cirrhosis, and the actual positive detection rate is very low, but the patient pays a high fee.
Fourth, a large number of medical advertisements and medical publicity means make patients suffer from "excessive diagnosis and treatment" caused by excessive overlapping of drugs and frequent dressing changes. Various promotional activities of medicine have made some doctors lose their fair position in choosing drugs, and some items and drugs that can or cannot be used may be added to patients; Patients often can't resist the temptation of drug advertisements and buy some drugs with poor efficacy for repeated use.
5. Various combination therapies that are not recognized are widespread. Clinically, it is very common for a patient to receive multiple drugs at the same time, including Chinese medicine, western medicine and various combinations of Chinese and western medicine. Some patients use interferon, lamivudine, altruism, oxymatrine and many Chinese patent medicines at the same time for antivirus, and the average daily consumption is about 1000 yuan. This "comprehensive" treatment is not very effective and sometimes even harmful. The burden on the liver is overwhelmed by drugs, and the degree of damage may be further aggravated.
Six, hepatitis B virus carriers should not be treated with drugs, but almost every hepatitis B virus carrier is undergoing experimental treatment in one way or another, and these treatments can hardly get the ideal curative effect, which is simply a waste.
■ "Excessive diagnosis and treatment" is very harmful.
1. Medical resources are seriously wasted. Statistics show that medical resources can be wasted by 20%-30% due to drug abuse and examination in medical institutions. Dr. Liu said that in order to get high profits from drugs, some medical institutions recover equipment costs as soon as possible, ignore domestic, cheap and effective drugs and inspection methods, encourage doctors to prescribe more imported high-grade drugs and do more CT and nuclear magnetic examinations, which actually caused great waste of medical resources.
2. The financial burden of patients is increasing. Hepatitis B virus carriers should not receive antiviral treatment, but many patients are using one treatment or another, including lamivudine. Dr. Liu said that the average annual cost of a patient using lamivudine should be around 6,000 yuan, and the whole course of treatment lasts for several years, which means that each patient may spend more than 10,000 yuan. If more than 100 million hepatitis B virus carriers in China try this treatment, it will mean an expenditure of one trillion yuan, which will be an "astronomical figure". In fact, these expenditures are likely to have nothing to gain, because the body of hepatitis B patients is still in a state of immune paralysis and does not respond to these treatments, so medication is actually a waste.
3. Drug-induced liver injury is increasing. Dr. Liu pointed out that the consequences of overdose are very serious, and the number of cases of drug-induced liver damage in China is increasing at a rate of 3% to 4.5% every year. Treating hepatitis B with traditional Chinese medicine is one of the characteristics of our country, but most traditional Chinese medicines themselves will have one kind or another of adverse reactions, and the prescriptions of traditional Chinese medicine for treating hepatitis B vary widely. Clinically, many patients with hepatitis B often get worse or even worse after blindly using traditional Chinese medicine prescriptions.
4. Too many examination items may also cause harm to the body. Dr. Liu said that the X-ray dose doubled in patients who had undergone CT examination many times in a short period of time. For hepatic hemangioma and stones, the accuracy of CT examination results was not as good as that of B-ultrasound examination. Frequent examination of HBV DNA quantification can not only explain the seriousness of the disease, but also make doctors and patients misunderstand each floating-point number change.
■ Measures to curb "excessive diagnosis and treatment"
Dr. Liu suggested that there should be a standard for the diagnosis and treatment of hepatitis B, including how to treat hepatitis B virus carriers, whether they need treatment, how to detect and follow up, what effective drugs to treat hepatitis B, how to use these drugs and so on. The standards should be as detailed as possible, including the standardization of commonly used drugs, the division of first-line drugs, second-line drugs and third-line drugs, and the scope of application of diagnostic items and therapeutic drugs.
The main purpose of the medical industry is to save lives and serve the people, not to make profits. Dr. Liu said that most patients do not understand the routine of diagnosis and treatment, and the medical experience is passive. Patients generally obey what doctors tell them to do and what medicine they take, so medical institutions are the masters. If medical institutions lose self-discipline and take profit as their main purpose, the phenomenon of "over-diagnosis and treatment" will become more and more serious. Therefore, it is imperative to formulate self-discipline guidelines for hepatitis B diagnosis and treatment industry.
The administrative department of health, the administrative department for industry and commerce, and the drug administration department should take practical measures to resolutely prohibit the spamming of hepatitis B advertisements, and restrict and put an end to the profit-making diagnosis and treatment activities organized by various individuals and contracted medical units.