目的: 研究腔镜吻合器集采对肺部恶性肿瘤手术患者住院费用的影响,评估集采政策实施效果并提出政策建议。方法: 从宁波市医疗机构综合监管平台,选取2022年6月至2024年5月市级综合医院肺部恶性肿瘤手术患者的病案首页数据,提取患者住院费用信息,采用结构变动度、中断时间序列分析腔镜吻合器集采后患者的次均住院费用和费用结构的变化情况。结果: 共纳入18065例患者病案首页,肺部恶性肿瘤手术患者次均住院费用从集采前的36228.12元降至集采后的31126.41元（P<0.05）。费用构成比最高的是耗材费（44.16%）,其次为手术治疗费（20.23%）。腔镜吻合器集采后,耗材费构成比下降6.52个百分点,药品费下降0.65个百分点,而手术治疗费、综合医疗服务费、检查检验费占比上升。其中,耗材费的结构变动度贡献率最大（45.47%）,其次为手术治疗费（22.70%）和综合医疗服务费（17.45%）。经中断时间序列分析,腔镜吻合器集采后肺部恶性肿瘤手术患者次均住院费用呈明显下降趋势（P<0.05）。结论: 腔镜吻合器集采后,肺部恶性肿瘤手术患者次均住院费用明显下降,费用结构得到一定优化,但医疗服务费占比的提升主要依赖于耗材费下降推动。建议医保部门要利用集采带来的“腾笼换鸟”契机,及时推进医疗服务价格调整改革,更好体现医务人员技术服务价值,同时要进一步科学完善耗材集采规则,减少因集采导致耗材巨大价格差异对病种费用的波动影响。

Objective: The paper attempts to investigate the impact of endoscopic stapler centralized procurement on hospitalization costs for patients undergoing lung malignant tumor surgery, evaluate the implementation effect of centralized procurement policy, and propose policy recommendations. Methods: According to the comprehensive supervision platform of medical institutions in Ningbo City, medical record homepage data of patients undergoing lung malignant tumor surgery in municipal general hospitals in Ningbo City from June 2022 to May 2024 were selected. Patients' hospitalization cost information was extracted, and the changes in average hospitalization cost, and cost structure of patients after staple centralized procurement was analyzed with degree of structure (DSV), and interrupted time series. Results: A total of 18065 patients' medical records were included, and the average hospitalization cost for patients undergoing lung malignant tumor surgery decreased from 36228.12 yuan before centralized procurement to 31126.41 yuan after centralized procurement (P<0.05). Consumables cost was highest in the cost structure (44.16%), followed by surgical treatment cost (20.23%). After endoscopic stapler centralized procurement, the proportion of consumables cost decreased by 6.52%, the proportion of drug cost decreased by 0.65%, while the proportion of surgical treatment cost, comprehensive medical service cost, and examination and testing cost increased. Among them, the contribution rate of DSV in consumables cost is the highest (45.47%), followed by surgical treatment cost (22.70%) and comprehensive medical service cost (17.45%). Through interrupted time series analysis, it was found that the average hospitalization cost for patients undergoing lung malignant tumor surgery after centralized procurement showed a significant downward trend (P<0.05). Conclusions: After stapler centralized procurement, the average hospitalization cost for patients undergoing lung malignant tumor surgery has significantly decreased, and the cost structure has been optimized to some extent. However, the increase in the proportion of medical service cost mainly depends on the decrease in consumables cost. It is suggested that the medical insurance department should take advantage of the opportunity brought by centralized procurement to promote the reform of medical service price adjustment, better reflect the technical service value of medical personnel, and further scientifically improve the rules of centralized procurement to reduce the impact of huge price difference of consumable on disease cost fluctuation.