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Objective: To explore the direct economic burden and factors affecting out-of-pocket direct costs of multidrug-/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) patients in Jiangsu Province. Methods: MDR/RR-PTB patients diagnosed and treated at 13 municipal tuberculosis (TB)-designated hospitals in Jiangsu Province between January 1, 2021, and December 31, 2022, were included, and basic information and direct economic costs were obtained through questionnaires and hospital information systems. Stepwise multiple linear regression was used to analyze the factors influencing patients' out-of-pocket direct costs. Results: The age of the 233 MDR/RR-PTB patients was (44.04±15.64) years. The M ( Q 1 , Q 3 ) direct medical expense of the patients was 134 051.00 (98 934.01,163 205.73) Yuan, of which the M ( Q 1 , Q 3 ) reimbursement by health insurance or policy reduction was 100 462.10 (78 120.00,130 816.00) Yuan, and the M ( Q 1 , Q 3 ) out-of-pocket direct medical expense was 21 694.62 (14 734.83,37 813.00) Yuan. The M ( Q 1 , Q 3 ) direct non-medical expense was 4 971.00 (3 138.00,7 870.00) Yuan. Age, registered residence location, TB resulting in divorce or separation from spouse or partner, drug resistance test results, and treatment regimens were the influencing factors associated with out-of-pocket direct costs for MDR/RR-PTB patients. Conclusions: The direct economic burden caused by MDR/RR-PTB in Jiangsu Province is heavy. It is necessary to emphasize psychological guidance and care for MDR/RR-PTB patients, improve the diagnosis, treatment, and management of MDR/RR-PTB, and effectively reduce the economic burden of MDR/RR-PTB patients.

Background: Sputum retention increases significantly the risk of repetitive respiratory tract infections, which may result in dyspnea and lung injury. Chest physical therapy is the most commonly used method to assist patients to expel sputum. This intervention promotes sputum clearance and prevents airway obstruction, thereby reducing the risk of lung infection., Purpose: The purpose of this study was to investigate the impact of chest physical therapy on the length of hospitalization and the medical expenditures of patients with pulmonary infection., Methods: A retrospective-correlation study was used. Data were collected from 2013 to 2017 in the medical ward of a medical center located in southern Taiwan. The annual differences in the length of stay, medical expenditures, and readmission rates for patients with pulmonary infection after chest physical therapy were analyzed., Results: A total of 707 patients with pulmonary infection were recruited and enrolled as participants. The mean age of the participants was 75.4 (± 13.8) years. The results showed that length of stay (F = 6.66, p < .001) and medical expenditures (F = 5.34, p < .001) were both significantly lower after chest physical therapy and that the corresponding readmission rates had decreased significantly, from 6.9% in 2013 to 1.7% in 2017 (x 2 = 5.84, p = .016)., Conclusions / Implications for Practice: After conducting a yearly comparison, the results of this study indicate that administering chest physical therapy may be an effective strategy for reducing the length of stay, readmission rates, and medical expenditures of patients with pulmonary infection. The findings of this study may serve as a reference for the clinical implementation of chest physical therapy in patients with pulmonary infection.

Objective: The existed economic evaluations of cancer screening in Chinese population are almost all single-cancer focused, evidence on parallel comparison among multiple cancers is lacking. Thus, the aim of this study was, from a priority setting perspective, to compare the cost-effectiveness of six common cancers(colorectal cancer, breast cancer, liver cancer, lung cancer, esophageal cancer and stomach cancer) to facilitate policy making in future scaled-up screening in populations in China. Methods: Partially based on our previous single-cancer systematic reviews (colorectal cancer, breast cancer, liver cancer, and lung cancer), evidence of economic evaluations of cancer screening in populations in mainland China were systematically updated and integrated. The main updates include: 1) Stomach cancer and esophageal cancer were newly added to the current analysis. 2) The literature searching was extended to 8 literature databases, including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, Wanfang Data, and VIP. 3) The period of publication year was updated to the recent 10 years: January 1, 2009 to December 31, 2018. 4) The study focused on populations in mainland China. Following the standard processes of literature searching, inclusion and exclusion from previous systematic reviews, the basic characteristics, evaluation indicators and main results of the included studies were extracted. All the costs were discounted to 2017 value using the by-year consumer price index of medical and health care residents in China and presented in the Chinese Yuan (CNY). The ratios of incremental cost-effectiveness ratio (ICER) to China's per capita GDP in 2017 were calculated (<1 means very cost-effective, 1-3 means cost-effective, >3 means not cost-effective). Given a specific indicator, the median value among all reported screening strategies for each cancer was calculated, based on which priority ranking was then conducted among all cancers when data available. Results: A total of 45 studies were included, 22 for breast cancer, 12 for colorectal cancer, 6 for stomach cancer, 4 for esophageal cancer (all conducted in high-risk areas), 1 for liver cancer and none for lung cancer (was not then considered for next ranking due to limited numbers of studies). When based on the indicator, the median ratio of cost per life-year saved to China's per capita GDP (reported in 12 studies), the lowest ratio (-0.015) was observed in esophageal cancer among 16 strategies of 2 studies ( N =2, n= 16), followed by 0.297 for colorectal cancer ( N =3, n= 12), 0.356 for stomach cancer ( N =1, n= 4) and 0.896 for breast cancer ( N =6, n= 52, P (75)=3.602). When based on another commonly used ICER indicator, the median ratio of cost per quality-adjusted life-year gained to China's per capita GDP (reported in 13 studies), the least cost was found in stomach cancer (0.495, N =3, n= 8, P (75)=3.126), followed by esophageal cancer (0.960, N =1, n= 4, P (75)=1.762) and breast cancer (2.056, N =9, n= 64, P (75)=4.217). Data was not found for colorectal cancer. In addition, cost per cancer case detected was the most adopted indicator (32 studies). The median cost among all screening strategies for each cancer was 14 759 CNY for stomach cancer ( N =5, n= 7), 49 680 CNY for colorectal cancer ( N =12, n= 25) and 171 930 CNY for breast cancer ( N =13, n= 24), respectively. Data was not available for esophageal cancer and rare for precancer cases detected. Evidence related to cost per disability-adjusted life-year gained was not available. Conclusions: At China's national level and limited to the six cancers covered by the current study, the preliminary analysis suggests that stomach cancer and colorectal cancer were the most cost-effective target cancers and could be given priority in the future scaled-up screening in general populations. Esophageal cancer screening should be prioritized in high-risk areas. Breast cancer was also cost-effective in general but some of the intensive screening strategies were marginal. Data on liver cancer and lung cancer were too limited to conclude, and more well-designed studies and high-quality research evidence should be required. This priority ranking might be changed if other common cancers were involved analyses.

Objective: To clarify the research status of economic burden of stomach cancer in China from 1996 to 2015. Methods: Based on three electronic literature databases (China Knowledge Resource Integrated Database, Wanfang Database and PubMed), a total of 2 873, 1 244 and 84 articles published during 1996 to 2015 were found, respectively, using keywords of"cancer","neoplasms","malignant tumor","tumor","economic burden","health expenditure","cost","cost of illness", and"China". According to the inclusion and exclusion criteria, 30 literatures were included in the final analysis. Then the basic information and study subjects, indicators and main results of economic burden were abstracted and analyzed. All the expenditure data were discounted to the values in 2013 by using China's percapita consumer price index. Results: Totally, 30 articles were included, covering 14 provinces and of which 16 were published during 2011-2015. One article was based on population-level and the remaining studies were all based on individual-level. The number of individual-level articles that reported direct medical, non-medical and indirectly economic burden was 29, 1 and 2, respectively. The main indicators of direct medical expenditure were expenditure per patient (22), per clinical visit (9) and per diem (11), respectively. The median expenditure per patient was 7 387-28 743 RMB (CNY), with average annual growth rate (AAGR) of 1.7% (1996-2013). The median expenditure per clinical visit was 18 504-41 871 RMB (2003-2013), with AAGR of 5.5%. The median expenditure per diem was 313-1 445 RMB (1996-2012), with AAGR of 3.7%. Difference was found among provinces. Conclusions: The evidence for economic burden of stomach cancer was still limited over the past two decades and mainly focused on individual and regional levels. An increase and differences in provinces were observed in direct medical expenditure. Evaluation on direct non-medical and indirect medical expenditure needs to be addressed.

Objective: To understand the government financial investments to community based organizations (CBO) involved in HIV/AIDS Control and Prevention of China and its influencing factors. Methods: Questionnaire of the situation of CBO involved in HIV/AIDS control and prevention were designed, and filled by the staff of Provincial Health Administrative Departments of 31 provinces (autonomous regions and municipalities). The research focused on the fields of CBO involved in HIV/AIDS response in 31 provinces (autonomous regions and municipalities), including intervention on HIV/AIDS high risk population (female sex worker (FSW), man who sex with man (MSM), drug user (DU) and case management and care for people living with HIV/AIDS (PLWH)). 29 valid questionnaires were collecting, with Shanxi Province and Inner Mongolia Autonomous Regions not filled. Questionnaire included financial supports from local governments, transfer payment from central government for CBO involved in HIV/AIDS response in 2014, and unit cost for CBO involved in HIV/AIDS control and prevention. Multivariate analysis was conducted on the project application and financial investment of community based organizations involved in HIV/AIDS control and prevention in 2014. Results: The total amount of CBO to apply for participation in AIDS prevention and control was 64 482 828 Yuan in 2014. The actual total amount of investment was 50 616 367 Yuan, The investment came from the central government funding, the provincial level government funding, the prefecture and county level government funding investment and other sources of funding. 22 of 28 provinces (autonomous regions and municipalities) received the funds from the central government finance, and median of investment funds 500 000 Yuan. 15 provinces (autonomous regions and municipalities) gained the funds from the provincial government finance, and median of investment funds 350 000 Yuan. 12 provinces (autonomous regions and municipalities) got the funds from the prefecture and county level government finance, and median of investment funds 408 750 Yuan. 12 provinces (autonomous regions and municipalities) acquired the funds from other sources, and median of investment funds 228 400 Yuan. The median ( P (25), P (75)) unit costs of intervention for FSW from 16 provinces (autonomous regions and municipalities) was 70 (23, 280) Yuan per year; DU from 14 provinces (autonomous regions and municipalities) was 83 (44, 200 ) Yuan per year; MSM from 16 provinces (autonomous regions and municipalities) was 100 (35, 280) Yuan per year; the follow-up and care for PLWH from 17 provinces (autonomous regions and municipalities) was 200 (45, 500) Yuan per year. Multivariate linear regression analysis results showed that the amount of PLWH in 2014 influenced on the total number of application funds of CBO involved in HIV/AIDS response ( b =178.11, 95% CI: 51.86-305.36) and the amount of PLWH ( b =77.72, 95% CI: 16.28-139.16), and Gross Domestic Product (GDP) per capita of the province ( b =36.20, 95% CI: 4.60-67.80) impacted financial investment to CBO involved in HIV/AIDS response, respectively. Conclusion: Funds application and financial investment of CBO involved in HIV/AIDS control and prevention were huge. Financial investment from government was main resources for CBO in 2014. The amount of financial investment funds from governments was influenced by the HIV/AIDS epidemic situation and the development level of local economic.

Objective: To explore existing evidence of economic burden of esophageal cancer in China over the past 20 years. Methods: Based on PubMed, CNKI and Wanfang, literatures published from 1996 to 2015 were retrieved with the key words such as " economic burden" , "cost of illness" and so on. Then the information excerpted from those literatures were analyzed after several exclusionary procedures for non-esophageal cancer related literatures. The information about subjects and data source, methodology, main results were structurally abstracted and then analyzed. Quality assessments were conducted independently by two investigators using an 11-item instrument recommended by the Agency for Healthcare Research and Quality (AHRQ) for cross-sectional studies. All the expenditure data were calculated according to year-specific personal health care consumer price index (CPI) of China, the annual growth rate was calculated according to the average speed of growth. Results: A total of 23 studies (21 individual surveys and 2 population-based surveys) were included in the analysis, in which 12 were published over the past 5 years. Among the 21 individual surveys, 17 were hospital-based and the data were obtained through medical record review, and most of which only considered the direct medical economic burden (including the average overall expenditure per patient, per time and per diem). The median expenditure per patient during 1996-2011 ranged from 7 463 to 37 647 yuan (RMB) and the average growth rate was 7.68 % . The median medical expenditure per clinical visit during 1996-2013 ranged from 6 851 to 57 554 yuan (RMB) and the average growth rate was 11.89 % . The median medical expenditure per diem during 1996-2010 ranged from 225 to 1 319 yuan (RMB) and the average growth rate was 12.53 % . The direct medical expenditure per clinical visit varied greatly with area, which were much higher in Beijing, Shanxi and Hubei. In both individual survey and population-based survey, less data about the direct non-medical expenditure and the influence of indirect expenditure on the economic burden were reported. Conclusion: Less data are available on economic burden of esophageal cancer in China over the past 20 years and the data's comparability are poor, especially in terms of population level or indirect burden. Direct medical expenditure is on the rise, and regional differences.

Objective: To understand the direct medical expense for surgical patients with splenomegalic advanced schistosomiasis and its influencing factors, so as to provide evidences for relevant departments to improve the rescue strategy of advanced schistosomiasis., Methods: The data about the expenses of patients with splenomegalic advanced schistosomiasis hospitalized in Xiangyue Hospital affiliated to Hunan Institute of Schistosomiasis Control from January 2010 to August 2014 were collected, the hospitalization expense and hospital stays of the patients were analyzed, and the factors influencing the hospital expenses were analyzed by the univariate and multi-factor analyses., Results: From January 2010 to August 2014, totally 249 cases were hospitalized in the hospital, their average hospital stays and hospital expenses were 28.92 d and 18 896.13 Yuan, and both of them were increased year by year. Among all the kinds of expenses, the constitution ratios of the medicine expenses were the highest, and those in the 5 years were all above 44%. The results of the univariate and multi-factor analyses showed that the hospital stays, the amount of intraoperative bleeding, liver function classification, postoperative complications, age, portal hypertensive gastropathy were the influencing factors of the hospital expenses., Conclusions: Presently, the burden of the direct hospital expenses of the patients with splenomegalic advanced schistosomiasis is still heavy. The government should further improve the proportion of the compensation of medical assistance and perfect the medical aid scheme. Meanwhile, the hospitals should strengthen the management and standardize medical behavior to reduce the hospitalization expenses of the patients.

Objective: To evaluate the disease burden of colorectal cancer in Jinchang cohort, and provide evidence for preventing colorectal cancer and reducing the disease burden of colorectal cancer in the cohort., Methods: The colorectal cancer mortality data from 2001 to 2013 and the medical records of colorectal cancer patients from 2001 to 2010 were collected for this retrospective cohort study. The colorectal cancer disease burden was described by using mortality rate, standardized mortality rate, medical expenditure, potential years of life lost (PYLL), average potential years of life lost (APYLL), working potential years of life lost (WPYLL), and average working potential years of life lost (AWPYLL). The development trend in disease burden of colorectal cancer was analyzed by using Spearman correlation and the average growth rate., Results: The crude mortality rate of colorectal cancer from 2001 to 2013 was 9.53/100,000 with the average annual growth rate of 12.89%. The PYLL, APYLL, WPYLL and AWPYLL of colorectal cancer were 485.00 person-years, 9.15 years, 253.00 person-years, and 4.77 years, respectively. The direct medical expenditure due to colorectal cancer was 7064.38 Yuan per case and 408.43 Yuan per day. There was no increasing trend in the direct medical expenditure due to colorectal cancer., Conclusion: Colorectal cancer mortolity rate was on the rise and it caused heavy disease burden in Jinchang cohort.

Objective: To understand the current status of disease burden caused by gastric cancer in Jinchang cohort., Methods: In this historical cohort study, the data of gastric cancer deaths from 2001 to 2013 and the medical records of gastric cancer cases from 2001 to 2010 in Jinchang cohort were collected to analyze the mortality, potential years of life lost (PYLL), working PYLL (WPYLL) associated with gastric cancer, and the medical expenditure data were used to evaluate the direct economic burden. Spearman correlation analysis and the average growth rate were used to describe the change trend of disease burden of gastric cancer., Results: A total of 213 gastric cancer deaths occurred in Jinchang cohort from 2001 to 2013. The average annual crude mortality rate of gastric cancer was 38.30 per 100,000 in Jinchang cohort during 2001-2013 and no obvious change was observed. The crude mortality rate in males was 6.84 times higher than that in females. Gastric cancer death mainly occurred in age group 50-79 years (82.62%), while the mortality rates was increasing among the people under 50 years with an average annual increase rate of 0.77%. The annual average PYLL (APYLL) and average WPYLL (AWPYLL) caused by gastric cancer decreased by 8.43% and 10.46%, respectively. No obvious change in medical expenditure of gastric cancer cases was observed in Jinchang Cohort during 2001-2010, and the medical expenditure and average daily cost of hospitalization were 8102.23 Yuan, and 463.45 Yuan per capita, respectively., Conclusions: The burden of disease for gastric cancer was heavy in Jinchang cohort. The PYLL and WPYLL had no change, while the APYLL and AWPYLL showed a increasing trend during the last ten years. Direct economic burden of inpatients with gastric cancer had no change.

Objective: To explore the impact of health management programs on hypertension related to their cost of the hypertensive, so as to provide evidence for related policy-making., Methods: Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps. Information regarding hypertensive patients were collected through a questionnaire. Two-part model was used to analyze the influence from health management scheme., Results: This study included 11 294 participants who were 35 years old or beyond, with 4 904 (43.42%) males and 6 390 (56.58%) females. The median cost from the outpatient was 100 (30-200) Yuan, and the cost of patients under management program were significantly lower than those without (P<0.05). Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P>0.05). Regarding the calculation on the outpatient cost, results showed that the patients under the management program were more likely to practice 'outpatient-medical-behavior' (OR =2.50, 95% CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients. Hypertensive patients from the urban areas were more likely to adopt 'medical behavior'(OR=1.31, 95% CI:1.18-1.45) which was 1.69 times of the costs from the rural patients. RESULTS of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10, 95% CI:1.01-1.20) and was 1.19 times the costs of the rural patients., Conclusion: Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.

Objective: To understand the economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing., Methods: People living with HIV/AIDS were divided into two groups, HIV infected patients and AIDS patients. The data about their direct medical expenditure, direct non-medical expenditure and indirect economic loss in the past year were collected. Univariate and multivariate analysis were conducted to identify the potential influencing factors., Results: The median of direct medical expenditure and total costs for 133 HIV infected patients were 1,200 yuan RMB and 1,972 yuan RMB respectively. The median of direct medical expenditure and total costs for 145 AIDS patients were 1 060 yuan RMB and 2 826 yuan RMB respectively. The differences in direct medical expenditure and total costs between HIV infected patients and AIDS patients showed no statistical significance. The results from univariate analysis indicated that the sample source influenced total costs significantly. Multivariate analysis showed that onset time and CD level were negatively correlated with direct medical expenditure. The patients infected through heterosexual contact had more direct medical expenditure than those infected through homosexual contact. The patients receiving HIV test in hospitals had more direct medical expenditure than those receiving volunteer counseling and testing., Conclusion: Further efforts should be made to expand HIV testing and treatment coverage in order to detect HIV infections as early as possible. Early antiretroviral treatment should be given to HIV infected patients to maintain their immunity and reduce their medical expenditure.

The study of the medical expenditure and its influencing factors among the students enrolling in Urban Resident Basic Medical Insurance (URBMI) in Taiyuan indicated that non response bias and selection bias coexist in dependent variable of the survey data. Unlike previous studies only focused on one missing mechanism, a two-stage method to deal with two missing mechanisms simultaneously was suggested in this study, combining multiple imputation with sample selection model. A total of 1 190 questionnaires were returned by the students (or their parents) selected in child care settings, schools and universities in Taiyuan by stratified cluster random sampling in 2012. In the returned questionnaires, 2.52% existed not missing at random (NMAR) of dependent variable and 7.14% existed missing at random (MAR) of dependent variable. First, multiple imputation was conducted for MAR by using completed data, then sample selection model was used to correct NMAR in multiple imputation, and a multi influencing factor analysis model was established. Based on 1 000 times resampling, the best scheme of filling the random missing values is the predictive mean matching (PMM) method under the missing proportion. With this optimal scheme, a two stage survey was conducted. Finally, it was found that the influencing factors on annual medical expenditure among the students enrolling in URBMI in Taiyuan included population group, annual household gross income, affordability of medical insurance expenditure, chronic disease, seeking medical care in hospital, seeking medical care in community health center or private clinic, hospitalization, hospitalization canceled due to certain reason, self medication and acceptable proportion of self-paid medical expenditure. The two-stage method combining multiple imputation with sample selection model can deal with non response bias and selection bias effectively in dependent variable of the survey data.

Objective: To evaluate the status and trend of direct economic burden on cerebrovascular disease, from 1993 to 2008 in China., Methods: Using two-step model to calculate the economic cost with related trend of cerebrovascular disease within the population among the over 30-year-olds, from 1993 to 2008. Data was gathered from the National Health Service Surveys Analysis Reports of 1993, 1998, 2003 and 2008, that including both direct outpatient and inpatient cost., Results: There appeared a significant increase on the burden of cerebrovascular diseases in the period of 15 years, with direct economic cost increasing from 8.473 billion to 103.125 billion RMB. In fact, the actual increase was 5.3 times, without the influence of the price. The average annual growth rate was 13.1%, exceeding the rate of total expenditure on health and GDP during the same time span. In addition, the growth rate in 2003-2008 was the fastest, which appeared to be 19.8%., Conclusion: Burden that caused by cerebrovascular disease on individuals and the whole society was heavy which warrented further theoratical and practical studies on it.

Objective: To explain the household healthcare expenditure among the rural floating population in Beijing and analyze the determinants of a household total healthcare consumption., Methods: The data came from the special investigation about rural floating population in Beijing which is part of The Fourth National Health Service Investigation of China. A total of 4 698-native rural migrants (2,728 families) in Beijing were chosen as subjects and a Tobit model was used to analyze the data. Base on the censored characteristics, we use the censored least absolute deviations (CLAD) method to estimate the parameters., Results: Compared with the general urban population, the population under investigation has a high proportion of male and unmarried, but low educated group of young people. The average household healthcare expenditure per month was 21.26 Yuan, and about 74% of the households had made no healthcare expenditure 3 months preceding the survey. The household healthcare expenditure was influenced by the household's education level, household's income level, household size, Engel's coefficient, head's choice of medical institutions and so on., Conclusion: The level of household healthcare expenditure is low with the determinants in the floating population, such as the household's economic circumstances and so on. We should make and develop relevant policies and improve the healthcare utilization of the floating population.

Objective: To evaluate the safety and feasibility of transradial coronary angiography at the outpatient clinic., Methods: From February 2007 to June 2007, 100 outpatients who received transradial coronary angiography in Anzhen hospital were included in this analysis, 100 inpatients underwent coronary angiography were selected as control group. Primary endpoints included success rate, percent of angiographic catheter use with different diameters, adverse events during the procedure (such as death, malignant arrhythmia, acute myocardial infarction, coronary artery spasm, coronary artery dissection, perforation or occlusion, etc.) and after the procedure (such as death, acute myocardial infarction, upper limb haematoma, osteofascial compartment syndrome, radial artery pseudoaneurysm or occlusion, etc.)., Results: The success rate (100% vs. 100%), procedure duration time [(12.5 +/- 3.4) min vs.(10.8 +/- 3.6) min, P = 0.517] and exposition time [(4.3 +/- 1.0) min vs. (4.1 +/- 1.0) min, P = 0.629] were similar between the outpatient and inpatient groups. Radial and coronary artery spasm were the main adverse events during the angiography, and haematoma was the main adverse event after the angiography. There were no significant differences of adverse events between the 2 groups. The total cost of the outpatient group was significantly lower than the inpatient control group [(4012 +/- 238) yuan vs. (5329 +/- 371) yuan, P < 0.001]. Expenditure including chemical tests, medicine, nursing care, room and board all decreased significantly., Conclusion: Transradial coronary angiography application at the outpatient clinic was safe and feasible for stable patients, and this procedure could decrease the medical expenditure and shorten the admission time.

Objective: The expanded programme on immunization (EPI) is an important part of the social commonwealth projects providing health care service by the government, which benefits communities. Government has the responsibility for EPI's financing which should be covered by the national budget. It is essential that the cost of EPI service be scientifically estimated to provide propriety information for policy makers., Methods: This study, using the cost accounting theory of health economics, to calculate EPI service cost at different levels. 3 provinces, 3 prefectures, 9 counties, 18 towns and 12 villages were selected from three provinces Guizhou, Heilongjiang and Zhejiang from the western, central and eastern regions of the country., Results: The average costs for one EPI-targeted child in Guizhou, Heilongjiang and Zhejiang, were 15.68 Yuan, 29.00 Yuan and 31.09 Yuan, and the costs for one dose were 10.99 Yuan, 18.64 Yuan and 16.51 Yuan, respectively. The costs for complete immunization program for one child were 131.88 Yuan, 242.32 Yuan and 280.67 Yuan, respectively. The main factors affecting the cost would include the average personnel cost (salary and benefit cost) by different economic levels of areas, the number of EPI items developed, and the number of total doses for one child., Conclusion: (1) Obvious differences were found between different areas. (2) The proportion of the cost was not reasonably set because of the shortage of input. (3) Guideline for different areas to compensate the working item cost according to the number of the items should be formulated.