體外電震波碎石術治療輸尿管下段結石的成本和治療效果的分析

Cost and Outcome Analysis of Extracorporeal Shock Wave Lithotripsy for Patients with Distal Ureteral Stone

莊光達(Guang-Dar Juang) ； 黃一勝(Thomas I-Sheng Hwang) ； 許怡欣 ； 湯澡薰(Choa-Hsiun Tang)

《輔仁醫學期刊》 4卷3期 (2006/09) Pp. 121-130

摘要

目的：以採用醫療資源耗用的方式，計算體外電震波碎石術治療輸尿管下段結石的直接醫療成本和客觀的治療效果。方法：從2002至2004年於新光醫學中心的回溯性研究，體外電震波碎石術是使用Lithostar Ⅱ震波碎石機碎石，以門診治療的方式進行。結果：在結石＜1公分的210位病患，治療的成功率為81.9%，再治療率為7.0%，而結石≥1公分的74位病患，治療的成功率為62.2%，再治療率為19.6%。接受治療的284位病患中僅有3位(1.06%) 於治療後有輕微的併發症發生。成本的計算是從醫院的觀點、以資源耗用的方式計算直接醫療成本。單位成本是根據健保醫令清單和各醫療單位的成本收費比計算。單次治療的成本當結石＜1公分，平均醫療成本為22884元而當結石≥1公分時為22494元。假設『全民健康保險醫療費用支付標準』中的一點為新台幣一元。單次體外電震波碎石術治療輸尿管下段結石，當結石＜1公分時醫院平均盈餘為6138元，而結石≥1公分時則為6528元。結論：臨床上以體外電震波碎石術治療輸尿管下段結石的成功率與成本耗費：當結石＜1公分時，成功率為81.9%，而單次碎石成本為22884元。當結石≥1公分時，成功率為62.2%，而成本則為22494元。

關鍵字

成本分析 ； 治療效果分析 ； 輸尿管下段結石 ； 體外電震波碎石術

並列摘要

Background and Purpose: In this study, we attempted to estimate the direct medical costs, based on resources utilization and objective outcomes, of extracorporeal shock wave lithotripsy (ESWL) for distal ureteral stones. Methods: From January 2002 through December 2004, 284 distal ureteral calculi were treated using ESWL (Siemens Lithostar Ⅱ). All ESWL treatments were performed with the patient under intravenous sedation and on an outpatient basis. Results: The stone-free rates were 62.2%for stone sizes of ≥1cm, and 81.9%for stone sizes of ＜1cm. Retreatment was required in 9 (19.6%) and 12 cases (7.0%), respectively. Minor complications occurred in 3 patients (1.06%). The direct medical costs of treatment were estimated by resource utilization from the viewpoint of the health provider and derived by adjusting for department-specific cost-to-charge ratios. The mean single treatment costs of ESWL were NT$22,884 and 22,494 (in 2004, the average exchange rate was US$1.00=NT$31.9) for smaller and larger stones, respectively. From the standpoint of benefits and the assumption that 1 point of reimbursement means NT$1, the mean hospital benefit of a single treatment of ESWL of a lower ureteral stone was NT$6138 and 6528 for smaller and larger stones, respectively. Conclusions: The success rates (and direct medical costs) of ESWL for treatment of lower ureteral stones were 81.9% (NT$22,884) and 62.2% (NT$22,494) for smaller and larger stones, respectively.

並列關鍵字

cost analysis ； treatment outcome ； distal ureteral stone ； extracorporeal shock wave lithotripsy ESWL