學齡前兒童弱視篩檢之經濟評估

Economic evaluation of vision screening for preschool children

黃昭惠(Chao-Hui Huang)

指導教授 ： 湯澡薰

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00122

摘要

眼睛為「靈魂之窗」，因為人類的知識與經驗百分之八十是經由視覺獲得，顯示視力是人感覺器官中極重要的一部份。視力若有問題，不僅影響個人的健康、安全與生活品質，更成為學習的主要障礙。在台灣，視力保健議題一直以來是政府對於國家青少年健康保健施政的重點，衛生署自1995 年度推出「學齡前幼童斜弱視篩檢計畫」，並由各縣市衛生所督導托兒所幼稚園陸續積極推行，針對篩檢異常之案例繼續追蹤治療，至今已有不錯的成果。然而，相較於歐美國家而言，國內較缺乏有關兒童視力篩檢成本資料的系統性整理及分析，對於兒童視力篩檢之效益研究也較為少數。因此，本研究的目的在評估學齡前兒童弱視篩檢計畫的成本與效益，其結果將作為衛生單位研擬兒童視力健康相關衛生政策的參考。
本研究以社會觀點，使用台灣弱視之流行病學參數，並彙整篩檢工具之特性及相關成本，透過建構決策分析模式，以評估4-6歲學齡前兒童視力篩檢計畫之成本效用及成本利益。在成本效用分析中追蹤其終生之品質調整後存活年數以及相關成本，評估沒有篩檢組與有篩檢策略之差異成本效用比。在成本利益分析中分別計算出有篩檢及沒篩檢之成本與利益，評估篩檢計畫介入之社會淨效益。本研究評估之效用指標是以生活品質調整後存活年數來評估，利益係以避免視力障礙之願付價值來評估。效益與成本皆使用3%折現。最後，本研究並且將模式之參數進行單變項敏感度分析與機率性敏感度分析，以了解研究結果之不確定性。
研究結果顯示折現後，若執行4-6歲弱視篩檢計畫可獲得29.2067品質校正人年，若無學齡前兒童弱視篩檢計畫可獲得29.2051品質校正人年。折現後，有、無4-6歲弱視篩檢計畫之總成本分別為NT$723.9與NT$593.6。其差異成本效果比值為NT$80932/QALY。若以社會淨效益評估之，若執行4-6歲弱視篩檢計畫可帶給學齡前兒童折現後的終生淨效益為NT$160.7，整體的篩檢策略相當於替社會帶來了約NT$6,900,297的淨效益。由單變項敏感度分析結果得知，弱視盛行率參數之變動所帶來的差異性成本效益比值之變動範圍最廣，甚至可能導致研究結果方向之改變。若對每單位品質人年的願付代價超過NT$50,000/QALY，則篩檢策略具成本效益的機率高於無執行篩檢策略。
本研究結果顯示，若執行4-6歲弱視篩檢計畫，每多得到一單位品質校正人年所需要多花的成本均低於世界衛生組織所建議之標準閾值。本研究結果顯示執行4-6歲學齡前兒童弱視篩檢是具有成本效益之策略。

關鍵字

弱視 ； 成本效益分析 ； 學齡前兒童視力篩檢

並列摘要

Background: Vision is very important because 80% of our knowledge and experiences is gained through eyes. Eye disorders have adverse impacts on health, safety, quality of life, and work and school performance. The Department of health in Taiwan has started implementing the vision screening program for preschool children in 1995, and has achieved the goal of early detection and early treatment on children with vision disorders. However, few study has been performed yet in Taiwan to evaluate the costs and outcome of an vision screening program for preschool children. The present study aimed to evaluate the long term cost-effectiveness of a vision screening program for early detection and treatment of preschool children with amblyopia in Taipei.
Methods: A decision analytic model was established to simulate the natural history of amblyopia in Taiwanese health care system. A societal perspective was undertaken to perform the cost-utility analysis and cost-benefit analysis. Cumulative life years, quality-adjusted life years(QALYs), lifetime benefits, lifetime costs QALYs, lifetime benefits, and lifetime costs for the following two strategies were compared: 1) A vision screening program was implemented toward preschool children aged 4-6; 2) No vision screening program. Net benefits and incremental cost-effectiveness ratio were calculated to assess whether vision screening programs is cost-effective and cost-benefit. All costs and outcomes were discounted at an annual rate of 3%. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to account for the uncertainty of the parameters.
Results: The model predicted that the discounted average life-time QALYs were 29.2067 QALYs per child for children with the vision screening program, and 29.2051 QALYs for children without the vision screening program. The discounted average total lifetime costs were NT$723.9 and NT$593.6 per child for children with the screening program and without the program, respectively. Incremental cost-effectiveness ratio (ICER) for the screening strategy was NT$80,932/QALY. The net social benefits was NT$160.7 per child and the vision screening program for preschool children could potentially bring approximately NT$6,900,297 net benefit to the society. Results were most sensitive to the prevalence rate of amblyopic. If the willingness-to-pay for a QALY of NT$50,000 is served as a threshold, the vision screening strategy was always preferred.
Conclusions: In comparison with no screening program, the ICER for the vision screening program for preschool children aged 4-6, was found to be less than the threshold proposed from the World Health Organization and therefore vision screening program for preschool children aged 4-6 could be considered cost-effective.

並列關鍵字

Amblyopia ； cost-effectiveness analysis ； vision screening ； preschool children

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