探討口腔癌手術病患盛行率、醫療資源耗用及死亡率之分佈趨勢及其影響因素

摘要研究目的口腔癌症是好發25~44 歲年齡層的男性，而此年齡層卻是家庭經濟或是國家主要生產力來源，可見口腔癌對於家庭、社會國家的重大影響。本研究目的有下列四點: 一、探討口腔癌手術病患盛行率之長期趨勢分析。二、探討口腔癌手術病患醫療資源耗用之分佈趨勢及其影響因素。三、探討口腔癌手術病患死亡率之分佈趨勢及其影響因素。四、比較國內外口腔癌手術病患對醫療資源耗用與死亡率之差異性分析。研究方法利用國家衛生研究院釋出之「全民健康保險研究資料庫」之次級資料建立。研究樣本為 1996年至2010年間健保住院申報資料，主/次診斷為口腔癌症的患者(ICD-9：140.0-145.0；排除142.0)，住院DD檔唇癌(140)、舌癌(141)、齒齦癌(143)、口底癌(144)、頰癌及其他部位癌(145)合併手術治療，共56,336 例。排除存活年異常值9例、年齡18歲以下的28例，總共符合分析之樣本數56,299例納入本研究分析。研究變項資料來源，利用資料庫「資料檔(ID)」及醫事機構基本資料取得病人及住院的基本資料，以「住院醫療費用醫令清單明細檔」相關診察費、手術費用、病房費、檢查費、放射線診療費、治療處置費、麻醉費、特殊材料費、藥費、總醫療費用之整理與串聯。研究結果一、口腔癌手術病患盛行率自1996-2010年期間，口腔癌手術病患盛行率每十萬人口從2.88增加至27.45，有逐年上升之趨勢)，其中又以男性患者居多(91.8%)。二、在1996至2010年，口腔癌手術患者之平均住院天數隨時間有下降之趨勢(18.4天下降至16.4天，P<0.001)。三、醫療總費用方面，口腔癌手術病患在1996至2010年分佈趨勢皆有顯著增加；相較於其他費用而言，手術費用佔總醫療費用最高，約30.3%。四、口腔癌手術患者之年齡、性別、CCI、醫院手術量、醫師手術量及住院天數皆與其醫療資源耗用及死亡率有顯著相關(P<0.001)。結論與建議本研究利用15年全國大型資料庫，探討口腔癌手術醫療資源耗用之長期分析比較，為少見之研究。口腔癌手術病患以男性、年齡＜65歲佔居多，盛行率分佈趨勢逐年上升，口腔癌手術病患之住院天數，隨時間有下降之趨勢，醫療總費用隨時間有顯著增加之趨勢，年齡增加及CCI值較高的死亡風險也相對增加，非常高醫師服務量比低醫師服務量的死亡風險較低。外科醫師及口腔癌手術病患或家屬應特別注意：除了病患本身人口學特性會顯著影響其術後療效之外，醫療機構特性亦與其術後療效之恢復具有顯著相關；再者，醫院手術量與醫師手術量對於口腔癌手術病患術後療效亦有顯著影響，可提供相關癌症患者及醫療專業人員於照護病人之參考。

關鍵字

口腔癌手術病人；盛行率；醫療資源耗用；死亡率

並列摘要

Purpose Oral cancer has been increased in Taiwan. The male from 25 to 44 years old showed a high incidence of oral cancer, during this distribution of age create domestic economy and high productivity, and, therefore, oral cancer produced an important effect to the family and the country. The study purposed: 一、To evaluate the prevalence of long-term trends in oral cancer surgery patients. 二、To identify the distribution of resource utilizations and their impact factors in oral cancer surgery patients. 三、To explore the trends and the impact factors of survival in oral cancer surgery patients. 四、To conduct the international comparison on resource utilizations and survival of oral cancer surgery patients. Methods This is a retrospective longitudinal study. This study analyzed administrative claims data obtained from the BNHI. A total of 56,336 patients whose main diagnosis or secondary diagnosis were oral cancer (ICD-9 140.0-145.0; Excluding 142.0), the hospitalization DD file of lip cancer (140), tongue cancer (141), gum cancer (143), oral cavity cancer (144), buckle cancer and other parts of cancer combined surgical treatment (145); A total comply with the analysis of samples of 56,299 patients included in the study, exclude abnormal values survived years for 9 patients, below the age of 18 for 28 patients. The variables data of basic information of patients and administration used were collected database「Data ID file」 and basic information of the medical institutions, collation and connected in series for relevant examination fees, surgical fees, unit fees, inspection fees, radiation treatment fee, treatment and disposal fees, anesthesia fees, special materials, drugs and total medical expenses. Results 一、 The prevalence of oral cancer surgery patients. The period of 1996 to 2010 , the prevalence of surgery patient with oral cancer per 100,000 population increased from 2.88 to 27.45, with an upward trend year by year, the majority of patients were male (91.8%). 二、 In 1996 to 2010 showed that average length of hospital stay became less and less with time in surgery patient with oral cancer (18.4 days decreased to 16.4 days, P <0.001). 三、 In 1996 to 2010, compared with others, the total medical expenditures had significantly increase, surgery expenditures (30.3%) were the highest component in oral cancer surgery patients. 四、 With regards to medical resource utilization and mortality rate, there is a significant effect on age, gender, CCI, hospital surgery volume, surgeon volume and length of stay (P <0.001). Conclusions Decreases in LOS and increases in total treatment cost were observed in oral cancer surgery patients. Government officials and health care providers should understand that total treatment cost depends on patient attributes as well hospital attributes. These results can be generalized to patient populations elsewhere in Taiwan as well as to other countries with similar patient profiles.