本研究的目的在於了解認知行為治療團體對心血管疾病個案的生活品質影響,並以成本效用分析的方式來評估其醫療經濟效益。本研究資料取自於翁嘉英教授所於民國100年主持的科技部專題研究計畫(100-2410-H-194-040-MY2)並額外納入台大醫院、成大醫院以及大林慈濟醫院的心血管病患為樣本,採混合實驗設計,分成實驗組以及控制組,實驗組共16位成員將參與八周的認知行為治療團體,而控制組的14位成員則未介入治療,兩組前後均進行心理因子(焦慮、憂鬱、敵意量表)以及生理因子(血容積脈波振幅、心跳以及呼吸速率)的評估,此外亦加入生活品質量表(SF-36),評估生活品質的改善狀況,再將生活品質的數值轉換成健康效用指數,並結合醫療成本進行成本效用評估。 研究結果發現,經過八周的認知行為治療團體之後,實驗組在心理因子上,特質焦慮以及敵意總分上有顯著進步(F(1,28) = 13.747; 10.068 p < .05);在生理上,血容積脈波振幅(F(1,23)= 4.64, p <.05)、心跳(F(3,75)= 3.64, p <.05)以及呼吸速率(F(1,28)= 5.24, p <.05)均有顯著改善,在生活品質上,角色-生理、身體疼痛以及心理健康上有顯著進步(F(1,28) = 8.507; 4.146; 7.162,p <.05),此外,在整體健康效用函數上,實驗組亦顯著高於控制組(F(1,28) = 6.417,p < .01),加入醫療成本考量後,認知行為團體治療的成本效用比率為2188.59至2407.45美元/ QALY(品質調整存活年數)之間,與其他醫療介入方案相比,認知行為治療團體的成本效用比率低於50000美金/QALY,故研究結果顯示,認知行為團體治療方案除了可以提供心理以及生理上的改善之外,亦可提升個案的生活品質,且具備醫療經濟效益,屬於可接受的醫療介入方案。
Purpose: To examine the treatment effects on quality of life and health-economic benefits of the cognitive behavioral group therapy for coronary artery heart disease (CHD) patients. Method: The database collected by the projects supported by the grants from Ministry of Science and Technology(100-2410-H-194-040-MY2) to Chia-Ying Weng. A case control study with matched age, sex and education, based on a two group pre- and post-test design was adopted. The experimental group included 16 CHD patients (mean age = 58.56 ± 6.64; male 75%) who attended a weekly two-and-a-half hour session of cognitive-behavior group intervention program with psycho-education and biofeedback-assistance relaxation training for two months. The control group included 14 CHD patients (mean age = 57.50 ± 9.91; male 78.5%) who did not receive any psychological treatment during these two months. Results and conclusion:The repeated measure of ANOVA showed significant interaction effects and indicated that there were significantly higher reductions of trait anxiety, total hostility(F(1,28) = 13.747; 10.068; p <.05), as well as blood volume amplitude(F(1,23)= 4.64, p <.05), heart rate(F(3,75)= 3.64, p <.05) and respiratory rate (F(1,28)= 5.24, p <.05) in the experimental group than those of the waiting-controlled group. For quality of life, there was significantly progress in the following domains: physical role functioning, bodily pain and mental health (F(1,28) = 8.507; 4.146; 7.162, p <.05). In addition, the experimental group also scored significantly higher on the Health Utilities Index (F(1,28) = 6.417, p <.01) than the control group. For the medical cost considerations, the cost-utility ratio of the cognitive behavioral group therapy is USD 2188.59 to 2407.45 per quality-adjusted life years (QALYs), which is below USD 50,000 per QALYs, and indicates that cognitive-behavioral group therapy not only provides psychological and physiological improvement, but is also a medical intervention program with an acceptable cost-utility ratio.