- 學位論文
健保給付連續性血糖監測儀後醫療利用情形
The Medical Utilization of Continuous Glucose Monitoring after Health Insurance Benefits
摘要
研究目的：我國中央健康保險署自106年3月1日開始給付連續血糖監測儀，本篇將以第一型糖尿病患者為對象，針對有無申報健保給付連續性血糖監測儀、患者之併發症發生率、患者門急診健保申報費用等探討糖尿病患者於健保給付連續性血糖監測儀後之醫療利用情形。 研究方法及資料：資料來源為衛生福利部衛生福利資料科學中心2005-2019年Health90_糖尿病主題式資料庫，研究對象為2017年到2019年期間曾就診第一型糖尿病且出生年介於1935-2014年，並分為使用連續性血糖監測儀(CGM，n=1,639)及未使用連續性血糖監測儀(Non-CGM，n=10,285)組別，並針對門診、醫療健保申報費用、門急診就醫次數以混合線性迴歸模型估計組別差異及介入前後不同時間點的效果，並控制人口學、共病症等共變數進行校正；針對糖尿病併發症發生率以Poisson方法估計發生率及其95%信賴區間，並檢定增減率是否達統計顯著意義。並以Time to Event的分析方法，比較兩組併發症發生風險。追蹤自指標日(Index date，CGM首次給付日期)直到發生特定疾病、死亡或研究終點(2019年12月)。並以Cox Proportional Hazard Regression分析，估算Crude及Adjusted Hazard Ratio以及95% 信賴區間。 研究結果：本研究結果發現在醫療總花費上，使用連續性血糖監測儀(CGM)組別及未使用連續性血糖監測儀(Non-CGM)組別之醫療總花費及門診總花費在健保給付連續性血糖監測儀後有上升之趨勢。在指標日前後兩年間，兩組別之急診率及住院率大致呈持平趨勢且無顯著差異。而在併發症的部分，CGM組別大多數併發症發生風險皆較低，其中又以腎病變、心血管疾病及糖尿病酮酸血症明顯較Non-CGM組別低。 結論與建議：建議血糖控制不佳之第一型糖尿病患者應使用連續性血糖監測儀，且健保應持續給付連續性血糖監測儀，以降低第一型糖尿病患者併發症發生率及提高其使用意願。
並列摘要
Objective: On March 1, 2017, the National Health Insurance (NHI) Administration in Taiwan started to pay for Continuous Glucose Monitor (CGM) for individuals with type 1 diabetes. The aim of this study is to explore the Medical Utilization of Continuous Glucose monitoring after Health insurance benefits. Methods: We used data from the Health90_Diabetes Thematic Database 2005-2019, a database managed by the Health and Welfare Information Science Center of the Ministry of Health and Welfare in Taiwan. Individuals diagnosed with type 1 diabetes between 2017 and 2019 and born between 1935 and 2014 were included in the analysis. We dichotomized the study population into two groups: those who had used a continuous glucose monitor (CGM, n = 1,639) and those who had not used a continuous glucose monitor (Non-CGM, n = 10,285). A mixed linear model adjusted for covariates such as demographics and comorbidities was used to estimate the difference in patients’ complication incidence risk and patients’ outpatient and emergency reimbursement claims between the two groups and the pre-post effect of intervention at different time points. Poisson regression was used for estimating the complication risk and 95% confidence interval (95% CI), and we examined whether the reduction rate reached statistical significance in each group (P<0.05). Time-to-event analysis was used to compare the risk of complications between the two groups. Cox proportional hazard regression was used to calculate the crude and adjusted Hazard Ratio and 95% CI. In the analysis, the follow-up period was defined as the index date (the date of the first CGM payment) until the occurrence of a specific disease, death, or the study endpoint (December 2019). Results: There was an increasing trend in total medical expenses and total outpatient expenses in the CGM group and the Non-CGM group after health insurance benefits CGM. In the two years period before and after the index day, the emergency visits rate and hospitalization rate of the two groups were similar, and there was no significant difference between the two groups. While the risk of nephropathy, cardiovascular disease and diabetic keto complications were significantly lower in the CGM group compared to the Non-CGM group, most complications did not reach statistical significance. Conclusion: We suggest that patients diagnosed with type 1 diabetes and with poor blood sugar control use a continuous blood glucose monitor. Moreover, the NHI should continue to pay for CGM to reduce the incidence of complications in patients with type 1 diabetes and increase patients’ willingness to use CGM.