小細胞肺癌患者之終身醫療成本分析

研究背景:根據衛生福利部2017年十大癌症死因統計結果顯示，死亡率排名第一為氣管、支氣管和肺癌。肺癌起源於呼吸道上皮細胞，依據組織學可分為兩大類，非小細胞肺癌和小細胞肺癌。小細胞肺癌是一個高度惡性的腫瘤，與非小細胞肺癌的五年存活率16%相比，在小細胞肺癌的存活率，以期別來說，侷限期的五年存活率為10%，而擴散型的兩年存活率僅有4.6%。過去30多年來，小細胞肺癌的治療選擇沒有顯著的變化，新的療法甚少，但是在國內每年小細胞肺癌人數都有增加的趨勢，且伴隨著老年人口增加，未來醫療成本可能會增加。因此本研究希望藉由終身醫療成本之結果，以提供未來新療法成本評估之參考。研究目的: 探討我國目前小細胞肺癌的終身醫療成本。研究方法: 本研究以次級資料進行分析，使用資料來源為國家衛生研究院之「癌症登記處」及「全民健康保險研究資料庫」，資料期間為2011年至2015年，利用Two-part model和Kaplan-Meier sample average估算每月平均醫療成本及終身累積平均醫療總成本。而資料處理及統計分析係利用SAS 9.4版統計軟體進行分析。研究結果: 本研究納入的研究對象共3,415人，分別為侷限期516人及擴散期2,899人。侷限期患者之存活期間的中位數為15.4個月，而擴散期患者則為7.3個月，而且兩組患者的存活達統計上的顯著差異(p = 0.0001)。侷限期患者的終身平均全部總醫療成本為768,688元 (95%信賴區間為705,139元至832,236元)，小細胞肺癌相關的總成本為739,572元(95%信賴區間為657,168元至821,975元)；而擴散期患者的終身平均全部總醫療成本為524,929元 (95%信賴區間為513,218元至536,641元)，小細胞肺癌相關的總成本為496,843元(95%信賴區間為484,479元至509,207元)。結論: 本研究發現侷限期和擴散期之患者都在確診後的三個月之醫療成本為最高峰，後續的費用趨勢漸漸下降趨緩。在終身平均總醫療成本，侷限期患者比擴散期患者多出17萬元至31萬元不等，其可能原因是侷限期患者的存活期間比擴散期患者還要久，也因此治療時間會較長，所累積之醫療成本也較高。

關鍵字

小細胞肺癌；存活分析；終身成本；醫療成本； Two-Part Model ； Kaplan-Meier sample average ； KMSA

並列摘要

Background: In Taiwan, according to the statistics of the top ten causes of cancer deaths by the Ministry of Health and Welfare in 2017, the number one mortality rate is trachea, bronchus and lung cancer. Lung cancer originates from respiratory epithelial cells and can be divided into two major categories based on histology, non-small cell lung cancer and small cell lung cancer (SCLC). Small-cell carcinoma is a type of highly malignant cancer. In terms of stage, the limited stage five-year survival rate is 10% and extensive stage two-year survival rate is only 4.6%. Over the past 30 years, there has been no significant change in treatment options for small cell lung cancer. However, the number of small cell lung cancer in Taiwan is increasing every year, and with the increase in the elderly population, the future medical costs may increase. This study hopes to provide a cost assessment of future new therapies through the results of healthcare costs. Objectives: Lifetime healthcare costs of small cell lung cancer in Taiwan. Methods: We conducted a retrospective study of 3,415 patients enrolled in the Taiwan National Health Insurance database from 2011 to 2015. The two-part model and Kaplan-Meier sample average were used to estimate the average monthly medical cost and lifetime healthcare costs. Results: A total of 3,415 subjects were studied, with limited stage of 516 patients and extensive stage of 2,899 patients. Limited stage of median survival was 15.4 months, and extensive stage was 7.3 months (p=0.0001). The lifetime average total cost of limited stage was NT$768,688 (95% CI: NT$705,139 – NT$832,236), and SCLC-related costs was NT$739,572 (95% CI: NT$657,168 – NT$821,975); in extensive stage, lifetime average total total cost was NT$524,929 (95% CI: NT$513,218 – NT$536,641), and SCLC-related costs was NT$496,843 (95% CI: NT$484,479 – NT$509,207). Conclusion: The limited stage and extensive stage had the highest cost three months after being diagnosed. For the lifetime healthcare costs, the average cost of limited stage patients was much higher than extensive stage. The possible reason is that the survival rate of limited stage patients is better than extensive stage patients.