- 學位論文
比較Levofloxacin與Ciprofloxacin治療對肺炎臨床成效及 醫療資源耗用分析研究
Comparison of clinical efficacy of Levofloxacin and Ciprofloxacin in the treatment of pneumonia Medical resource consumption analysis
摘要
研究目的 本研究旨在探討肺炎患者，使用Levofloxacin與Ciprofloxacin兩種藥物的治療療效(存活率、30天再住院率) 及醫療資源耗用(總住院天數、總藥費、總住院費用) 上的差異。 研究方法 本研究設計是回溯性之次級資料分析，主要資料來源是全民健康保險研究資料庫2005年世代百萬歸人抽樣檔中1997-2013年的DD檔「住院醫療費用清單明細檔」及住院醫療費用醫令清單明細檔（DO），經資料處理後共取得共23,148位之肺炎患者的住院資料; 以Levofloxacin與Ciprofloxacin兩種Fluoroquinolone抗生素為主要分析標的，符合因為感染肺炎的病人有21985筆資料，經篩選後餘4206筆符合研究條件，考量兩組人數比例,以PSM方式做性別,age配對條件配對比例採1:2,其結果為,Levofloxacin共2804 人Ciprofloxacin共1402人，做為本研究樣本。控制變項共分為1人口學變項：性別、年齡2 :醫療機構：醫院層級別及各地健保分局. 3罹病變項: 共病症加權總分;結果變項包括療效(存活率、30天再住院率) 及醫療資源耗用(總住院天數、總藥費、總住院費用) 。本研究以SPSS20.0為統計軟體進行描述性統計及推論性統計，且所有檢定以α=0.05 為信賴水準並定義P值小於0.05為到達統計學上顯著差異。 研究結果 依據年齡、性別、機構、分局與疾病分數別分層分析觀察到,肺炎患者使用Levofloxacin組結果比較於Ciprofloxacin組結果有較低的死亡率(調整後發生率率比0.83，信賴區間0.76到0.90)P值<0.0001；較低的再住院率(調整後發生率率比0.88，信賴區間0.80到0.95)。P值=0.0023。 在醫療耗用上，肺炎患者使用Levofloxacin組相較於Ciprofloxacin組有較低的用藥醫療耗用(調整後勝算比0.49，95%信賴區間0.46到0.52) 可降低肺炎患者0.49倍用藥耗用 (P=<0.0001) ;住院醫療耗用上，Levofloxacin組相較於Ciprofloxacin組可節省0.62倍的住院費用耗用 (調整後勝算比0.62，95%信賴區間0.58到0.66) P = <0.0001。 另外醫療總費用上，可節省0.47倍(調整後勝算比0.47，95%信賴區間0.44到0.51) P = <0.0001。 以上所觀察到兩組藥物在用藥醫療耗用、住院醫療耗用、醫療總費用上都有顯著差異(P = <0.0001)。 結論與建議 本研究發現在肺炎患者，使用Levofloxacin與Ciprofloxacin治療，療效的部分不管是存活率、30天再住院率，Levofloxacin 優於Ciprofloxacin且都有顯著差異，也發現到在醫療耗用方面，包括住院天數、藥費、及總住院費用整個醫事成本節省上皆有統計學上顯著的差異，故本研究結果可提供醫療院所在管理上提供醫療品質與成本上的參考。
並列摘要
Objective The aim of this study was to investigate the effects of 2 different antibiotics, levofloxacin and Ciprofloxacin , on the treatment of pneumonia patients. We first observe whether the demographics, medical institutions facors and medical comorbidities are different between the two groups. Then we compare if medical resource consumption and survival rate are different between the two antibiotics groups Methods: The study used a sub-dataset in 1 million randomly sampled subjects derived from the National Health Insurance Research Database to get 4,206 pneumonia patients treated by Levofloxacin and Ciprofloxacin 1997-2013. We randomly matched these two groups 1:2 by age, gender and propensity scores. Finally we got Levofloxacin cases totalled 2,804, and Ciprofloxacin being 1,402 as a sample of this study.The outcome measurement include medical resources consumption and quality of care, that is survival rate and 30-day readmission rates. In this study, SPSS20.0 was used as statistical software for descriptive statistics and deductive statistics, and all tests achieved a statistically significant difference with α=0.05 as the trust level and P value less than 0.05. Results: The use of Levofloxacin in patients with pneumonia compared with the use of Ciprofloxacin has lower risk of death based on age, gender, institution, sub-segment and disease score stratification analysis as well as a higher survival rate compared to Ciprofloxacin (adjustment) in patients with pneumonia. The post-incidence rate ratio was 0.83, the confidence interval was 0.76 to 0.90), and lower hospitalization rate was found (adjusted incidence rate ratio was 0.88, and the confidence interval was 0.80 to 0.95). The drug consumption of Levofloxacin in patients with pneumonia was 0.49 times lower than that of Ciprofloxacin (adjusted odds ratio 0.49, 95% confidence interval 0.46 to 0.52) (P=<0.0001), and for hospitalization medical consumption (day), Levofloxacin's situation compared to Ciprofloxacin could save 0.62 times the cost (adjusted odds ratio 0.62, 95% confidence interval 0.58 to 0.66). Overall, for total medical expenses, savings were 0.47 times the cost (adjusted odds ratio 0.47, 95% confidence interval 0.44 to 0.51P = <0.0001), with significant differences in medical expenditure, hospitalization costs, and total medical expenses observed as above (P = <0.0001). Conclusion: Based on the results of this study, Levofloxacin was superior to Ciprofloxacin in the medical resources consumption and survival rate significantly. It can provide a reference for the medical cost and quality of care of medical institutions. Keywords: pneumonia, Fluoroquinolones, comorbidity, medical resource consumption, survival analysis