Longitudinal Analysis for Hepatocellular Carcinoma's Medical Resource Utilization

肝癌患者醫療資源使用長期縱貫分析

黃竫棻(Ching-Fen Huang) ； 洪信嘉(Hsin-Chia Hung)

《醫務管理期刊》 9卷4期 (2008/12) Pp. 243-254

https://doi.org/10.6174/JHM2008.9(4).243

摘要

目的：本研究希望藉由探討肝癌患者醫療費用與存活情形，了解肝癌患者存活率與所耗用醫療費用成本在時間序列上的分布，作爲台灣癌症之醫療成本效益分析研究上的比較。
方法：以全民健康保險資料庫1996年至2002年間，ICD碼爲155之肝癌患者，探討國內肝癌患者在各年度及長期追蹤之醫療耗費情形，並推估五年累積費用與五年累積存活機率，呈現每極救生命之平均醫療費用。
結果：以1997年肝癌患者推估五年累積醫療費用爲台幣219,398元，若以存活年數超過五年者推估，其累積醫療費用爲491,288元；五年整體存活機率爲3076%、20.94%、15.22%、11.29%、9.65%，性別與年齡仍是影響存活機率之重要因子；以五年仍存活個案作爲治療成功者，每極救生命之平均醫療費用2,273,554元，男性與年紀長者仍是花費較高族群。
結論：本研究藉由對全國健保資料費用與存活的分析，了解國內肝癌患者所關切之處置成效與經濟效益問題。在肝癌的成效分析上，以每拯救生命成本比較評量，作爲未來評估預防介入計畫之成本效益的參考。

關鍵字

肝癌 ； 醫療費用 ； 累積存活機率 ； 成效分析 ； 每拯救生命成本

並列摘要

Objective: To present detailed cost estimates for HCC by 1-5 year survival probability and estimates the medical cost per life saved for treating HCC patient, which could offer the policy-maker, provider, and patient an outline for dealing with the HCC in Taiwan.
Methods: The National Health Insurance data includes inpatient and outpatient medical expenditure of 97% insured in Taiwan. Survival analysis and medical expenditure were computed to show 1-5 year survival probability and direct medical cost for HCC patients. Furthermore, we create a ratio to present the relationship between cost and survival estimate in five years as estimation of cost per life saved.
Results: The cumulating cost of direct medical expenditure is NT$ 219,398 for five years. One to five-year survival probability is 30.76%, 20.94%, 15.22%, 11.29%, and 9.65% for the cases of 1997 respectively. The relative risk of male is higher than that of female, and age in ≤45 and ＞65 groups have lower survival probability than ＞45-65 group. The ratio of cost with the probability of survival rate is calculated to present the amount of medical cost per life saved for treating the HCC patient. The total medical expenditure for people to live at least five years may yield to 2, 2273, 554 NT dollars. Both male and ＞65 groups have higher expense in the estimation.
Conclusions: The ratio we suggest can offer the estimation for the cost-effectiveness analysis of the intervention. The cost-effectiveness should be based on sound medical profession rather than driven by financial constraints.

並列關鍵字

HCC ； medical expenditure ； survival probability ； cost-effectiveness ； cost per life saved

參考文獻

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Sherman M.(2005).Hepatocellular carcinoma: epidemiology risk factors, and screening.Semin Liver Dis.25(2),143-154.