以再手術和醫療資源使用探討亞曼式青光眼引流瓣膜手術適應症之規範

A Discussion of the Indication Standards for Ahmed Glaucoma Valve Implantation from the Perspectives of Reoperation and the Allocation of Medical Resources

洪世明(Shih-Ming Hung) ； 錢慶文(Ching-Wen Chien)

《醫務管理期刊》 13卷3期 (2012/09) Pp. 179-189

https://doi.org/10.6174/JHM2012.13(3).179

摘要

目的：本研究主要以醫療費用之差異來評估健保局對亞曼式青光眼引流瓣膜手術之適應症限制條件放寬之合理性。方法：本研究之資料來源是2003-2006年全民健保學術研究資料庫，用以計算因頑強性青光眼進行傳統青光眼濾孔手術一次及二次手術失敗率及相關之醫療費用。結果：分析全民健保資料庫並進行推估，顯示所有第一次傳統青光眼濾孔手術失敗個案都接受亞曼式青光眼引流瓣膜手術所產生的費用，會比假設所有第一次傳統青光眼濾孔手術失敗後都先接受第二次傳統青光眼濾孔手術，失敗後才再進行亞曼式青光眼引流瓣膜手術，平均每人節省6,267～15,426元。結論：針對本研究之結果顯示健保局的新規定是合理的，放寬限制讓「頑強性青光眼」接受一次傳統青光眼濾孔手術失敗後，就進行亞曼式青光眼引流瓣膜手術，可以提升病患照護品質並減少醫療支出。

關鍵字

青光眼 ； 亞曼式青光眼引流瓣膜手術 ； 適應症

並列摘要

Objective: This study evaluated the rationale behind the relaxation of the Bureau of National Health Insurance restrictions on the indications for Ahmed glaucoma valve implantation in terms of the differences in medical expenditure.Methods: The data for this study came from the 2003-2006 National Health Insurance Research Database. We calculated the failure rates of primary and secondary surgery as well as the relevant medical expenses for patients who underwent traditional glaucoma filtering surgery due to refractory glaucoma.Results: The results showed that if all the patients who failed primary traditional glaucoma filtering surgery directly received Ahmed glaucoma valve implantation, then the medical expense would decrease by 6,267~15,426 NTD per patient on average, when compared with patients w ho received Ahmed glaucoma valve implantation after failing both the traditional primary and secondary glaucoma filtering surgical procedures.Conclusion: The new rules of the Bureau of National Health Insurance are indeed rational. The relaxation of restrictions to allow refractory glaucoma patients who failed traditional primary glaucoma filtering surgery to receive Ahmed glaucoma valve implantation directly could improve the quality of medical care for patients and reduce medical expenses.

並列關鍵字

Glaucoma ； Ahmed Glaucoma Valve Implantation ； Indication

參考文獻

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