使用針刺治療與經濟效益關係之實證醫學文獻評讀

Critical Appraisal of cost and economics effect on Acupuncture treatment

傅彬貴(Fu,Pin-Kuei) ； 林昭庚(Lin, Juang-Geng)

《中華針灸醫學會雜誌》 9期 (2006/12) Pp. 1-11

摘要

目的：本文的目的在選取符合實證醫學較高證據等級—隨機對照實（Randomized Controlled Trial-RCT）的文章作為評讀對象，並探討針刺治療所能帶來的經濟效益。材料與方法：則是以pubmed為資料庫，使用Health Services Research (HSR) Queries為資料庫，鍵入關鍵字為acupuncture，分別選擇以cost及Economics為Category，扣除重複及不符合條件的文獻，最後選出4篇進行評讀。結果：討論針刺治療在偏頭痛的經濟效益文章，其中前兩篇發表在BMJ（SCI 2003 impact factor:7.585），顯示針刺治療慢性頭痛有顯著的療效，能夠改善QAYL，同時只增加一小部分的支出。與英國國家衛生局（NHS）提供的其他各種治療方式相比，相對較具經濟效用。第三篇研究顯示加權上義大利全國民眾罹患無先兆性偏頭痛的年發生率為800,000人次，再以一個人使用針次刺治療和對比使用西藥治療可節省的醫療支出為1,332,000 Italian liras來計算，若使用針刺治療無先兆性偏頭痛，預估一年可以為義大利節省醫療支出約1,000 billion liras。第四篇討論針刺治療加入衛教可降低心絞痛醫療費用的支出，在經濟效益評估指標上，研究團隊以減少住院率及減少在手術率去加權住院及手術所需支出的費用，計算出在拒絕接受手術的病人5年下來每人平均節省31000美元；在願意接受手術的病人則節省了36000美元。結論：針灸這樣的傳統醫藥也能夠透過現代嚴謹的實驗設計，來驗證其臨床療效及經濟效益。在國內以全民健保納入中醫迄今所累積的資料庫、國內擁有足夠數量的合格醫師可執行針灸業務以及國人同胞對中醫藥的高接受度等各方面主客觀條件而言，應可有相對品質的研究成果可以發表。政府部門也應重視傳統醫藥在醫療支出上所帶來的經濟效益。

關鍵字

acupuncture ； cost ； Economics

並列摘要

Introduction: For the purpose of evaluation the economical and cost benefits on treatment with acupuncture, we had selected some articles which used RCT as approach methodology. We appraised the methodology of the paper and summarized the economical and cost effects they presented. Methodology: Search strategy: Pub-med data based searching was started with key words as cost and economics. Criteria with Health Services Research (HSR) Queries, need abstract, published in English was set. Four articles was matched these criteria and was appraised. They included three articles discussed of the treatment and economical effect when acupuncture was using to treatment patients suffered from headache. Another one was about the effect that acupuncture was used in addition to self-care education in the treatment of patients with severe angina pectoris. Data extraction: 2005.11.20 Result: On the aspect of chronic headache, it suggested that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Besides, acupuncture improves health related quality of life at a small additional cost; it is relatively cost effective compared with a number of other interventions provided by the NHS. Expansion of NHS acupuncture services should be considered. Study the using of acupuncture in Italy suggested that the application of acupuncture in the treatment of migraine without aura would allow a saving of the health expenses in Italy of over 1,000 billion liras. On the aspect of addition of acupuncture and self-care education in the treatment of patients with severe angina pectoris, it shows that estimated cost saving during 5 years were $32,000 (U.S.) per patient, mainly due to a 90% reduction in hospitalization and 70% reduction in needed surgery.

並列關鍵字

acupuncture ； cost ； Economics