阻塞型睡眠呼吸中止症患者以正壓呼吸器治療之成本效果分析

Cost-effectiveness Analysis of Continuous Positive Airway Pressure Therapy for Patients with Obstructive Sleep Apnea Syndrome

李國鴻(Gou-Hong Li)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.10137

摘要

研究背景：阻塞型睡眠呼吸中止（Obstructive Sleep Apnea Syndrome，以下簡稱OSAS）是一種常見的疾病，主要是因為上呼吸道在睡眠當中反覆的塌陷所致，進而導致睡眠當中缺氧與睡眠容易中斷，造成一連串的生理反應。目前證實與睡眠呼吸中止症有關的併發症包括車禍意外事件、心肌梗塞、高血壓、中風等，造成社會沉重之經濟負擔。因此如何有效治療阻塞型睡眠呼吸中止症與避免其造成嚴重失能之併發症，便成為一重要課題。
研究目的：以健保局觀點，評估使用正壓呼吸器治療方案與無積極治療方案，對於OSAS病人成本效果。
研究方法：使用馬可夫模式來估計因阻塞型睡眠呼吸中止症所造成各項疾病與其醫療費用，進而評估使用正壓呼吸器與未使用者之差額成本效果比值 (Incremental Cost-Effectiveness Ratio, ICER)。
研究結果：正壓呼吸器治療組相較於不治療組，ICER值為新台幣564,134元，在世界衛生組織建議的ICER閾值內。敏感度分析顯示每年中斷正壓呼吸器治療的百分比對結果的影響最劇，當年中斷治療百分比高於60%，則正壓呼吸器介入之ICER將高於具有成本效果之閾值。
結論：目前台灣的健保制度尚未給付正壓呼吸器，本研究發現相較於不治療，正壓呼吸器是具有成本效果的介入，然中斷正壓呼吸器治療的百分比為影響方案是否具有成本效果的關鍵因素。

關鍵字

阻塞型睡眠呼吸中止症 ； 正壓呼吸器 ； 差額成本效果比值 ； 馬可夫模式 ； 成本效果

並列摘要

Background： Obstructive sleep apnea syndrome is a common disease, and is mainly caused by recurrent collapse of upper airway during sleep, leading to series of physiological changes including hypoxia and easy arousal while sleeping. It’s proved that the complications associated with obstructive sleep apnea syndrome (OSAS) include road traffic accident, myocardial infarction, hypertension and stroke, causing a heavy economical burden to society. It’s an important topic that how to treat obstructive sleep apnea syndrome and prevent the severe complications leading to disability.

Objective：We use the perspective of National Health Institute to evaluate the cost-effectiveness of using continuous positive airway pressure (CPAP) treatment versus no treatment for patients with obstructive sleep apnea syndrome.

Methods：We use Markov model to estimate the cost of disease and complications caused by obstructive sleep apnea syndrome and then evaluate the incremental cost-effectiveness ratio of using CPAP versus no treatment.

Results：The incremental cost-effectiveness ratio (ICER) is 564,134 NTD, within the threshold of WHO recommendation. The sensitivity analysis revealed that the most influential factor is the percentage of patients who ceased to receive CPAP treatment in the next year. When the percentage of patients who ceased to receive CPAP treatment exceeds 70%, the ICER of CPAP treatment versus no treatment will exceed the threshold of WHO recommendation of cost-effectiveness analysis.

Conclusions: Now the CPAP equipment is not paid by National Health Institute in Taiwan and CPAP is a cost-effective intervention in comparison with no treatment. The key factor to influence the result of cost-effectiveness analysis is the percentage of patients who ceased to receive CPAP treatment in the next year.

並列關鍵字

Obstructive sleep apnea syndrome ； continuous positive airway pressure ； incremental cost-effectiveness ratio ； Markov model ； cost-effectiveness

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