罹患高血壓合併高血脂之病人使用單方併用療法與固定複方治療之醫療支出

The Medical Expenditure of Free Combination and Fix dose Combination for Treating Hypertension with Hyperlipidemia

張家源(Chia-Yuan Chang)

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(2013年)

https://doi.org/10.6342/NTU.2013.00470

摘要

研究背景：高血壓、高血脂是心血管疾病的重要危險因子，各國無不致力於對於高血壓及高血脂的預防與治療。
研究目的：本研究目的為了解高血壓合併高血脂之病人單方併用療法或固定複方用藥在心血管相關疾病的控制情形，及其與心血管疾病相關的醫療費用。
研究方法：本研究以國家衛生研究院全民健康保險學術資料庫2005年百萬承保歸人檔為資料來源，選出2005到2010年間有就醫資料者，針對高血壓合併高血脂並使用單方併用藥品與固定複方用藥治療的45歲以上成年人，排除過去心血管病史、資料不全的就診資料，共有15,124人納入研究分析。其中持有單方併用藥品的人數為14,545人，複方用藥的人數有579人。統計方法包括威爾克森符號等級檢定、卡方檢定、Cox Proportional Hazard Regression及Multiple regression analysis。
研究結果：男性、年齡越高者、使用單方併用藥品者、疾病嚴重度低者、在基層醫療院所就醫者，罹患心血管疾病的風險越高。醫療費用方面，男性、年齡低者、單方併用藥品者、藥品持有率越高者、疾病嚴重度越嚴重者、北區、南區、東區健保分局、基層醫療院所以外醫療機構的平均每人每月門診總費用較高。男性、年齡高者、單方併用藥品者、藥品持有率越低者、疾病嚴重度越嚴重、北區、中區、高屏區、東區健保分局、基層醫療院所以外醫療機構的平均每人每月住院費用較高。複方用藥平均追蹤天數1,178天和持有藥品天數1,371天都較單方併用藥品的平均追蹤天數為1,256天和持有藥品天數1,622天少，但發生心血管疾病的每萬人口發生率卻較低。使用單方併用藥品的病人得到心血管疾病風險是複方用藥是得到心血管疾病風險的1.244倍。
研究結論：複方用藥平均追蹤天數和持有藥品天數都較顯著低於單方併用藥品者，但發生心血管疾病的每萬人口發生率卻較低，使用單方併用藥品的病人得到心血管疾病風險是複方用藥是得到心血管疾病風險的1.244倍。單方併用藥品組的門診醫療費用及住院醫療費用皆顯著高於複方用藥組。

關鍵字

單方及複方用藥 ； 高血壓 ； 高血脂 ； 健保資料庫

並列摘要

Background: Hypertension and Hyperlipidemia are the important risk factors of cardiovascular disease. Developed Countries are doing every effort to prevent and treat hypertension and hyperlipidemia.
Objective: To compare the treatment results and expenditure between fix dose combination and free combination treatment of hypertension with hyperlipidemia patients.
Method: The data of this study came from the National Health Insurance database released by the National Health Research Institute. Toally15,124 patients with hypertension and hyperlipidemia were identified. Among them, fix dose combination treatment group has 579 patients while free combination treatment group has 14,545 patients. We used Wilcoxon signed Rank test, Chi-square Test, Cox Proportional Hazard Regression Model and Multiple regression analysis to test the relationship between cardiovascular disease and different treatment to observe result and expenditure.
Results: Being male, older, free combination medicine and the more severity of disease had higher risk of cardiovascular disease. In terms of medical costs, male, free combination treatment, the high medicine coverage rate, severe cases and patients belong to North, Southern, Kaohsiung and Pingtung District Health Insurance Branch or patients in Medical center and Regional hospital and Area hospital had higher outpatient expenditure. Being female, older, free combination group, the low medicines coverage rate, the more severity of disease, patients belong to North, South, Kaohsiung-Pingtung Eastern District Health Insurance Branch or patients in Medical center and Regional hospital and Area hospital had higher hospitalization expenditure. The average follow up days of fix dose group was 1,178 days and 1,371 days medicine days while free combination group was 1,622 days and 1,256 days. But the occurrence rate of cardiovascular disease was lower than free combination group. According to the analysis result of the Cox Proportional Hazard Regression Model, the risk of having cardiovascular disease for patients using free combination medicine was 1.244 times higher compared to fix dose combination group.
Conclusions: The average follow up days and prescription days for the fix dose group were all significantly lower than that of free combination group. However, the risk of having cardiovascular disease was lower for the fix dose group. The outpatient and hospitalization expenditures were significantly higher in the free combinational group.

並列關鍵字

Free combination ； fix dose combination ； hypertension ； hyperlipidemia ； Nation Health Insurance Research Database

參考文獻

丁予安. (2003). 高血脂防治手冊: 國人血脂異常診療及預防指引: 行政院衛生署國民健康局.

文羽苹, 黃旭明, & 江東亮. (2012). 台灣醫療保健支出成長率的分析: 醫療通膨, 質量與公平性. 臺灣公共衛生雜誌, 31(1), 2-11.

王俊雄, 紀櫻珍, 吳振龍, 施奕仲, & 薛亞聖. (2007). 高血壓病患疾病管理之臨床應用. 金山, 3610(35), 15.15.

江東亮. (2002). 台灣醫療保健支出之趨勢. [公衛]. 台灣衛誌, 21(3), 7.

汪秀玲, & 關皚麗. (2011). 健康照護系統中潛在浪費的衡量與國際比較. 臺灣醫學, 15(3), 233-243.