- 學位論文
2009年台灣H1N1新型流感流行期間之oseltamivir藥物利用研究
Oseltamivir utilization during the 2009 H1N1 influenza pandemic, Taiwan
摘要
2009年3月起，H1N1新型流感病毒從墨西哥與美國開始，散播至全世界造成流感大流行。流感抗病毒藥物被建議使用在所有疑似或確診為流感的病人，特別是容易產生併發症之高危險族群。其中以oseltamivir最廣為被使用。台灣全民健康保險於此波大流行期間給付流感抗原快速篩檢以及oseltamivir藥物。oseltamivir藥物利用，尤其在不同年齡層與地區的差異是重要的議題。此外關於大量使用oseltamivir之效果，藥物安全與抗藥性病毒的問題也引起大眾關注。 本研究利用2009年台灣全民健保資料庫，擷取其中所有開立oseltamivir或流感抗原快速篩檢之處方箋，分析2009 H1N1新型流感流行期間之oseltamivir藥品利用情形，初步分別檢視不同地區，年齡群及醫院別之藥物利用情形，並進一步探討藥物使用與流感病毒快速篩檢陽性率之關係。另針對使用oseltamivir個案，作短期結果(outcome)的初探。 在2009年間，健保資料庫共有1,559,233次流感抗原快篩的處方以及516,772次的oseltamivir處方。大於99.9％的處方是於八月之後開立。Oseltamivir處方量於第48週達到最高，處方量趨勢與流感病毒活動的趨勢相當。就學年齡之兒童開立oseltamivir之比率為最高，其次是青少年以及學齡前兒童。台北區開立oseltamivir的高峰約在第44週，此趨勢早於台灣其他地區。南部地區開立oseltamivir比率則低於北部地區。六成左右的oseltamivir處方是從診所開出。隨著流感病毒陽性率升高，快篩陽性率也隨之升高，最高時達40％。藥物處方量也隨之增高。而隨著流感疫情之下降，快篩處方之次數與其陽性率亦大幅下降。門診處方使用oseltamivir者約有2％之後有住院的紀錄。 整體來說，台灣開立oseltamivir之比率較其他國家為高，分離出oseltamivir抗藥性病毒之比率與其他國家相當，而整體流感死亡率則較低。罹患新型流感而接受oseltamivir治療者絕大多數為18歲以下族群。Oseltamivir開立趨勢與流感病毒活動趨勢大致相符。
並列摘要
Background A global pandemic of novel influenza A/H1N1 emerged from Mexico and US in March 2009. Antiviral medications are recommended to treat suspected or confirmed influenza patients, especially in those with high risk for morbidity and mortality. Influenza rapid test and oseltamivir were paid by National Health Insurance （NHI） and widely used during the influenza pandemic in Taiwan. The trends of prescription in specific age group and geographic difference are of particular interest. Material and Method The study collected all influenza rapid test and oseltamivir prescription from NHI claims database in 2009. Rates of oseltamivir prescription in different age groups and regions are calculated using population data from Taiwan Statistical Yearbook of Interior. The trend of prescription was compared with measures of influenza virus activity from Taiwan Centers for Disease Control. Results There were 1,559,233 influenza rapid test conducted and 516,772 courses of oseltamivir prescriptions from NHI claims database in 2009. Less than 0.1% of oseltamivir were prescribed before August. Both peaks of oseltamivir and rapid test prescriptions were seen in week 48, which were compatible with the trend of influenza virus activity. School-aged children had the highest oseltamivir prescription rate, followed by adolescents and pre-school-aged children. The prescription rate in Taipei region peaked in week 44, which is earlier than other regions. Generally, oseltamivir prescription rate is low in southern Taiwan. Conclusions The trends of influenza rapid test and oseltamivir prescription were closely realted to the level of influenza virus activity. Oseltamivir prescription rate is high among persons aged under 18 years, who are at high risk of 2009 H1N1 influenza infection.
參考文獻
延伸閱讀
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