肺結核感染高風險群X光巡迴篩檢之醫療經濟效益評估

Medical economic benefit evaluation of chest X-ray tour screening for high-risk group of tuberculosis infection

林澤宏(Tse-Hung Lin)

指導教授 ： 白佳原

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2018年)

摘要

摘要：前言:
臺灣於2006年四月開始實施全台灣的都治計畫，全省發生率每十萬人口63.2人降至2015年每十萬人口45.7人。但是結核病發生率集中於老年人口，是青壯年人口各年齡層發生率2倍以上甚至高達十倍，老年人口生理機能日漸退化、免疫能力下降，以至於潛伏於體內之結核菌伺機發病，造成結核病發生率於越高齡人口則機率越高。加上老年人口行動不便、生活無法自理者、獨居等多重原因，多居住於安養機構，使得此群體屬於傳染性疾病容易爆發的高風險族群，更加突顯出必須執行老年人口全面性結核病篩檢政策的重要性。
研究目的:
本研究旨在了解進行無障礙X光車到點巡迴篩檢各機構住民現有或潛伏結核病情況及所耗費之資源，由每次無障礙X光巡迴車到點篩檢所需消耗之材料、設備折舊及醫療人員費用等成本，作為X光巡迴篩檢之成本分析以評估其醫療經濟效益。
研究方法:
本研究為橫斷面研究（cross-sectional study），以彰化縣內安養機構之住民為對象，統計其老年人口年齡分布狀態及篩檢結核病現況，並針對胸部X光巡迴篩檢以作業基礎成本法進行該行為在各項活動所耗用之醫療資源，依據成本動因、成本庫來分配間接費用以計算成本，並比較執行該計畫所耗用之花費與政府撥款的差異、耗用成本有無含X光巡迴車的折舊費用，以及計算檢驗疑罹患結核病之驗痰三套所耗用點數。
結果:
彰化縣衛生局「106年度彰化縣衛生局胸部X光巡迴篩檢、判讀及追蹤委託服務」案，總計執行56場，其中包括48家機構及8家公司行號或學校。X光巡檢篩檢數3,229人。經醫師複判為異常共1,240人，佔全體受檢者比例為38.40%。安養機構:計2,829人。經醫師複判為異常共1,191人，佔安養機構全體受檢者比例為42.10%。團體接觸者:計400人。經醫師複判為異常共49人，佔團體接觸者全體受檢者比例為12.25%。異常通報數為15個人，最後確診為7人，總計醫院成本為1,428,133元，政府撥款為1,341,344元。每發現一位病人醫院的成本為204,019元，每發現一位病人政府撥款的成本為191,620。
結論:
安養機構之住民肺部X光經醫師複判為異常遠高於團體接觸者全體受檢者，代表這些這些須入住安養之家的年老病人大多不是身體健康的老人，大多有心臟 、肺部、 或曾經肺部有感染留下來的痕跡，此外，安養機構居民篩檢出肺結核的比例還是遠高於一般大眾高，每發現一位病人醫院的成本為204,019元，每發現一位病人政府撥款的成本為191,620。對照以往研究，代表未來要發現一個結核病確診個案的成本只會越來越高，尤其是安養機構之住民，因行動不便，成本更高。對承辦計畫案醫院來說，不管有無含X光巡迴車的折舊費用，兩者的醫院成本都比政府撥款來的高。只要找到一位會傳染的肺結核病人，按健保治療病人花費，影響照護人員或家屬因被感染無法工作減少的收入，最快八年最慢十年，本計畫案的花費可節省的治療費用將超過篩檢費用，達到篩檢的經濟效益，本計劃案一共發現七位確診病人，依發現病人數和此疾病以等比級數的散播速度，本計畫案依照經濟效益評估只要一到兩年就可達到篩檢的經濟效益，可見安養機構之住民肺部X光巡迴篩檢划算又有用

關鍵字

肺結核 ； 胸部X光巡迴篩檢 ； 安養機構 ； 醫療經濟效益評估

並列摘要

Foreword: Since April 2006, Taiwan began to implement the Directly Observed Treatment Short-Course, DOTS Plan. The province's incidence rate dropped from 63.2 per 100,000 population to 45.7 per 100,000 population in 2015. However, the incidence of tuberculosis is concentrated in the elderly population. The elderly have more than twice the incident rate compare with the young and middle-aged population. Sometimes, ten times the incident rate. The physiology of the elderly is deteriorating and the immunity is declining. As a result, the tuberculosis cells that are lurking in the body are waiting for the disease, causing tuberculosis. The incidence is higher in the older population. Coupled with the inconvenience of the elderly, the inability to take care of selves, living alone, and many other reasons, many of them live in nursing home, making this high-risk group are prone to outbreaks. Therefore, this highlight the need to implement comprehensive TB screening for the elderly population.

Research purposes: The purpose of this study is to understand the resources and equipment consumed by the residents of the barrier-free X-ray to point-to-point screening for the residents of each institution, and the materials and equipment required for each X-ray tour by barrier-free X-ray tour. Costs such as depreciation and medical personnel expenses are used as cost analysis for X-ray inspection to assess their medical economic benefits.
Research methods: This study is a cross-sectional study. The population of the elderly in Changhua County is used as a target. The age distribution of the elderly population and the status of screening for tuberculosis are counted, and the basis for chest X-ray screening was been used. The cost method performs the medical resources consumed by the activity in each activity. Then allocate the overhead according to the cost driver and the cost pool to calculate the cost. Finally, compares the difference between the cost of executing the plan and the government budget. This research also count the depreciation charges for X-ray tour vehicles, and the number of medical points (money) spent on the calculation of three sets of tests for suspected tuberculosis.

Result: The Changhua County Health Bureau's "106 Changhua County Health Bureau Chest X-ray roving screening, interpretation and tracking entrusted service" case, a total of 56 screen tours, including 48 institutions and 8 company or schools. The total number of X-ray inspections was 3,229. The number of abnormalities was 1,240 by the physician, accounting for 38.40% of the total subjects. Nursing home: 2,829 people. The total number of abnormalities was 1,191, which was 42.10%. Group contacts: 400 people. The total number of abnormalities was 49, and the proportion of all subjects in the group contact was 12.25%. The number of abnormal notifications was 15 and the final diagnosis was 7 with a total hospital cost of 1,428,133 yuan and a government grant of 1,341,344 yuan. The cost of a hospital for each patient is 204,019 yuan, and the cost of a government grant for each patient is 191,620.yuan

Conclusion:
The X-rays of the residents’ lungs in the nursing home are reconsidered as abnormally higher than all the subjects in the group contact. Most of the elderly patients who are required to stay in the nursing home are not healthy elderly people. Most of them have heart, lung diseases or ever infected in the lungs. In addition, the proportion of screening for tuberculosis in residents of nursing institutions is still much higher than that of the general public. The cost of finding a hospital for each patient is 204,019 yuan. The cost of government funding for patients is 191,620. Compared with previous studies, this means the cost of a confirmed case of tuberculosis will become higher and higher in the future, especially for residents of nursing home, which are more expensive due to inconvenient movements. For the hospitals that plan the project, regardless of the depreciation expenses of the X-ray tour vehicle, the hospital costs of are still higher than this screen plan. As long as you find a tuberculosis patient who is infected, the cost of treating patients according to health insurance, affecting the income of the caregiver or family members who are unable to work due to infection. In no more than eight years, the cost of treatment can be saved will much more than the cost of the project. In did, this screen plan is hold economic benefits.

Finally, In this plan, a total of seven confirmed patients were found. According to the number of patients found and the spread speed of the disease in such proportions, the positive economic benefits could be achieved within two years. It can approve that the X-ray screening plan for residents’ lungs in nursing home is useful.

並列關鍵字

Tuberculosis ； chest X-ray tour screening ； security agencies ； medical economic benefit assessment

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