台灣1997-2011年青光眼治療之長期趨勢

Long-Term Trends in Glaucoma Treatment in Taiwan Between 1997 and 2011

邵儀菁(Yi-Ching Shao)

指導教授 ： 李茂盛

中山醫學大學/醫學院/醫學研究所/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00224

摘要

研究目的:本研究旨在分析1997-2011年台灣青光眼局部製劑及青光眼手術的治療趨勢，探討這十五年藥物的研發及手術的演進，對傳統青光眼局部製劑及手術治療的影響，期能提供臨床醫師治療的參考。
研究方法:本研究採回溯性研究設計，以1997-2011年全民健康保險研究資料庫之門診及住院系統抽樣檔為基礎，分別逐年擷取出所有眼科青光眼門診及住院記錄，再過濾出15年總計24,929筆門診青光眼局部製劑，417筆門診青光眼手術以及1,256筆住院青光眼手術。分析門診青光眼局部製劑藥理成分趨勢與合併藥理作用處方趨勢，以及門診與住院青光眼手術術式的趨勢。以SPSS PC 19.0統計軟體進行描述型統計，及Cochran-Armitage trend test進行推論性趨勢統計。
研究結果:從1997-2011年台灣健保資料庫系統抽樣檔發現，台灣青光眼門診就診診次15年增加114%，門診青光眼局部製劑醫令增加196%。傳統青光眼局部製劑β阻斷劑、擬副交感神經製劑與非選擇性腎上腺促效劑處方率有逐年下降趨勢。1999年起健保給付的新藥前列腺素衍生物、α2腎上腺促效劑及所有複方製劑(除β阻斷劑併擬副交感神經製劑之複方製劑)處方率均上升。前列腺素衍生物處方率於2011年已上升至26.8%，逼近第一位β阻斷劑(29.1%)。新藥中只有碳酸酐酶抑制劑處方率趨勢無顯著變化。每次門診同時處方2種以上青光眼藥理作用處方的診次佔31.1%；而同時處方3種以上的處方率有持續增加的趨勢，至2011年已佔12.9%。門診青光眼手術量穩定，且各類手術趨勢無顯著差異。住院青光眼手術量自1997年127筆降至2011年51筆，其中降壓手術由107筆降至49筆；住院虹膜切開/切除術手術率有減少趨勢。雷射虹膜切開術是主要門診青光眼手術，佔總門診手術86.3%。小樑切除術是主要住院青光眼手術，佔總住院手術70.0%。Ahmed 瓣膜植入術近年來開始施行，無顯著趨勢差異。
結論與建議:台灣新青光眼藥物的給付，提供青光眼患者更多藥物選擇，青光眼局部製劑的處方量逐年增加。合併3種以上藥理分類的藥物治療也有增加的趨勢，但是青光眼降壓手術並沒有增加。可能是藥物提供更好的降壓效果，所以選擇青光眼藥物治療的患者增加。本研究受限於健保資料庫資料內容，無法得知此治療趨勢對台灣青光眼患者預後的影響。未來青光眼治療趨勢應持續觀察。

關鍵字

青光眼 ； 青光眼藥物 ； 青光眼手術 ； 趨勢 ； 健保資料庫

並列摘要

Purpose: To evaluate traditional first-line options and explore newer emerging options of medical and surgical treatment in glaucomatous patients in Taiwan.
Methods: We conducted a longitudinal observational study using systemic sampling data from the National Health Insurance Research Database between 1997 and 2011. Outpatient and inpatient visits which had diagnoses of glaucoma were identified and their claims of topical glaucomatous medicine and glaucomatous operations were collected and analyzed. The trends in the medicine and operations were described in terms of the rates in each year by Cochran-Armitage trend test.
Results: Use of β-blockers and parasympathomimetics decreased, but utilization rates increased substantially for α2-agonists, carbonic anhydrase inhibitors, fixed combination agents, and especially prostaglandin analogs. Thirty-one percentages of prescriptions had 2 or more classes of medication. The rates of 3 or more classes showed a sustained rise. The annual number of outpatient operations for glaucoma was stable in the past 15 years. However, the annual total number of inpatient operations fluctuantly decreased in this time period from 127 to 49. Laser iridotomy was the major outpatient operation. Trabeculectomy was the major inpatient operation. Ahmed valve implants have been performed in the recent years, and their trends need further investigation.
Conclusions: The introduction of multiple new medications has resulted in an increasing amount of glaucoma prescriptions and a change in patterns of medical therapy. The demand of addition of a third or fourth drug increased, but the volume of glaucoma operations did not increased. This might indicated that improvements in medical therapy enable further intraocular pressure reduction. However, this study utilized the claim database; the treatment outcome was not able to be analyzed. The future trends in glaucoma treatment should be kept investigating.

並列關鍵字

glaucoma ； medicine ； operation ； trend ； National Health Insurance Research Database

參考文獻

3. 陳怡菁。(2011)。台灣青光眼盛行率及青光眼局部眼用製劑之處方趨勢研究。高雄醫學大學碩士論文，高雄市。

4. 楊佳靜。(2008)。青光眼量性預防醫學與成本效益評估。台灣大學博士論文，台北市。

1. The AGIS investigators. (2000). The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 130(4), 429-440.

2. Anderson D.R. (2003). Collaborative normal tension glaucoma study. Curr Opin Ophthalmol. 14(2), 86-90.

4. Bateman D.N., Clark R., Azuara-Blanco A., Bain M. and Forrest J. (2001). The impact of new drugs on management of glaucoma in Scotland: Observational study. British Medical Journal. 323, 1401-1402.