肝癌患者醫療成本分析-以某醫學中心患者為例-

楊少萱

指導教授 ： 湯澡薰 ； 洪維河

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2003年)

摘要

自1990年起，癌症即躍升為國人十大死因第一位，肝癌更佔國人癌症死亡的首位。罹患肝癌後，所產生之各種醫療費用及相關支出，皆造成患者及社會沉重的負擔。 本研究為了解國內肝癌患者，在確定診斷且接受長期追蹤治療後的各治療階段直接醫療成本及相關因素。因此針對台灣北區某公立醫學中心在1996-2000年間確診並密集追蹤治療的1014位肝癌患者，蒐集其病人特性及疾病特性資料，並將直接醫療成本（含健保申報及自付費用），區分為治療前期、治療持續期，及臨終期醫療成本，進行肝癌直接醫療成本估算及探討肝癌各治療階段直接醫療成本的相關因素。 研究結果得知治療前期醫療成本，平均值為 213,841元；治療持續期醫療成本，平均值為 142,493元；臨終醫療成本，平均值為 207,026元。並發現治療前期與臨終醫療成本為治療肝癌患者耗費醫療資源的兩大高峰。至於影響治療前期醫療成本的相關因素包括診斷期別越後期（遠端轉移）、治療方式越積極（內外科療法）及併存診斷數越多，治療前期醫療成本越高。但存活期間越長，治療前期醫療成本則越低；至於影響治療持續期醫療成本的相關因素，包括存活期間越長、併存診斷數越多、及治療方式越積極（內外科療法），治療持續期醫療成本越高。但診斷期別越後期（侵犯週邊組織與遠端轉移），治療持續期醫療成本則越低。最後，影響臨終醫療成本的相關因素包括併存診斷數越多，治療持續期醫療成本越高，但存活期間越長，則治療持續期醫療成本越低。 本研究結果得知早期發現肝癌可收醫療成本較低之益。衛生主管機關可參考推行各類可能早期發現肝癌之計畫與活動，例如定期健康檢查、衛生教育及針對高危險群進行肝癌篩檢計畫等，以收早期診斷肝癌之效。

關鍵字

肝癌 ； 治療階段 ； 直接醫療成本

並列摘要

Since 1990, cancer has being the leading cause of death in Taiwan, and Hepatocellular Carcinoma (HCC) is always the leader in death of cancer. Once a person is contracted with HCC, enormous costs of medical care, such as expenditures associated with care, will have tremendous economic impacts on patients and the society. The objective of this study was to estimate the direct medical costs and to explore the costs determinants occurred to the patients with HCC patient in Taiwan. This study employed the data of 1,014 patients with Hepatocellular Carcinoma that were diagnosed from 1996 to 2000 and followed on schedule by a medical center located in north Taiwan. Costs are classified into 3 categories: initial care, continuing care, and terminal care. By pooling data from Hospital Charges file and Insurance Claims file (including ambulatory, emergency, and inpatient care), costs were estimated by the 3 categories, and multiple regression technique was applied to analyze the determinants of costs in each category. The result showed that the average costs of initial care, continuing care, and terminal care were 213,841, 142,493, and 207,026 NT dollars, respectively. Initial care costs and terminal care costs were higher than continuing care costs in treating HCC patients. Stage at diagnosis, type of treatment, number of comorbidity and length of survival are significant factors in determining the level of initial and continuing care costs：both larger number of comorbidity and type of treatment was surgery or medical therapy indicated higher initial care costs and continuing care costs. However, longer length of survival and diagnosis at earlier stage attributed to lower initial care costs but higher continuing care costs. However, only length of survival and number of comorbidity are significantly associated with the level of terminal care costs：smaller number of comorbidity and longer length of survival predicts less terminal costs. The results of this study suggest that substantial costs saving may be achieved if diagnosing HCC patients at early stage. A policy aims at early detection of HCC patients, such as HCC screening programs, may be considered to administered to higher risk groups.

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