- 學位論文
以臺灣健保資料庫分析子宮肌腺症患者之醫療利用與藥物治療概況
The Analysis of Drug Treatment and Utilization of Health Services among Patients with Adenomyosis Using National Health Insurance Research Database
摘要
背景：子宮肌腺症的盛行率與發生率，在國外已有多位學者研究，但在臺灣婦女的盛行率與發生率如何，卻鮮少研究詳盡指出。 目的：本研究使用國家衛生研究院發行的2010年臺灣健保資料庫承保抽樣歸人檔，分析2001年到2011年子宮肌腺症的就醫記錄，做出回溯性的相關研究與統計。 方法：首先定義盛行率的病患，先納入門診或住院的ICD-9-CM (International Classification of Disease, 9th Revision-Clinic Modification) 診斷代碼含“6170＂(子宮肌腺症) 者，接下來進一步納入診斷代碼為“6253＂(經痛) 或“6262＂(經血過多) 者，最後納入18到55歲的女性；在新發生病患的部分，首先定義觀察起始日(index date) ，為每個盛行病患在該年度最早就診紀錄的日期，接下來納入在觀察起始日回溯一年內診斷碼前三碼不含 “617＂者，並將有使用過治療子宮肌腺症藥物的病患排除，最後即為新發生病患人數。藉由統計歷年患有子宮肌腺症的盛行人數與新發生病患人數，將病患就醫紀錄中的醫療資訊，包含健保申報費用、藥物的使用概況等，做描述性的趨勢分析。 結果：分析結果發現，歷年盛行人數都有增加的趨勢，從2001年的223人增加到2011年917人，每千人盛行率可達3.14人，新發生病患也從2002年165人增加到2010年的529人，每千人發生率可達1.81人。在疾病好發年齡的部分，主要為41到45歲的婦女居多。財團法人醫院為民眾最常就診的醫院，其次是私立醫院、私立診所，看診科別主要是婦產科。在藥品使用方面，口服避孕藥與黃體素類是用來治療子宮肌腺症最普遍的藥物，接下來依序為Danazol、Gestrinone等。以承保抽樣歸人檔統計，健保2010年花在治療子宮肌腺症上的健保費用，約為新台幣58萬元，而藥費花在治療子宮肌腺症約為新台幣30萬元。 結論：臺灣18到55歲婦女，其子宮肌腺症盛行率每千人約為3.1人，發生率每千人約為1.8人。若病患有經痛或經血過多的症狀，建議進一步做子宮肌腺症的篩檢。
並列摘要
Background: The prevalence and incidence of adenomyosis were well-studied abroad. However, the same topic in Taiwan was rarely described. Purpose: In this retrospective study, we analyzed the Utilization of Health Services and drug treatment by using National Health Insurance Research Database (NHIRD), published by National Health Research Institutes in 2010. Method: First, the prevalence of adenomyosis patients were included whose diagnosis in ICD-9-CM (International Classification of Disease, 9th Revision-Clinic Modification) codes contained “6170” (adenomyosis). Second, these patients were further included with ICD-9-CM coded “6253” (dysmenorrhea) or “6262” (menorrhagia). We included female patients with age between 18 to 55. The first diagnosis date in the year was defined as each patient’s index date. Washout period was defined as one year prior to index date. The incidence patients were further defined as prevalent patients who did not have diagnosis record in “617”, or never used drugs treated for adenomyosis during washout period. The study estimated the prevalence and incidence of adenomyosis, fee of drug treatment, and utilization of health services. Results: The trend of patients in prevalence and incidence rose from 0.87 to 3.14 per1000 persons during 2001 and 2011. The incidence ascended from 0.63 to 1.81 between 2002 and 2010. Those who in age 41 to 45 were mostly observed, and they mainly visited gynecology. Legal Foundation hospitals were the highest visited hospital type, followed by private hospitals and private clinics. The analysis of drug utility can be shown by different categories. Oral contraceptives and progestins were mostly common used to treat adenomyosis, followed by Danazol、Gestrinone. The average expenditure of adenomyosis treatment was more than NT 0.58 million in 2010, whereas the drug apply amount in out-patients was about NT 0.3 million. Conclusion: The prevalence of adenomyosis was 3.1 per 1000 persons in women who were 41 to 45 years old in Taiwan, and the incidence was 1.8. It is recommended to have further diagnosis when people have dysmenorrhea or menorrhagia in age 41 to 45.
參考文獻
延伸閱讀
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