- 學位論文
台灣地區社區型肺炎門診抗生素治療處方趨勢及費用分析
Prescribing pattern and cost of antibiotics in treating community-acquired pneumonia in the ambulatory sector in Taiwan
摘要
從2008年起，肺炎已經成為國內十大死因中的第四名。社區型肺炎經驗性抗生素選擇對於病情的發展與治療結果非常的重要，本研究的目的是探討社區型肺炎在門急診的發生率、經驗性抗生素的處方型態、各種經驗性抗生素的治療成效與經驗性抗生素的藥費探討。 本研究採回溯性資料分析，利用健保資料庫兩千年的二十萬人抽樣歸人檔分析其兩千年四月一日至兩千零七年十二月三十一日的就醫資料。病人的納入條件為ICD-9-CM主診斷前三碼中含有481、482.XX-483.XX、485或486 其中一個，若是病人有下列三種情況中的一種或一種以上則予以排除: (1)癌症或洗腎的病人，(2)在九十天內有住院的記錄， (3)三十天內有肺炎診斷。我們將抗生素分為五大類進行處方型態分析、治療成果分析與藥費探討。 在社區型肺炎的總發生率有一個下降的趨勢，從兩千零一年的一千四百二十三(每十萬人年)降至兩千零七年的九百三十一(每十萬人年)(p<0.0001)。處方型態方面，整體而言最常被處方的抗生素依序為巨環黴素(43.0%)、頭孢菌素(27.0%)與青黴素(24.1%)。治療成果方面，巨環黴素與四環黴素有較低的住院率(3.1%與2.8%)，而在急診回診的比率方面，各組間均沒有顯著的差異，此外在門診的回診率方面，我們發現接受巨環黴素治療的病人有較低門診回診率(13.8%)。最後是經驗性抗生素的藥費分析，在這八年的區間，每一經驗性抗生素療程的平均費用有顯著上升的趨勢，從兩千年的一百四十四塊台幣上升至兩千零七年的兩百一十八塊台幣(p<0.0001) 。 在門診就醫的成人社區型肺炎的發生率有下降的趨勢，巨環黴素在五類抗生素中最常被處方給社區型肺炎門診治療的病人。整體而言，巨環黴素類有顯著較低的入院率與門診回診率，此外在這八年間，每一經驗性抗生素療程的平均費用有顯著上升的趨勢。 關鍵字: 社區型肺炎、門急診、藥費、經驗性抗生素、台灣、治療成果、處方型態
並列摘要
Since 2008, pneumonia has become the fourth leading cause of death in Taiwan. Choosing the right empirical antibiotics is really important. The aim of the study was to access the incidence of Community-acquired pneumonia (CAP), the empirical antibiotic prescribing patterns, the treatment outcomes and the cost of empirical antibiotics in Taiwan. This is a retrospective analysis. We use the NHIRD 2000 as our study material to access the claim data from April 1, 2000 to November 31, 2007. Patients who were diagnosed with pneumonia in ambulatory setting (one of the first three diagnostic codes contained 481, 482.XX-483.XX, 485, or 486) would be enrolled. The exclusion criteria are patients having one of the following statements—(1) being hospitalized in previous 90 days, (2) receiving intravenous antibiotic therapy, chemotherapy or hemodialysis in previous 90 days, (3) having CAP diagnosis in previous 30days. The total incidence of CAP in ambulatory setting decreased over time, from 1423 per 100,000 patient-year in 2001 decreased to 931 per 100,000 patient-year in 2007 (p<0.0001).Macrolides (43.0%), cephalosporins (27.0%) and penicillins (24.1%) were most frequently prescribed. Macrolides and tetracyclines recipients had lower admission rate (3.1% and 2.8%), no statistically significant difference between all the five groups was observed in ED visit rate, and lower OPD visit rate was found in macrolides treatment group (13.8%). The empirical antibiotic’s cost per course has increased in the eight years period, from 144 NTD increased to 218 NTD (p<0.0001). In conclusion, the incidence of CAP in ambulatory setting has decreased. Macrolides was the class of antibiotics that most frequently prescribed for CAP patients in outpatient setting. Overall, macrolides showed some benefit on hospital admission and OPD visit rate. Empirical antibiotic’s cost per course has increased in the eight years period. Key words: Community-acquired pneumonia, Taiwan, Prescribing patterns, Treatment outcomes, Cost, Ambulatory setting, Empirical antibiotics