手術治療糖尿病的成本效益

Cost effectiveness of surgical treatment of type 2 diabetes mellitus

于克忠(Ko-Chung Yu)

指導教授 ： 劉恒逸

元智大學/管理學院/管理碩士在職專班/碩士(2011年)

摘要

摘 要

糖尿病為不可逆的慢性疾病，隨著罹病時間增加，造成許多合併症，其死亡率更是一般人的兩倍，隨著生活型態及人口結構的改變導致盛行率不斷上升，WHO估計2030年全世界191個會員國中有3億6千6百萬人罹患糖尿病，盛行率從2.8%上升到4.4%。糖尿病及其合併症會造成病患、家人、醫療系統及國家沉重的經濟負擔，許多研究都在尋找新的有效方式來治療糖尿病。
本研究探討台灣糖尿病全民健保費用使用情形及減重手術治療糖尿病的成效與經濟效應，分析國家衛生研究院提供的2009年全民健康保險資料庫，總醫療費用為486,646,210,083元，其中門診佔總醫療費用67%，住院費用為33%，平均每人使用健保資源21,049元。台灣糖尿病病患共1,453,049人，盛行率為6.28%，費用佔總醫療費用的11%，平均費用為125,828元，為一般民眾的5.97倍。
許多研究顯示減重手術後糖尿病得到的緩解，使病患完全脫離慢性疾病的侵蝕，本研究統計55位南部某區域教學醫院接受減重手術的糖尿病病患，探討減重手術成效及經濟效益，手術成效以身體質量指數、空腹血糖值及醣化血色素做治療指標。手術後一年均有顯著改善，其一年內死亡率為零，手術一年相關平均費用為223,011元，只高於糖尿病傳統治療1.77倍，兩年即可平衡糖尿病傳統治療費用，術後五年每人平均可節省353,259元，雖然需要更多臨床研究證明減重手術根治糖尿病的機轉，本研究顯示減重手術治療糖尿病是有經濟效益的，可發展成新陳代謝手術，提供治療糖尿病有效的策略及選項。於目前健保資源短缺的情況下，建議健保局制定給付單位可積極鼓勵減重手術，將手術納入治療糖尿病給付項目，不但治癒糖尿病更可節省醫療資源。
關鍵詞:糖尿病，減重手術

關鍵字

糖尿病 ； 減重手術

並列摘要

ABSTRACT

Diabetes mellitus is a chronic and irreversible disease, over time diabetes can damage the heart, blood vessels, eyes, kidney and nerves, the death rate is double than normal people.WHO projected the prevalence to be 2.8% in 2000 rise to 4.4% in 2030, The total diabetes patient reach to 366 million in 191 countries，The prevalence increasing duo to life style and demographic change,The diabetes and its complications have heavy impact on patients,families,healthcare system and counties。Many researches try to find the new ways to treat diabetes.
The purpose of this study is to analysis the healthcare costs of diabetes and the cost effectiveness of bariatric surgery in Taiwan, The study calim data from national health research institutes for 2009 whole year database.The total costs of healthcare in Taiwan was NT 486 billion, 67% was used for outpatient care, and 33% for inpatient care, the total cost was NT21, 049 per capita per year. And there were 1,453,049 diabetes patients in 2009. Diabetic prevalence of Taiwan was 6.28%, the direct cost of diabetes was 11% of the total healthcare costs, and was 5.97 times higher than non-diabetes patient.
Many evidences support bariatric surgey induced diabetes remission. We collect 55 patients who had surgery with diabetes from regional teaching hospital, to evaluate safety, effectiveness and cost effectiveness of surgery, all biochemical markers of diabetes have significant improved and no mortality. The mean of surgery treatment and one year follow up cost were NT255, 831, Only 2 years can balance the conventional treatment fee.Even more studies are needed to confirm diabetes remission evidence，It appears surgery is an efficient strategy from economic view duo to saving diabetes related costs,bariatric surgery is effective way for managing diabetes,
Key Words: diabetes, bariatric surgery

並列關鍵字

diabetes ； bariatric surgery

參考文獻

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