流感疫苗接種對氣喘病患醫療利用的影響評估

Evaluation of the Effect of Influenza Vaccination on Medical Utilization of the Asthmatic Patients

林基正(Chi-Cheng Lin)

指導教授 ： 張永源

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00001

摘要

目的
本研究是藉由國家衛生研究院健保資料庫的次級資料，統計氣喘病患流行感冒疫苗的接種率，以及分析流行性感冒疫苗接種對氣喘病患醫療利用及費用的影響，以及繼發肺炎的醫療利用及醫療費用影響。
方法
從國衛院健保資料庫的承保抽樣歸人檔第一組，選擇九十和九十一年度，擷取氣喘( 主診斷為ICD-9-CM 493.** )病患的資料，九十、九十一年歸人檔第一組各有42,617人和42,207人，氣喘病患各有1,559人和1,534人，盛行率分別是3.66％和3.63％。從氣喘病患案件分類中，擷取有接種流感疫苗的患者，九十年和九十一年各有179人和190人，接種率分別是11.48%和12.39%。九十年和九十一年氣喘病患各選取有接種流感疫苗的169人和164人，用年齡和性別各選取沒有接種流感疫苗169人和164人做一對一匹配，分為有接種流感疫苗和沒有接種流感疫苗兩組。研究方法以SPSS 10.0 For Windows套裝軟體進行描述性和推論性的統計分析，分析接種後一年，有和沒有接種流感疫苗兩組的氣喘、上呼吸道感染、流行性感冒和肺炎的醫療利用( 門診次數、急診次數、住院天數 )及醫療費用( 門診醫療費用、急診醫療費用、及住院醫療費用 ) 的情形，以及兩組之間有無顯著差別。
結果
有、無接種流感疫苗兩組各有男性167人，女性166人，90年兩組的平均年齡分別是77.60歲和76.88歲，91年兩組的平均年齡分別是77.49歲和77.27歲。一、醫療利用：除了因為氣喘而就醫，有接種者的平均門診次數48.55次，高於沒有接種38.59次外，其餘急診和門診就診次數兩組之間沒有差異。因為氣喘而住院有接種者的住院天數是7.24天，低於沒有接種者15.75天。因流感或肺炎而住院，有接種者的住院天數是10.68天，低於沒有接種22.86天。二、醫療費用：因為氣喘而就醫，有接種者的平均門診費用935.15元低於沒有接種者1033.39元；有接種者的平均急診費用2690.86元，低於沒有接種者3841.64元；有接種者的平均住院費用35387.54元，低於沒有接種者93188.67元。因為肺炎或流感而就醫，有接種者的平均門診的費用477.52元，低於沒有接種者2603.04元；有接種者的平均急診費用是2517.20元，低於沒有接種者15670.67元。以就醫的醫院層級來看，沒有接種者住區域醫院等級以上是住地區教學醫院以下的約為2.28倍，而沒有接種者在區域醫院以上門、急診就醫的是地區教學醫院以下的約為3.25倍。
結論與建議
本研究顯示，有接種流感疫苗的氣喘病患因為氣喘、肺炎和流感而住院的住院天數明顯少於沒有接種者；因為氣喘而就醫的門診、急診、住院費用及因為流感和肺炎而就醫的門診、急診費用都低於沒有接種者。就醫院層級的分析也發現，沒有接種疫苗組至區域醫院層級以上就醫的比地區教學醫院層級以下的多2-4倍，間接推測沒有接種者罹病時的嚴重度較高。綜合上面的結論顯示，流感疫苗確實可以降低氣喘病患的醫療利用和醫療費用，間接推測流感疫苗對氣喘病患有正面效益。本研究因為是健保的次級資料，無法從資料中直接得知病患的嚴重度，有賴以後配合病歷資料及問卷調查，以瞭解嚴重程度的影響。另外本研究只選擇歸人檔第一組做分析，而未分析其他三組，每組的結果是否不同，有賴以後能做更大規模、年齡層更廣及時間更長的研究。

關鍵字

氣喘 ； 流感疫苗 ； 肺炎 ； 醫療利用 ； 醫療費用

並列摘要

This research is to analyze the data retrieved from National Health Insurance Research Database and to evaluate the vaccination rate of influenza among the asthmatic patients. Furthermore, the research is to evaluate whether influenza vaccination results in differences in medical utilization and medical expenditure among asthmatic patients and influenza-related pneumonia.
This is retrospective study and based on the data of asthmatic patients from 2001 to 2002, retrieved from the first group of Registry for beneficiaries from National Health Insurance Research Database. There are 1,559 asthmatic patients in 42,617 patients in this group in 2001 and prevalence rate of asthma is 3.66％.In 2002, there are 1,534 asthmatic patients in 42,207 patients in this group and prevalence rate of asthma is 3.63%. In 2001, 179 patients received influenza vaccination among 1,559 asthmatic patients and vaccination rate is 11.48%. In 2002, 190 patients received influenza vaccination among 1,534 asthmatic patients and vaccination rate is 12.39%. 169 of 179 in 2001 and 164 of 190 in 2002 patients with asthma that received influenza vaccination are enrolled in this research. Another 169 asthmatic patients in 2001 and 164 asthmatic patients in 2002 without influenza vaccination were chosen based on sex and age are serving as matched group. The software of SPSS 10.0 for Windows was used for statistical analysis. The medical utilization ( outpatient visits, emergency visits and days of hospitalization ) and medical expenditure ( outpatient service expenditure, emergency service expenditure and hospitalization service expenditure ) available 1 year after vaccination are analyzed.
Results: There are 167 men and 166 women in the vaccinated group and matched group individually. Mean age of the vaccinated group and matched group are 77.60 and 76.88 in 2001 and 77.49 and 77.27 in 2002. In analysis of medical utilization, the mean OPD visit of asthma in the vaccinated group is 48.55 times and the match group is 38.59 times. This is statistically significant between the two groups. The average hospitalization day caused by asthma in the vaccinated group is 7.24 days and the match group is 15.75 days. The average hospitalization day caused by influenza or pneumonia in the vaccinated group is 10.68 days and the match group is 22.86 days. Both are statistically significant between the two groups. In analysis of medical expenditure, the average OPD expenditure caused by asthma in the vaccinated group is 935.15 NT dollars and the match group is 1033.39 NT dollars. The average emergency expenditure caused by asthma in the vaccinated group is 2690.86 NT dollars and the match group is 3841.64 NT dollars. The average hospitalization expenditure caused by asthma in the vaccinated group is 35387.54 NT dollars and the match group is 93188.67 NT dollars. The average OPD expenditure caused by influenza or pneumonia in the vaccinated group is 477.52 NT dollars and the match group is 2603.04 NT dollars. The average emergency expenditure caused by caused by influenza or pneumonia in vaccinated group is 2517.20 NT dollars and match group is 15670.67 NT dollars. These are all statistically significant between the two groups.
Conclusion: This study shows that the hospitalization day of the vaccinated group is shorter than in the unvaccinated group. The medical expense of OPD visit, emergency visit and hospitalization of the vaccinated are less expensive than the unvaccinated group in asthma, influenza or pneumonia. The unvaccinated group has 2-4 folds of OPD or ER visits and admission to hospital of higher level compared to lower level.

並列關鍵字

Asthma ； Influenza vaccine ； Pneumonia ； Medical utilization ； Medical expenditure

參考文獻

中文部份

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2. 王森德：老人流行性感冒疫苗接種之效能及健康經濟評估─某縣流行性感冒疫苗接種計畫之經驗，國立台灣大學預防醫學研究所碩士論文，2002。

3. 行政院衛生署：氣喘診療指引，2000。

4. 行政院衛生署，中華民國台灣地區全民健保主要疾病就診統計，2001