生物製劑治療對類風濕性關節炎病人的醫療效果、費用及生活品質之影響

The impact of biological treatment on medical outcomes, cost and life quality in rheumatoid arthritis patients

翁嘉佩(Chia-Pei Weng)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2017年)

摘要

研究目的
本研究是想了解接受不同藥物治療的類風濕性關節炎病人在醫療效果及費用、健康相關生活品質及生產力之差異及影響。
研究方法
本研究同時為前瞻性及回溯性研究，前瞻性研究是以問卷的方式取得病人健康相關生活品質之資料，回溯性研究是以病歷查閱及使用醫院研究資料庫的方式。QUEST_RA問卷，收集類風濕性關節炎病人身體殘疾狀況、生活品質、整體健康狀態及生產力等資料。病歷審查:收集回溯受訪病人之病史、用藥史及疾病活動度之變化。次級資料庫:分析類風濕性關節炎病人之用藥前後一年的醫療費用。統計方法：依照變項屬性採用描述性統計:卡方、獨立T檢定、ANOVA等。推論性統計: Multiple logistic regression、複迴歸等。
研究結果
問卷收案期間，共收234名類風濕性關節炎病人，排除病歷資料不全的病人6名，最後研究樣本為228名類風濕性關節炎病人，有使用生物製劑的病人為116名，無使用生物製劑的病人為112名。
醫療效果，複迴歸結果:使用生物製劑治療的病人最近一次的DAS28比沒有使用生物製劑的病人低0.05(P=0.750)。藥物費用，使用生物製劑的病人一年平均藥費比無使用多369,285元(P<0.001)。健康相關生活品質方面，複迴歸結果:使用生物製劑的病人自覺疼痛程度比無使用低於6.82分(P=0.037)；使用生物製劑的病人HAQ_DI高於無使用0.14分(P=0.094)；使用生物製劑的病人EQ5D比無使用減少0.02分(P=0.463);自覺當天健康狀態，使用生物製劑的病人比無使用高2.55(P=0.314)。工作生產力，有無使用生物製劑的兩組病人其無工作比率分別為45.24%和54.76%，有工作佔率分別為48.05%和51.95%，皆無顯著性差異；對數迴歸分析，工作生產力及家事生產力有無受到影響的病人，兩組無顯著性差異。
結論與建議
本研究結果病人接受生物製劑治療後在醫療效果DAS28明顯降低且持續維持，但未達到低疾病活動度(DAS<3.2)或緩解(DAS<2.6)的達標治療目標。在醫療費用，僅藥物費用有明顯增加。整體而言，疾病活動度能獲得改善，且生活品質及生產力已和無使用生物製劑的病人無顯著差異，生物製劑仍然是有其價值的。建議放寬使用規範在病人病情發展進入重度疾病活動度前(DAS28>5.1)介入治療，將可避免病人因疾病而導致生活品質及生產力降低，甚至不可逆的身體殘疾的風險發生，讓台灣的類風濕性關節炎病人更能達到全球的達標治療目標。

關鍵字

類風濕性關節炎 ； 生物製劑 ； QUEST_RA ； HAQ_DI ； EQ5D ； DAS28

並列摘要

Aim of research
The aim of this research is to analyze the differences of medical outcome, cost , life quality and work productivity(including house work) of patients with Rheumatoid Arthritis(RA) depending on usage of biological or non-biological treatment.
Methodology
This study is both prospective and retrospective .Data were obtained from three different resources-QUEST_RA questionnaire ,chart review and hospital database. QUEST_RA questionnaire was filled by patients and included questions about physical disability ,life quality , general health and work productivity. Chart review was about disease and medical record , and the change of Disease Activity Score by 28 joints(DAS28). The hospital database was used to analyze the medical cost. Statistic tools including Chi- square test, independent T, one-way Anova, Multiple logistic regression and Multiple linear regression were used to compare the data.
Result
During the period of study, a total of 234 RA patients completed the questionnaire, 6 patients without complete medical records were excluded. Finally, a total of 116 RA patients with biological treatment and 112 RA patients without biological treatment were included .
According to Multiple linear regression analysis, biological treatment for patients with RA is more costly in terms of used medicine than non-biological (more than NT369,285, P<0.001). Patients with biological treatment had lower pain score than those without biological treatment(scores’ difference is 6.82,P=0.037). No significant differences were observed between the two groups of patients in terms of the newest DAS28,HAQ-DI,EQ-5D, general health and work productivity.
Conclusion
In general, the disease activity score 28 can be improved, and there is no significant difference between life quality and work productivity of patients depending on the usage of biological or non-biological treatment. Biological treatment is still worth using.

並列關鍵字

Rheumatoid Arthritis ； biologics ； QUEST_RA ； HAQ_DI ； EQ5D ； DAS28

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