長期追蹤結直腸癌患者之療效與醫療資源耗用

研究背景與目的結直腸癌位居十大癌症死因順位之第三名，每十萬人口死亡率自2002年男性的17.23，女性的12.75，上升至2007年男性的17.90，女性的12.81。因此本研究主要目的為追蹤術後五年存活者與死亡者Initial、Continuing、Terminal phase之醫療資源利用。研究方法本研究採回溯性縱貫性研究，研究期間為2001年1月至2008年12月。研究樣本為2001-2003年1%健保資料新確診且「主診斷代碼」為153、154之結直腸癌病患，每位病患皆追蹤五年之療效與醫療資源利用。首先，追蹤積極治療組與未治療組於不同時間點之療效與醫療資源利用；再以手術切除病患追蹤不同時間點之療效；最後，追蹤手術切除病患存活者於Initial、Continuing phase之醫療資源利用，及存活天數大於270天死亡者之Initial、Continuing、Terminal phase之醫療資源利用，與存活天數小於270天死亡者之Terminal phase之醫療資源利用。研究結果未積極治療平均年齡為71.6歲，CCI分數為3.8分，分別高於積極治療的67歲與2.6分。五年存活率分別為34.8%與63.6%，在五年存活率上達顯著關係(P=0.00)。在未累計醫療資源利用部分，積極治療與未積極治療於術後6個月之住院天數、住院費用及總醫療費用達顯著關係(P=0.03、P=0.04、P=0.02)，兩組於術後24個月之總醫療費用達顯著關係(P=0.03)。在累計醫療資源利用部分，積極治療與未積極治療於術後24個月、術後60個月之門診費用達顯著關係(P=0.02、P=0.02)；手術切除病患平均年齡為66.9歲。追蹤至術後五年，存活率為66.0%，五年存活之影響因子為年齡、併發症。當次住院天數之影響因子為性別、診斷位置、當次存活。當次總醫療費用之影響因子為診斷位置、當次存活。追蹤至術後五年存活者於當次、Initial、Continuing phase之總醫療費用分別為102,521元、72,400元、335,774元；存活天數大於270天之死亡者，當次、Initial、Continuing、Terminal phase之總醫療費用分別為142,685元、66,114元、547,107元、359,156元，存活天數小於270天之死亡者總醫療費用為369,053元。結論未治療組因年紀較大本身疾病嚴重度較高，導致當次和往後之累計死亡率皆高於積極治療，此結果也反應在醫療資源利用上。手術切除病患隨著年齡與疾病嚴重度逐年增加，年紀較大者與有併發症者較容易進入死亡的風險。手術切除病患追蹤至五年，存活者術後存活至五年平均總醫療費用為510,695元，死亡者術後五年期間平均總醫療費用為1,124,959元。

關鍵字

結直腸癌；手術；醫療資源利用

並列摘要

Background Colorectal cancer is the third disease of top ten cause of death. The standardized mortality rate of male and female is form 17.23%, 17.90% in 2002 up to 17.90%, 12.81% in 2007 per 100,000 people. Hence, the major purpose of this research is to estimated patients who alive or death medical resource utilization on initial continuing and terminal phase. Method and Materials This research adopts retrospective longitudinal study in term of 2001/1/1-2008/12/31. The research samples are from the 1% CRC group defined by NHI Research Database during 2001/1/1-2003/12/31 and ICD9CM_CODE is 153 or 154, all patient Undergoing follow up 5 years on outcome and utilization. First, tracked patient who received treatment and non-treatment of outcome and medical resource utilization at difference time point. Second, for surgery patients tracked outcome and medical resource utilization at difference time point. Finally, for alive patients tracked medical resource utilization on initial and continuing phase. For death patients who alive≧270 days tracked medical resource utilization on initial, continuing and terminal phase, otherwise, death patients who alive＜270 days tracked medical resource utilization on terminal phase. Result Patients who were not received treatment average age is 71.6 older, CCI score is 3.8 were more than received treatment. The five year survival rate is 34.8% and 63.6%, respectively. In the accumulated medical resource part, 6 months after the surgical phase significance influence length of stay, inpatient cost and total cost. In the accumulated medical resource part, 24 and 60 months after the surgical phase significance influence outpatient cost. Surgery patients average age is 66.9 older. The five year survival rate is 66.0%. Age and complication significance influence mortality rate. Sex diagnosis site and surgery deaths significance influence length of stay. Diagnosis site and surgery deaths significance influence total cost. For alive patients tracked medical resource utilization on surgery、initial and continuing phase is 102,521, 72,400, 335,774, respectively. For death patients who alive≧270 days tracked medical resource utilization on surgery initial continuing and terminal phase is 142,685, 66,114, 547,107, 359,156, respectively. Otherwise, death patients who alive＜270 days tracked medical resource utilization on terminal phase is 369,053. Conclusion Patients who not received treatment are more older and sicker then received treatment, the result also reflect on medical resource utilization. Surgery patients’ age and comorbidity increased by year, they have high risk of death. In the follow up 5 year period, alive patients average total cost is 510,695 dollars, death patients average total cost is 1,124,959 dollars.