攝護腺癌男性荷爾蒙阻斷治療與男性荷爾蒙阻斷合併放射線治療之成本效果分析之比較

A cost-outcome analysis of androgen deprivation therapy and androgen deprivation therapy combine radiotherapy for locally advanced prostate cancer

王維那(Wei-Na Wang)

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(2011年)

摘要

研究目的
1. 比較男性荷爾蒙阻斷治療與男性荷爾蒙阻斷合併放射線治療之病人特質與就醫醫院特質之差異。
2. 比較男性荷爾蒙阻斷治療與男性荷爾蒙阻斷合併放射線治療之成本差異。
3. 比較男性荷爾蒙阻斷治療與男性荷爾蒙阻斷合併放射線治療之效果差異。
4. 男性荷爾蒙阻斷治療與男性荷爾蒙阻斷合併放射線治療成本效果分析之比較。
研究方法
本研究採回溯性次級資料分析，以1997年1月至2008年12月間診斷為原發性攝護腺癌的
住院及門診病人為基礎，選擇以「男性荷爾蒙阻斷治療」以及「男性荷爾蒙阻斷合併放射線治療」為研究樣本。本研究的資料取得來源，主要來自國家衛生研究院釋出的全民健康保險研究資料庫，分析1997年一月至2008年十二月之門診處方治療明細檔（CD）及住院醫療費用清單明細檔（DD）與醫事機構基本資料檔，採用統計套裝軟體SPSS for Windows 14.0中文版，進行資料處理與分析，根據研究架構及研究假設進行描述性及推論性統計，採用雙尾檢定（two-tailed）其p值設為0.05。利用卡方檢定、獨立樣本t檢定、單因子變異數分析及存活分析進行資料分析與驗證研究假設。

研究結果

研究結果發現，台灣地區攝護腺癌病人執行男性荷爾蒙阻斷治療及男性荷爾蒙阻斷合併放射線治療共有124人，推論的末期攝護腺癌的病人年齡主要分布在大於75歲以上。目前男性荷爾蒙阻斷合併放射線治療的病人以醫學中心為主，又男性荷爾蒙阻斷合併放射線治療台北分局佔50%顯著高於男性荷爾蒙阻斷治療的台北分局別；而男性荷爾蒙阻斷治療則以南區佔30.1﹪，高於男性荷爾蒙阻斷合併放射線治療。再者成本分析部份，兩種治療方式直接成本於兩年及五年的成本有顯著差異，及總直接成本亦達顯著差異，另效果分析發現，效果指標提及發生併發症的次數、存活時間、門診次數及住院日數沒有差異，最後是成本效果分析；兩種治療方式門診次數之成本效果有顯著差異。

結論與建議

整體而言，就病人特質、醫院特質及分局別而言發現，男性荷爾蒙阻斷合併放射線治療方式在台北分局且以醫學中心為主，推估顯示南北區之醫師提供病人選擇治療方式或病人自己選擇的方式有很大的不同。本研究比較男性荷爾蒙阻斷治療及男性荷爾蒙阻斷合併放射線治療之成本、效果及成本效果的差異，發現兩者治療方式的總成本相差約23萬，然在治療效果皆無差異，又成本效果分析發現在門診次數等級平均數；男性荷爾蒙阻斷合併放射線治療多於男性荷爾蒙阻斷治療，統計數據顯示治療效果無差異，又門診次數的成本效果分析結果，其男性荷爾蒙阻斷優於男性荷爾蒙阻斷合併放射線治療方式，再者成本分析結果又顯示治療費用以男性荷爾蒙阻斷治療低於男性荷爾蒙阻斷合併放射線治療。
選擇末期攝護腺癌的治療方式的基本依據為病人本身條件與意願，加上臨床專科醫師的臨床判斷，然而本研究發現隨著治療方式的不同，可能會造成病人在治療成本及門診次數之成本效果的差異，將此結論提供給醫療服務機構、攝護腺癌病人與其家屬討論其行為決策之原則，及建議有關單位可利用本研究之研究數據，作為未來醫療資源分配之參考，以訂定合宜且符合現實需求的給付標準。

關鍵字

攝護腺癌 ； 男性荷爾蒙阻斷治療 ； 放射線治療 ； 成本效果分析

並列摘要

Purpose

1. Comparison of androgen deprivation therapy to androgen deprivation therapy with radiation therapy at the patient characteristics and hospital characteristics of the different medical treatment.
2. Comparison of androgen deprivation therapy to androgen deprivation therapy with radiation therapy at the cost difference.
3. Comparison of combined androgen deprivation therapy and differences in the effect of radiation therapy.
4. Androgen deprivation therapy to androgen deprivation therapy with radiation therapy Comparison of cost-effectiveness analysis

Methods

This study was retrospective secondary data analysis, form January 1997 to December 2008 between the diagnosis of primary prostate cancer patient and outpatient basis, Select the " androgen deprivation therapy "and" androgen deprivation therapy "for the study sample. The sources of this study, Mainly from the National Institutes of Health released the National Health Insurance Research Database, Of January 1997 to December 2008 detailed file of outpatient prescription treatment (CD) and hospital expenses detailed file list (DD) and the basic data file medical institutions, The statistical software package SPSS for Windows 14.0 Chinese, For data processing and analysis, Based on the framework and assumptions descriptive and inferential statistics, Using two-tailed test (two-tailed) of its P value to 0.05. Using chi-square test, independent sample t test, one factor ANOVA and survival analysis for data analysis and verification of hypotheses.

Results

The results showed, Prostate cancer patients in Taiwan to perform a single androgen deprivation therapy and androgen deprivation therapy and radiation therapy at a total of 124, Infer the end of the age of prostate cancer patients are mainly distributed in more than75 years of age. Currently patients androgen deprivation therapy and radiation therapy to the main medical center, And androgen deprivation therapy with radiation therapy 50% of the Taipei branch of androgen deprivation therapy significantly higher than that of a single branch in Taipei do not, The androgen deprivation therapy is 30.1% higher than the area south of androgen deprivation therapy with radiation therapy, Furthermore, Part of cost analysis, Direct costs of two treatments for two years and five years in significant differences, And total direct costs are also significant differences. The other effect analysis, Impact indicators referred to the number of complications, Survival time, outpatient visits and hospital days did not differ. Finally, cost-effectiveness analysis, both treatments may, the cost of outpatient treatment results are significantly different.

Conclusions and suggestions

Overall, for patient characteristics, hospital characteristics, and not in terms of branches found, androgen deprivation therapy with radiation therapy at the Medical Center, Taipei Branch and the main, Estimate shows north-south area treatment patients choose physicians of their choice or the way patients are very different, This study compared the androgen deprivation therapy and radiation therapy and androgen deprivation therapy cost , effectiveness and cost effectiveness of different, Found that both the total cost of treatment difference of about 23 million, However, no difference in treatment, nd cost-effectiveness analysis found that the average level of outpatient visits, androgen deprivation therapy with radiation therapy more than androgen deprivation therapy, Statistics show no difference between treatment. Its better than androgen deprivation therapy and radiation treatment of drug, addition cost analysis also showed that treatment costs less than a androgen deprivation therapy and radiation therapy.
Select the end of the basic treatment for prostate cancer patients based on their conditions and will, Coupled with the clinical diagnosis of clinical specialist, However, this study found that treatment with different patients may cause the number of out-patient treatment costs and cost-effectiveness of different, This conclusion provides medical services, prostate cancer patients and their families to discuss their behavior decision-making principles, and propose that the unit can use the data of this study as a reference for the future allocation of medical resources to provide for appropriate and realistic Demand for payment standards.

並列關鍵字

prostate cancer ； androgen deprivation therapy ； radiotherapy ； cost-effectiveness analysis

參考文獻

第一節 中文部份

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