乳癌乳房攝影篩檢之成本效果分析

Cost-effectiveness analysis of breast mammography

李日騰(Jih-teng Lee)

指導教授 ： 張永源

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(2016年)

摘要

摘 要
研究目的
一、探討曾接受乳房攝影篩檢與未接受篩檢的成本。
二、探討曾接受乳房攝影篩檢與未接受篩檢的效果。
三、探討曾接受乳房攝影篩檢與未接受篩檢的成本效果遞增成本效果比。

研究方法
本研究為類實驗設計，採用回溯性次級資料分析法，利用健保百萬歸人檔資料庫，採用2010年度百萬全國抽樣歸人檔資料為資料來源，研究對象為2007年1月1日至2012年12月底診斷乳癌、乳房原位癌個案共3047人，將參與此研究的乳癌及乳房原位癌患者分為二組：1.為住院前乳房攝影篩檢患者2.住院前未接受乳房攝影篩檢篩檢患者；分析乳房攝影篩檢在乳癌乳房原位癌病患的成本與效果。本研究利用住院以及門診醫療費用清單明細檔、承保資料檔、重大傷病證明明細檔，串聯檔案及資料處理後，對本研究探討篩檢組及未接受篩檢組的乳癌、乳癌乳房原位癌病患經二項對數回歸分析進行一比一傾向分數配對(propensity score matching, PSM)後進行成本效果分析之比較。研究工具為SPSS 22統計軟體執行統計分析，分為描述性統計(包括平均值、標準差、次級分配及百分比)與推論性統計(包括卡分檢定、t檢定)之統計進行資料分析及驗證假說。最後針對兩組-篩檢組及未篩檢組進行成本與效果分析比較，並計算乳房攝影篩檢之遞增成本效果比(incremental cost effectiveness ratio, ICER) 。

研究結果
(1) 2007-2012年 乳癌以及乳房原位癌患者共3047人，其中篩檢組991人，未篩檢組2056人。經二項對數回歸分析進行一比一傾向分數配對(propensity score matching， PSM)消除年齡及共病差異後後篩檢組991人，未篩檢組991人。
(2) 成本探討，篩檢組總醫療費用為485051.3199點，低於未篩檢組為527512.2977點，相差42460.9778點。F = 3.133， p= .077，未達顯著差異。以年齡分組比較，50-69歲組，篩檢組每人平均總醫療費用為469192.6986元，低於未篩檢組為550999.6967元，F = 8.150，p = .004，50-69歲篩檢組每人平均總醫療費顯著低於未篩檢組。45- 49歲組，篩檢組每人平均總醫療費用為416608.9849元，低於未篩檢組為456911.1550元，F = .871，p = .351未達顯著差異。50-69歲實施乳房攝影篩檢對降低每人平均總醫療費用較為有利。
(3) 效果比較，在診斷原位癌方面，篩檢組原位癌佔13.52%，未篩檢組原位癌佔5.85%，卡方值為33.31 p值:.000，篩檢組原位癌比例顯著多於未篩檢組。以年齡分組比較，50-69歲組，原位癌佔9.44%，篩檢組乳房原位癌佔14.00%未篩檢組原位癌4.86%卡方值為17.091，p=.000 篩檢組原位癌比例顯著多於未篩檢組。45-49歲組，原位癌佔11.78%，篩檢組乳房原位癌佔14.57%未篩檢組原位癌佔9.00% 卡方值為2.981 p值:.084，篩檢組原位癌並無顯著多於未篩檢組，50-69歲實施乳房攝影篩檢對早期診斷出乳房原位癌顯著有利。
結論與建議
本研究結果顯示有乳房攝影篩檢50-69歲之女性無論在乳房原位癌比例、住院中存活率、以及之後醫療資源耗用均顯著優於未篩檢組。同時乳房攝影篩檢在50-69歲之女性效果較45-49歲女性為佳。
建議：以政策制定者角度而言，提供更多資源在提高50-69歲之女性參與乳房攝影篩檢比率較符合成本效果。
關鍵詞：乳房攝影篩檢，成本效果分析，遞增成本效果比(ICER)

關鍵字

乳攝影篩檢 ； 成本效果分析 ； 遞增成本效果比

並列摘要

Abstract
Background
Breast mammography is the standard procedure for breast cancer screening now. Serious of meta-analysis had proved the cost-effectiveness of breast mammography screening in breast cancer-related mortality reduction. Breast mammography screening had been preceded in Taiwan as a breast cancer screening procedure since 2004. To evaluate the cost-effectiveness of the breast mammography program in Taiwan, a single insurance system, we analyzed the cost and effectiveness of breast mammography screening concurrent with incremental cost-effectiveness analysis (ICER).
Method
This is a quasi-experiment design retrospective secondary data analysis study. The longitudinal health insurance database (LHID) 2010 of national health insurance research database (NHIRD) from 2007 to 2012 was acquired. We divided the invasive breast cancer (IBC) patients and the breast ductal carcinoma in situ (DCIS) patients into screening and non-screening groups. IBM statistical product and service solutions (SPSS) 22nd version was adopted as statistic analysis.
Result
There were 3047 IBC and breast DCIS patients detected in 2007 to 2012 LHID.
Cost:
The screening group patients took 485051.3199 standard payment rate (SPR) per patient, which was lesser than the non-screening group patients (527512.2977 SPR) (p=.077) in the entire study population. And the screening group patients in the 50-69-year-old sub-group took 469192.6486 SPR per patient which was significantly lesser than the non–screening group patients’ 550999.6967 SPR (p=.004). But breast mammography screening in the 45-49-year-old group took 416608.9849 SBR per patient which was 40,302.1711 SBR lesser than the non-screening group (p=.351).
Effectiveness:
In the whole study population, the breast DCIS detection rate was 13.52% in the screening group, which was significantly higher than that of the non-screening group (5.84%) (p=.000). Previous detection rate in the 50-69-year-old group was 14.00% versus 4.86 %( p=.000) whereas in the 45-49-year-old group was 14.57% versus 9.00 %( p=.084)
Cost-effectiveness analysis:
The ICER in the 45-49-year-old group was 3358.5 SPR per breast DCIS detection. The ICER in the 50-59-year-old group was 1298.5 SPR per breast DCIS detection, which was 2060 SPR lesser than the 45-49-year-old group.
Conclusion:
Our study demonstrated that breast mammography screening in the 50-69-year-old subgroup was more cost-effectiveness than the 45-49-year-old group in Taiwan.
Key word: Breast mammography screening, cost-effectiveness, incremental cost-effectiveness radial (ICER)

並列關鍵字

Breast mammography screening ； cost-effectiveness ； incremental cost-effectiveness radial (ICER)

參考文獻

英文參考文獻

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