- 學位論文
缺血性腦中風病患有無接受血栓溶解劑之成本效果分析
Cost-effectiveness Analysis of Recombinant Tissue Plasminogen Activator among Ischemic Stroke Patients
摘要
研究目的 腦血管疾病是全球以及台灣第三大死因，缺血性腦中風是最常見的腦血管疾病，血栓溶解劑證實能改善缺血性腦中風之結果，但亦有潛在併發症。本研究將分析缺血性腦中風患者有無接受血栓溶解劑治療之差異，其研究目的如下： 一、探討台灣地區缺血性腦中風病患有無接受血栓溶解劑治療的人口學特質及臨床特性上之差異。 二、探討缺血性腦中風病患有無接受血栓溶解劑治療之成本差異。 三、探討缺血性腦中風病患有無接受血栓溶解劑治療之效果差異。 四、探討缺血性腦中風病患有無接受血栓溶解劑治療之成本效果分析。 研究方法 本研究採類實驗設計，以缺血性腦中風病患為研究對象，依有無接受血栓溶解劑治療分為兩組，資料來源採回溯性次級資料分析，利用國家衛生研究院之全民健康保險研究資料庫2000年承保抽樣歸人檔，分析自2004年至2012年缺血性腦中風病患的住院及門診就醫資料。使用SPSS for Windows 22統計套裝軟體中文版作為分析的工具，進行描述性統計與推論性統計分析，利用二項對數迴歸分析(Binary logistic regression analysis)，進行傾向分數配對(propensity score matching, PSM) 1:3配對，兩組各取206人及618人，最後以成本效果評估指標針對兩種治療模式進行成本效果分析。 研究結果 經傾向分數配對後之成本分析，有血栓溶解劑治療之醫療總費用(內含血栓溶解劑)多於無血栓溶解劑治療，檢定達顯著差異(P<0.01)。於效果分析中，有血栓溶解劑治療之再次中風次數以及30天再入院次數少於無血栓溶解劑治療，有血栓溶解劑治療之二年存活時間(月)較長，皆達顯著差異(P<0.05)。有血栓溶解劑治療之總醫療費用中，總住院天數和再次中風次數之成本效果比(CER)低於無血栓溶解劑治療，顯示有血栓溶解劑治療為較佳方案；兩種治療方式之遞增成本效果比(ICER)值小於三倍國民生產毛額1,873,365元，皆具成本效果。 結論與建議 缺血性腦中風患者有接受血栓溶解劑治療之醫療總成本較高，但治療後之成本效果分析優於無血栓溶解劑治療。建議有能力治療腦中風患者之醫療機構，對於缺血性腦中風能建立迅速之評估及治療流程，以提升血栓溶解劑施打率；將此結論提供給有關單位作為醫療資源參考，以訂定更合宜的給付標準。
並列摘要
Objectives Cerebrovascular disease is the third leading cause of death globally and Taiwan. Ischemic stroke is the most common cerebrovascular disease. Thrombolytic agent included recombinant tissue plasminogen activator (rt-PA) had be proved to improve outcomes of ischemic stroke, but there are potential complications. The study will analyze the differences between presence and absence of ischemic stroke patients receiving thrombolytic therapy. The purpose of study as follows: Ⅰ. Explore the demographic characteristics and differences in clinical characteristics of ischemic stroke patients whether receiving thrombolytic agents in Taiwan. Ⅱ. Comparing the cost in ischemic stroke patients whether receiving thrombolytic therapy. Ⅲ. Comparing the effectiveness in ischemic stroke patients whether receiving thrombolytic therapy. Ⅳ. Comparing the cost-effectiveness analysis in ischemic stroke patients whether receiving thrombolytic therapy. Methods This study was adopted quasi-experimental design. The subjects were patients with ischemic stroke. According to whether the receiving thrombolytic therapy divided into two groups. Secondary sources of information collected retrospective data analysis. The use of the National Institutes of Health's National Health Insurance Research database 2000 underwriting sampling subsumed archives. To analyze inpatient and outpatient data from 2004 to 2012 from ischemic stroke patients. Using SPSS for Windows 22 statistical software package Chinese edition as a tool for analysis descriptive statistics and inferential statistical analysis. The use of binary logistic regression analysis, propensity score matching (PSM) 1: 3 pairing. 206 and 618 from each of two groups of people. Finally, in order to assess the cost-effectiveness indicators cost-effectiveness analysis for the two treatment modes. Results In costs analysis after propensity score matching, the total cost of medical treatment of thrombolytic agent (containing a thrombolytic agent) is more than none thrombolytic therapy, verification of significant differences (P <0.01).In effect analysis, the number of stroke again and 30-day readmission of thrombolytic treatment are fewer than none thrombolytic therapy. The two years of survival time of thrombolytic therapy group was longer then none thrombolytic therapy group, and revealed significant difference (P <0.05). Among the total medical costs of thrombolytic therapy, the cost-effectiveness ratio (CER) of the total number of days of hospitalization and once again stroke frequency are less than those without thrombolytic therapy, showed thrombolytic therapy is the preferred option. The increments cost-effectiveness ratio (ICER) of two treatments groups are less than three times the GDP NT $1,873,365 yuan, cost-effectiveness respective fields. Conclusions and proposition Ischemic stroke patients have to accept a higher total medical costs of thrombolytic therapy, but the cost of post-treatment analysis is better than no thrombolytic therapy. Recommends that medical institutions have the ability to treat stroke patients, the ischemic stroke can be established for the rapid assessment and treatment process to enhance the thrombolytic agent is administered slugging percentage. The conclusion to the relevant units to provide medical resources as a reference to set more expedient payment standards.