使用生物標誌物檢測結直腸癌病患術後一年之成本效益分析

Cost-effectiveness For Received Biomarker Exam In Surgical CRC Parients

黃莞智(Wan-Chih Huang)

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班/碩士(2017年)

摘要

研究背景與目的
結直腸癌(Colorectal Cancer，CRC)自民國95年以來已經是所有癌症發生率的第一名，同時也是十大癌症死亡原因的第三名，近年來部份醫院採用生物標誌(Biomarker)做為癌症檢測的方法，但較少有探討Biomarker運用在CRC檢測之成本效果，本研究探討CRC病人術後接受Biomarker檢測結直腸癌病患生活品質之改善趨勢、死亡風險並評估成本效果評估。
研究方法
本研究同時使用回溯性與前瞻性設計，回溯性是以病歷審查摘錄病人臨床資料和醫院費用，前瞻性以健康相關生活品質的問卷，調查樣本為2010年8月1日至2014年10月31日，在某醫學中心被確診為結直腸癌並接受切除手術的病患。研究資料來源為：病歷、醫院費用申報檔、健康相關生活品質問卷。生活品質量表：整體健康相關生活品質(QLQ-C30)、結直腸癌特定癌症治療評估(FACT-C)、焦慮憂鬱量表(HADS)。使用統計軟體SPSS20.0版進行描述性(卡方、獨立樣本T檢定)、迴歸分析(變異數檢定、COX存活分析)，STATA1進行執行廣義估計方程式分析結直腸癌病患成本效果分析。
研究結果
QLQ-C30、FACT-C在術後3個月後皆有顯著性改善，並持續改善至術後一年。控制其他變項後，復發、檢測方式為生活品質的影響因素。整體存活方面，控制其他變項後發現，接受Biomarker及無復發的病患一年後的死亡率較低。成本效果分析分面，經生活品質較正後發現，使用Biomarker檢驗的病患較接受傳統檢測的病患高0.102個Life year，Biomarker檢測較傳統檢測，術後一年每增加一個QALY門診費用會多花936,786元，術後一年每增加一個QALY可節省住院費用1,514,457元，術後一年每增加一個QALY可節省總費用1,041,976元。

結論與建議
兩組結直腸癌檢測病患，在生理與心理健康相關生活品質皆隨治療時間有顯著改善，使用Biomarker檢測在生活品質方面並未與傳統檢測有差異，但因使用Biomarker檢測可以提早偵測腫瘤狀況，在生活品質上某些構面的改善是有影響的。在成本效果部份，將QALYs一併計算進去後，使用Biomarker檢測的病患較傳統檢測的病人更具成本效果，對於臨床管理方面，建議醫療院所針對Biomarker檢測做完善的推廣與宣導以降低病患對於新檢測的恐懼及陌生在，在學術方面，針對不同癌症的重點基因進行區分，進一步探討不同基因檢測出短期、長期之整體成本效果評估，並與其他地區做為討論比較。

關鍵字

結直腸癌 ； 健康相關生活品質 ； 焦慮憂鬱 ； 成本效果 ； Biomarker

並列摘要

Background
Colorectal Cancer (CRC) has been top one of incidence among all cancers since 2006, and ranked third of top ten cancers death in Taiwan. In recent years, hospitals starting to use Biomarker for cancer screening or detection. Fewer studies had explored the cost and effectiveness of Biomarker used in CRC detection. The study aimed to evaluate the improvement of life quality, mortality and cost-effectiveness in surgical CRC patients who had Biomarker test.

Method
The research use retrospective and prospective study design. Patients’ clinical information was abstracted from medical records, health care cost were derived from hospital information system. Health related quality questionnaires were used to collect patients’ life quality.. Study sample are the patients diagnosed with Colorectal Cancer and underwent surgery at a medical center during August 1st, 2010 to October 31st, 2014. Health related quality questionnaire include QLQ-C30, FACT-C, HADS. Chi-square test, independent sample-test, Cox regression analysis were performed by SPSS 20.0 version. Generalized estimating equation analysis and cost-effectiveness were executed by STATA 11.0.

Results
CRC patients had significant improvement three months after surgery in QLQ-C30 and FACT-C, and improvement continued in 6- and 12-month. After controlling covariates, recurrence and detection type are the factors associated health related quality. Patients without recurrence and received Biomarker detection appeared lower 1-year mortality. Patients in Biomarker group gained 0.102 Life year than those in conventional group. Compare with conventional group, Biomarker group patients per QALY gained, cost more NT$ 936,786 in outpatient cost one year after surgery ;However, saved NT$1,514,457 per QALY gained in inpatient cost ,and saved NT$1,041,976 per QALYs for total medical expense one year after surgery.

Conclusion and Suggestion
Both group of Colorectal Cancer patients demonstrated better physical and psychological life quality over time after surgery. Biomarker group appeared cost-effectiveness one year after surgery in inpatient and overall cost. Hospitals and clinicians are suggested to use Biomarker as one of supplemental test if the Biomarker test cost is acceptable to patient.

並列關鍵字

colorectal cancer ； health-related quality of life ； anxiety and depression ； Cost-effectiveness ； Biomarker

參考文獻

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