比較混合療法與三合療法在幽門螺旋桿菌第一線藥物之成本效益分析

Hybrid Therapy Versus Triple Therapy in The First Line Treatment of Helicobacter Pylori Infection: A Cost-Effectiveness Analysis

石志安(Chih-An Shih)

指導教授 ： 許弘毅

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(2017年)

摘要

研究背景
幽門螺旋桿菌為引發胃炎、消化性潰瘍及胃癌的主要原因。在發展中國家，感染率甚至高達80%；在台灣，感染率為54%，顯示除菌治療重要性。2005年馬斯垂克專家共識會議建議第一線除菌處方為7至14天療程之三合療法。隨著全球細菌抗藥性菌株增加，三合療法的失敗率在全球許多地區已高達20%以上。因此高除菌率的療法相繼發表問世。2011年由高雄榮總胃腸肝膽科許秉毅教授團隊所研發混合療法有高達97%除菌率。
研究目的
探討比較感染幽門螺旋桿菌導致消化性潰瘍的病患接受三合療法與混合療法的臨床療效及成本效益分析
研究方法
本研究是以回溯性研究方式，來分析全民健康保險研究資料庫中，有關承保抽樣歸人檔之就醫紀錄。研究對象是自2005 ~ 2013年間因消化性潰瘍併幽門螺旋桿菌感染病人，門診初次接受第一線的三合與混合療法治療。在兩種療法除菌後分別追蹤一年間是否接受第二線藥物治療。若無接受二線除菌治療病人，視為除菌成功，並分析兩種療法一年間各項醫療費用，以評估除菌療效及成本效益。
研究結果
本研究自2005年至2013年為止，共納入26,427人次，分為三合療法組26,119人次，混和療法組308人次。經由精確配對後兩組人數分別為1,232及308人，兩組除菌後追蹤一年內之療效分析，混合療法組除菌率為95%，三合療法組除菌率為91%；p值為0.022，有顯著統計學差異。觀察一年，遞增成本效益比為-9,925，混合療法相較於三合療法，有較佳成本效益。
討論與建議
本研究結果顯示混和療法組病人，有較高除菌療效，較低總醫療費用。混合療法相較於三合療法於幽門螺旋桿菌感染病人之有較佳成本效益。建議政府應推廣各醫療院所臨床醫師提升開立混和療法使用率，以提昇整體全民醫療照護品質。

關鍵字

混合療法 ； 三合療法 ； 幽門螺旋桿菌 ； 成本效益

並列摘要

Background
Helicobacter pylori is a major cause to develop gastritis and peptic ulcer, and gastric cancer. The infection rate could be up to 80% in developing countries, and the infection rate in Taiwan is 54%. Therefore, treatment regimens for H. pylori are especially important. According to the Maastricht III Consensus Report in 2005, the first-line treatment to eradicate H. pylori is using triple therapy with a 7- to 14-day course of regimen. Unfortunately, because of the increased resistant in H. pylori, the aforementioned treatment has more than 20% of failure rate across different areas globally. Therefore, new novel therapies for H. pylori with high eradication rate were developed. Specifically, in 2011, the hybrid therapy was developed by Prof. Hsu with his colleagues in shows extremely high eradication rate at 97%.
Aims of this study
This study aimed on comparing the clinical effects and cost-effectiveness between triple and hybrid therapies among a sample with H. pylori-induced peptic ulcer.
Methods
Using a retrospective design, the outpatient records in the Large Health Insurance Dataset (LHID) from the National Health Insurance Research Database (NHIRD) were analyzed. Study subjects were patients who first received first-line triple or hybrid therapy in outpatient because of the H. pylori-induced peptic ulcer between 2005 and 2013. After the two regimens on eradication, we followed up whether they have received second-line medication treatment. A successful eradication was defined if a patient did not receive the second-line treatment. We analyzed the frequency in outpatient and total cost in treatment to evaluate the effects and cost-effectiveness of both therapies.
Results
Between 2005 and 2013, we analyzed 26,427 person-times, including 26,119 on triple therapy and 308 on hybrid therapy. After exact mach, 1,232 and 308 patients were divided, respectively. The one-year follow-up on the eradication rate was 95% in hybrid therapy and 91% in triple therapy (p=0.022), which indicates the significant differences between two therapies. In the first year observation, the incremental cost-effectiveness ratio (ICER) was -9,925. Hybrid therapy indicates better cost-effectiveness.
Conclusion and Suggestion
Our results indicate that patients who received hybrid therapy as compared with those who received triple therapy had better eradication rate in H. pylori and lower cost in treatment regimens. Hybrid therapy outperformed triple therapy in the cost-effectiveness for patients who are infected by H. pylori. We suggested our government promoting the use of hybrid therapy among all the hospitals; thus, the quality of general healthcare can be increased.

並列關鍵字

hybrid therapy ； triple therapy ； Helicobacter pylori ； cost-effectiveness

參考文獻

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