遠距醫療運用在慢性阻塞性肺病治療之成本效果分析-系統性回顧與統合分析

Cost-effectiveness analysis of Telemedicine in the treatment of Chronic Obstructive Pulmonary Disease: Systematic review and Meta-analysis

陳栢崇(Pochung Chen)

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(2019年)

摘要

研究目的: 本研究主要探討遠距醫療的介入在慢性阻塞性肺病的治療上，減少急診與門診就醫費用、減少住院費用、減少總醫療費用及生活品質改善成本效果分析。
研究方法: 本研究所採用的方法是系統性回顧與統合分析，利用關鍵字搜尋11個電子資料庫，再依據Prisma四階段文獻篩選流程及檢核表檢核後為本研究所要進行統合分析的文獻，最後再利用Comprehensive Meta-analysis (CMA)第三版統合分析軟體進行分析。
研究結果: 本研究總共搜尋之相關文獻計2547篇，最後納入統合分析文獻計十一篇，其中包含十篇隨機臨床試驗及一篇世代研究。總共有10,123 位COPD 病患，其中遠距醫療介入組1,843位，對照組8,280位。急診與門診就醫成本的統合分析結果:Z= 2.005, p=.045，有顯著差異；住院成本的統合分析結果: Z= -2.582, p=.01，有顯著差異；總醫療費用的統合分析結果: Z= -0.487, p=.626，無顯著差異；ICER 的比較，各國不一致，其中丹麥的研究ICER為62,417美元(人均GDP為56,307美元)，介於人均國內生產總值的1-3倍，具有成本效果。
結論與建議: 根據本研究結果，遠距醫療的介入在慢性阻塞性肺病的治療上，無法減少急診與門診就醫費用但可以減少住院費用；在減少總醫療費用及生活品質改善成本效果分析上，並不顯著，ICER平均為206,750美元。台灣目前正在積極發展遠距醫療，但仍無這方面的成本效果分析研究，希望此研究能給予國內發展遠距醫療的參考。

關鍵字

慢性阻塞性肺病 ； 遠距醫療 ； 效果分析

並列摘要

Abstract
Objective
This study focuses on the intervention of telemedicine in the treatment of chronic obstructive pulmonary disease, reducing the cost of emergency and outpatient medical treatment, reducing hospitalization costs, reducing total medical costs and improving the quality of life.

Materials and methods
The method used in this study is a systematic review and integrated analysis. It uses keywords to search 11 electronic databases, and then according to the Prisma four-stage literature screening process and checklist, it is necessary for the Institute to conduct an integrated analysis. Literature, and finally use the Comprehensive Meta-analysis (CMA) third edition of the integrated analysis software for analysis.

Results
A total of 2,547 related articles were searched in this study, and the final analysis included 11 articles in the comprehensive analysis, including ten randomized clinical trials and one generational study. There were a total of 10,123 COPD patients, including 1,843 in the telemedicine intervention group and 8,280 in the control group. The results of the integrated analysis of emergency and outpatient medical costs: Z = 2.005, p = .045, significant differences; integrated analysis of hospitalization costs: Z = -2.582, p = .01, significant differences; integrated medical expenses analysis Results: Z = -0.487, p=.626, no significant difference; in ICER comparison, countries are inconsistent, of which Denmark's research ICER is 62,417 US dollars (per capita GDP is 56,307 US dollars), 1-3 per capita GDP times, with cost effectiveness.

Conclusions and recommendations
According to the results of this study, the intervention of telemedicine in the treatment of chronic obstructive pulmonary disease can not reduce the cost of emergency and outpatient treatment but can reduce the cost of hospitalization; in the analysis of the reduction of total medical costs and quality of life improvement costs, Not significant, ICER averages $206,750. Taiwan is currently actively developing telemedicine, but there is still no cost-effect analysis in this area. I hope this research can give reference to the development of telemedicine in Taiwan.

並列關鍵字

COPD ； Telemedicine ； cost-effectiveness analysis

參考文獻

參考文獻

英文部分

Ambrosino, N., Vagheggini, G., Mazzoleni, S., & Vitacca, M. (2016). Telemedicine in chronic obstructive pulmonary disease. Breathe (Sheff), 12(4), 350-356. doi:10.1183/20734735.014616

Cheng SL, Chan MC, Wang CC, et al., COPD in Taiwan: a National Epidemiology Survey. Int J Chron Obstruct Pulmon Dis 2015: 10: 2459-2467

Chan TC, Chiang PH, Su MD, et al., Geographic disparity in chronic obstructive pulmonary disease (COPD) mortality rates among the Taiwan population. PLoS One 2014: 9(5): e98170