淋巴癌病患之醫療資源利用與療效之探討

The Study on the Medical Utilization and Clinical Outcome in Patient with Malignant Lymphoma

楊靜宜(Ching-I Yang)

指導教授 ： 張肇松

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(2014年)

摘要

研究目的
根據台灣衛生福利部的統計資料顯示，淋巴癌之發生率及死亡率有逐年上升之趨勢，2011年資料顯示淋巴癌占男女癌症死因的第九位，為所有血液惡性疾病之首。本研究目的主要在探討淋巴癌病患人口學、疾病特性與其醫療資源利用和存活率之相關。
研究方法
本研究設計為回溯性方式之研究設計，資料收集包含三方面:一為病歷回顧(chart review)，收集2006年至2013年間所有淋巴癌病患之人口學特性、疾病特性，醫療處置等相關資料。二為病理報告檔，另一為資訊室申報健保署之住院醫療費用明細及門診醫療費用明細進行資料分析。所得資料將使用SPSS套裝軟體第20.0版處理，以描述性統計分析各個變項。以單因子變異數分析、線性迴歸分析醫療資源利用情形。以Kaplan-Meier存活分析其存活率。
研究結果
有448位淋巴癌病患納入此研究，結果發現淋巴癌病患平均發病年齡為57歲，組織型態以B cell lymphoma為主，有53.3%病患有接受標靶藥物治療。每人平均住院天數為27天、門診次數為57次、總醫療費用為457,460元。其CCI值較高、B型肝炎帶原者、使用標靶藥物、有接受治療者其醫療資源利用較高，而組織型態上則無顯著差異。在存活率方面，結果顯示淋巴癌五年的整體存活率可達60%，女性的存活率明顯比男性高，臨床檢驗數值包含LDH值、β2-Microglobulin值都對淋巴癌病患存活有影響。
結論與建議
本研究結果顯示性別、年齡、癌症分期、LDH值、β2-Microglobulin值、B型肝炎帶原以及IPI score為影響醫療資源利用與存活率主要因子。癌症第四期、LDH值及β2-Microglobulin值較高者、B型肝炎帶原者以及IPI score高者其醫療資源利用較多。Albumin值低於正常值者其醫療資源利用較少。未來可更進一步的研究其相關因果關係。

關鍵字

淋巴癌 ； 醫療資源利用 ； 療效

並列摘要

Purpose
Increasing incidence and mortality by years has been reported in patients with malignant lymphoma according to Taiwan’s Ministry of Health and Welfare statistic, 2011. Malignant lymphoma has been the 9th leading cause of death in Taiwan and the most common cause of death in all hematologic malignancies. The purpose of this study was to investigate the impacting factor of medical utilization and survival in lymphoma patients.
Methods
A retrospective study was performed by chart review between 2006 and 2013. The demography、disease characteristics and treatment were recorded. Medical utilization and cost were retrieved from the reimbursement data from the division of medical information. The data were recorded and statistically analyzed using SPSS version 20.0 software. ANOVA、linear regression analysis were performed to compare the difference among groups. Kaplan-Meier survival analysis was done for survival analysis.
Results
A total of 448 patients with lymphoma with median age was 57 years were enrolled for study. B cell lymphoma account for the major type of lymphoma. 53.3% of patients accepted target treatment. The medical utilization showed a average use of 27 days of hospitalization, 57 times of outpatient visits and total medical cost of 457,460 dollars per person. There was a positive correlation between high CCI level、presence of hepatitis B carrier and using of target therapy and chemotherapy and medical utilization. No signification difference in histological pattern was noted. The 5-years survival rate is 60%, which is longer in female than that of male. The patients’ LDH and β2-Microglobulin level before treatment were significant factors to affecting their survivals.
Conclusion and suggestion
Our results showed sex、cancer stage、LDH and β2-Microglobulin level、chronic hepatitis B carrier affecting the medical utilization and survival rate of patients with lymphoma. Higher medical utilization was noted in patients with stage IV、high level of LDH and β2-Microglobulin、chronic hepatitis B carrier and high IPI score. Age, LDH and β2-Microglobulin level were independent factors to predict patient’s survival. Further study is needed for its causal effect.

並列關鍵字

Lymphoma ； Medical Utilization ； Clinical outcome

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