- 學位論文
南部某醫學中心Augmentin與Cleocin用在吸入性肺炎之藥事費用評估
Cost Evaluation of Augmentin and Cleocin for Aspiration Pneumonia in a Medical Center
摘要
研究背景：全民健保自開辦以來，國民雖然有獲得更進一步的醫療保障，但卻衍生出醫療資源過度使用與費用急遽上漲的問題，因此要如何更有效的運用有限的醫療資源，是非常迫切而且需要探討的課題。到目前為止國內外有關於抗生素治療吸入性肺炎的藥事費用幾無報導。 研究目的：探討Augmentin及Cleocin兩種藥品用來治療吸入性肺炎之治療有效率，並且計算所用抗生素藥品費用及住院費用來評估其藥事費用。 研究方法：本研究為一回溯性研究，某醫學中心從2002年1月至2004年12月的住院病歷中篩選出242筆吸入性肺炎病歷，並按照病患住院時肺炎的情形分成輕、中、重三級。以治療過程抗生素選用考量條件、治療過程醫療指標考量條件依序來評估Augmentin或Cleocin對於吸入性肺炎治療的有效性或無效性。並以統計分析其有效率所用抗生素藥品費用和住院日數是否具有顯著的差異，再推估兩組抗生素在藥事費用上有否優劣。 研究結果：在疾病的各分級之間Augmentin和Cleocin的有效治療率，並沒有統計學上的意義，但若沒有分級，Augmentin和Cleocin的有效治療率是有統計學上的意義，且Augmentin的有效治療率比Cleocin好。以趨勢檢定分析Augmentin和Cleocin對輕、中、重三級的有效治療率趨勢，兩者均有統計學上的意義，P value分別為0.005及0.008。在藥事費用評估上，以統計分析所用抗生素藥品費用和住院日數，進一步計算出有效治療一人之藥事費用，按疾病嚴重度輕、中、重分別在Augmentin組為69,821元; 900,39元; 123,858元，在Cleocin組為78,273元; 113,110元; 300,012元。 結論與建議：本研究建立一種簡易的評估方式來評定抗生素治療吸入性肺炎之藥事費用，而且本研究設定之判斷有效、無效性的方法是可信賴的。醫師如選擇Augmentin或Cleocin來治療吸入性肺炎時，建議盡量考慮選擇Augmentin，如此將是治療有效率且藥事費用較佳的用藥選擇，以一家醫學中心為例，一年推估可節省62萬元。
並列摘要
Background: The implementation of National Health Insurance (NIH) program provides better access to medical services, but it has brought about concerns of overusing medical resources and increasing expenditures. So the NIH program is faced with the problem of increasing costs every year. So far, the cost about the treatment of aspiration pneumonia with antibiotics had not yet been published worldwide. Objective: The study was designed to explore the use of Augmentin or Cleocin for their rates of effective treatment, the cost of antibiotics, average length of stay on aspiration pneumonia and further to calculate their costs of pharmaceutical treatment. Methods: 242 medical records of aspiration pneumonia were extracted from a medical center hospital in south Taiwan, from January 2002 to December 2004 in this retrospective study. Patients when they were admitted to hospital were classified by their conditions as mild, moderate, and severe classifications. The selecting criteria for antibiotics and the results of process were used to determine whether Augmentin and Cleocin had effective treatment. The cost of antibiotics and average length of stay were applied to evaluate whether there were significant differences between two antibiotics by statistical analysis. And the costs of pharmaceutical treatment of two antibiotics were calculated to measure which was economical. Results: Statistically, no significant differences were shown on the rates of effective treatment of different classifications between Augmentin and Cleocin, but it did show significant difference on the rates of effective treatment without classifications between Augmentin and Cleocin. It showed statistically significant differences by trend analysis on the rates of effective treatment of different classifications within Augmentin and Cleocin. The P values of Augmentin and Cleocin were 0.005 and 0.008, respectively. Based on the costs of pharmaceutical treatment, effective costs of pharmaceutical treatment for a person were estimated for mild, moderate, severe classifications as NT$69,821, NT$90,039, NT$123,858 in Augmentin group and NT$78,273, NT$113,110, NT$300,012 in Cleocin group, respectively. Conclusions: A simple evaluation of the cost of pharmaceutical treatment for aspiration pneumonia has established by this study. The criteria for the effective treatment which were set up in this study were reliable. If doctor planned to treat aspiration pneumonia with Augmentin or Cleocin, it was recommended that choice of Augmentin would have better rate of effective treatment and lower cost of pharmaceutical treatment which would be estimated to save about 0.62 million in a medical center in a year.