台灣地區帕金森氏病之藥物流行病學研究

中文摘要研究背景：隨著世界各地老年人口不斷增加而造成高齡化社會，使得帕金森氏病的發生率及盛行率也不斷攀升。在美國，帕金森氏病是僅次於阿茲海默症之第二個最常發生於老年人腦神經退化的疾患，65歲以上成人罹患帕金森氏病的盛行率約為1%。在台灣，所有的抗帕金森藥物都在全民健保的給付之下，所以利用健保資料庫來分析此類藥物在全國的使用情形是可行的。研究目的：本研究的目的是利用健保資料庫的門診檔案進行台灣地區帕金森氏病的藥物流行病學分析，包括抗帕金森藥物的處方型態(例如最常被合併處方的藥品種類)。研究方法：本研究是以1997~2003年健保資料庫中0.2%的抽樣比例之門診處方及治療明細檔（CD）和門診處方醫令明細檔（OO）為資料來源，依ICD-9-CM碼332或A-code A221主診斷為帕金森氏病患者，利用SAS 8.2軟體進行疾病流行病學(人口特質)及藥物處方型態與藥費支出之分析。研究結果：帕金森氏病的門診就診率隨著年齡增加而增高，男性的門診就診率高於女性，主要集中在65歲以上年齡層。城市地區的就診率高於鄉下地區。最常見的合併診斷病名為便秘及高血壓。levodopa是最常被處方的抗帕金森藥物，levodopa合併dopamine agonists是耗用金額最多且最常見的抗帕金森藥物合併處方型態。研究結論：本研究台灣地區在帕金森氏病的藥物流行病學研究結果與國外文獻相似，在門診處方型態方面，處方率最高的levodopa始終是帕金森氏病治療的黃金準則。未來的研究方向應著重在神經元保護劑治療的新領域。關鍵字：帕金森氏病、藥物流行病學、健保資料庫。

關鍵字

健保資料庫；帕金森氏病；藥物流行病學

並列摘要

ABSTRACT Background: As the elderly population of the world grows, the incidence and prevalence of Parkinson’s disease(PD) will continue to increase. PD is the second most common neurodegenerative disease after Alzheimer’s disease in the United States where 1% of the population over the age of 65 years have the disorder. Because all anti-Parkinson's drugs are reimbursed under the National Health Insurance program in Taiwan, it is possible to access and analyze nationwide data on the use these drugs. Objectives: The purposes of this study were to research the pharmacoepidemiology of Parkinson's disease in Taiwan using the NHI Research Database (NHIRD) claims for outpatient services. This study included an analysis of the co-prescribing patterns of anti-Parkinson's drugs (i.e. which classes of anti-Parkinson's drugs were most frequently co-prescribed). Methods: This study analyzed 2 sampling files from the years 1997 to 2003, the linked visit(OO) and prescription(CD) files using a sampling ratio of 0.2% from the NHIRD . A person was considered to have Parkinson's disease if database claim contained the ICD-9-CM diagnosis code 332.0. or A code A221.Anti-Parkinson's drugs were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System. Software SAS Version 8.2 was used for data linkage and the analysis of the anti-Parkinson's drugs co- prescriptions, consumption amounts and population characteristics. Results: The outpatient visit rates for PD increased with age and men had higher visit rates for PD than women, with particularly high rates for those aged >=65 years. Urban areas had higher visit rates for PD than rural areas.Constipation and hypertention were most common diagnostic diseases combined with Parkinson's disease. Levodopa was the most frequently prescribed anti- Parkinson's drug. The combination of Levodopa add dopamine agonists was the most frequent co-prescription pattern and accounted for most of the anti- Parkinson's drug consumption. Conclusions: The study results show that the pharmacoepidemiology of Parkinson's disease in Taiwan is consistent with foreign research. Levodopa was the gold standard anti-Parkinson's medication having been included in most coprescription patterns. Further research should focus on neuroprotective therapy. Key words: Parkinson’s disease, pharmacoepidemiology, NHIRD.