不符健保抗濾過性病毒藥物給付規定之帶狀疱疹患者處方分析

Analysis of the prescribed herpes zoster medications that were not reimbursed by the NHI program

陳淑梅(Shu-Mei Chen)

指導教授 ： 李勇進

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2006年)

摘要

目的: 探討不符健保抗濾過性病毒藥物給付規定之帶狀疱疹患者，其處方用藥、年齡與帶狀疱疹後神經痛之關係及其藥物經濟效益；並分析gabapentin在帶狀疱疹後神經痛之臨床使用。

方法: 以某醫學中心2002至2004年門診電腦系統資料庫中，篩選帶狀疱疹 (ICD-9-CM診斷碼為053) 及其相關併發症診斷碼(053.XX)之患者資料進行回顧性研究分析 (1414人)。經由審閱病歷紀錄，將不符健保抗濾過性病毒藥物給付規定之帶狀疱疹患者，依其有無自購抗濾過性病毒劑治療、處方止痛劑、慢性病、前驅痛、處方gabapentin等，分組進行描述及推論性統計分析。

結果: 由門診1414位因帶狀疱疹相關疾病就診患者中篩選出不符健保抗濾過性病毒藥物給付規定且就醫背景相同之帶狀疱疹患者共416人。研究發現帶狀疱疹後神經痛之發生在是否大於50歲之年齡兩組間有顯著性差異 (p < 0.001)；帶狀疱疹後神經痛之發生，在有無自購使用抗濾過性病毒劑治療兩組間無顯著性差異 (p = 0.123)；自購抗濾過性病毒劑之治療天數 (3.73 ?b 1.32) 與健保給付抗濾過性病毒劑之治療天數 (5.00 ?b 1.53)，兩者間有顯著性差異 (p＜0.001)；而六個月內自購抗濾過性病毒劑治療組藥物花費總額為209,287元 (含抗濾過性病毒劑157,739元)，無抗濾過性病毒劑治療組藥物花費總額為189,406元。帶狀疱疹後神經痛之發生，處方止痛劑者顯著性大於無處方止痛劑者 ( p＜0.006 )。治療帶狀疱疹後神經痛之gabapentin處方，98.27 % 不符合健保藥品給付規定。

結論: 針對未符全民健保抗濾過性病毒劑給付規定之帶狀疱疹患者，年齡大於50歲、發作時較疼痛者其帶狀疱疹後神經痛之發生機會愈大。自購不足治療天數之抗濾過性病毒劑使用並未能有效預防帶狀疱疹後神經痛，且不符合經濟效益。gabapentin 治療帶狀疱疹後神經痛之臨床使用與健保藥品給付規定並不相符。

關鍵字

帶狀疱疹 ； 帶狀疱疹後神經痛 ； 抗濾過性病毒藥物

並列摘要

Purpose:
This study was to investigate pharmacoeconomic effects for those who Herpes-Zoster infected patients were not in compliance with NIH reimbursement regulation, in terms of medication, age and postherpetic neuralgia. The second topic was covered with gabapentin for the treatment of postherpetic neuralgia.

Methodology:
The claims database, which was searched based upon the Herpes zoster disease ICD-9-CM code (053) and its complication syndromes (053.XX), was conducted retrospectively in a medical center from the period of the year 2002 to 2004. Two comparative groups with similar medication background, which were identified from a total of 1414 patients with and without antiviral therapies, prescribed analgesics, prodromal pain and prescribed gabapentin. Those were underwent inferential statistical analysis individually.

Results:
Total of 416 patients using similar medication background were chosen from number of 1414 patients in association with herpes zoster disease. There was statistically significant difference between age older than 50 years old and occurrence of postherpetic neuralgia (p < 0.001). No statistically significant difference of occurrence of postherpetic neuralgia between two distinctive groups of either with or without antiviral treatment (p = 0.123) was noted. Treatment duration between purchased medication (3.73 ?b 1.32) and reimbursed medication (5.00?b 1.53) was different (p＜0.001). The total expenditure for purchased medication group cost NT$ 209,287 (including antiviral treatment of NT$ 157,739) compared to NT$189,406 of therapeutic cost for non-antiviral treatment. There was statistically significant difference of occurrence of postherpetic neuralgia between with prescription of analgesics and without prescription (p＜0.006). The percentage of the prescribed gabapentin medication that was not followed the regulation of the NHI drug payment for postherpetic neuralgia is 98.27 %.

Conclusions:
The study is concluded the chance of occurrence of postherpetic neuralgia is higher among age more above 50 and extreme painful patients. The information is subtracted from patients of non-compliance with NIH reimbursement. The evidence shows no economic benefits among those who have herpes zoster but not reimbursed by the NHI program pay for the extra expense of antiviral therapy in shorter regimen duration. In addition, gabapentin in clinical use for postherpetic neuralgia is not subject to NIH reimbursed program.

並列關鍵字

herpes zoster ； postherpetic neuralgia ； antiviral drug

參考文獻

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