- 學位論文
腹膜透析與血液透析於末期腎臟疾病治療之成本效益分析與最佳預算分配
Cost-Effectiveness Analysis and Optimal Budget Allocation of Peritoneal Dialysis and Haemodialysis Using in End Stage Renal Disease Treatment
摘要
台灣國人末期腎臟疾病(ESRD)之患者逐年增加，每年新增洗腎患者達八千人，根據台灣腎臟學會統計表示，台灣洗腎病患於2002年首度超越美國，成為世界第一。另外，根據台灣每年死因報告中顯示，腎炎、腎徵候群及腎變性病是國人十大死因第八名，健保支出更是年年高升，根據中央健康保險局之統計數字，健保局一年約需花費300億元台幣於洗腎治療上，此數據為健保局支付單項醫療項目中最大的花費，甚至遠超過於第一死因癌症病患之60億元台幣。雖然ESRD病患人數僅占健保中之0.15%，其所花費之費用竟占健保之7.2%，高居重大傷病第一位，是健保單一給付最高的疾病。由此可知，末期腎臟疾病所需之資源和金錢為社會之極大負擔。 因此，於此篇研究中便探討並研究現在台灣所面臨洗腎狀況之相關議題，提出一馬可夫模式以描述ESRD病況的行進，並分析兩種洗腎方式：血液透析(HD)和腹膜透析(PD)之成本效益，之後，再提出一數學模式以有效分配有限之資金於ESRD病患，並使他們獲得最佳之生命品質調整壽命年(QALYs)，而此模式之目標為將推廣計劃之投資滿足政府所訂定之增加腹膜透析病患比例之目標，並最大化其效益，經由案例分析和敏感度分析之方式，提供政府一未來醫療政策之參考。
並列摘要
End stage renal disease (ESRD) has been a widespread disease in many countries, especially in Taiwan. According to statistics from the Taiwan Society of Nephrology in 2002, Taiwan ranks second globally in the prevalence and also has the highest incidence of ESRD. In addition, although ESRD patients occupy only 0.15% in the whole health insurance in Taiwan, it costs 7.2% (the highest of whole diseases) of the expense of health insurance. In other words, it is known that the resources and money spent in this disease become a huge burden in the society. Hence, this paper examined the cost-effectiveness of ESRD treatment for patients to make them treated with better cost-effectiveness treatment modalities. The Markov-chain model was used to study the influence of substitutive policies on the overall cost-effectiveness of the ESRD treatment program. After analyzing the cost-effectiveness of the treatments, a mathematical model was constructed to allocate the patients to maximize the effectiveness under the limited funds and to achieve their best QALYs (quality-adjusted life-years). The result shows that Peritoneal Dialysis is the treatment with better cost-effectiveness; therefore, various policies in the budget allocation model are constructed to analyze how the policy will change under different parameters by using sensitivity analysis. The method provides the government a reference for promoting popularization program to change patient proportions in the specific treatment.