台灣境內與境外腎臟移植之成本效性分析

Cost effective analysis on domestic and foreign renal transplantation in Taiwan

游淑貞(Shu-Chen Yu)

指導教授 ： 葉玲玲

亞洲大學/健康學院/健康管理研究所/碩士(2009年)

摘要

腎臟移植可以減少洗腎之健康照護花費，亦能延長病患的壽命與提昇生活品質。然因台灣境內等待換腎的病人甚多，因此有些病人則至境外移植腎臟，雖健保不用給付境外移植腎臟手術的費用，但仍負擔術後醫療照護費用。因此本研究以保險人的角度分析境外腎臟移植之成本效性，並與境內腎臟移植者加以比較。
本研究之成本項目及預後結果項目(效性)來源為國家衛生研究院之健保申報資料庫。本研究共有100位境內腎臟移植與249位境外腎臟移植病人。台灣境內與境外腎臟移植後第一年之直接成本分別為356,632元和394,857元，第二年分別為318,230元和391,177元，第三年分別為286,082元和346,416元。
境內與境外腎臟移植第一年病患存活率分別為98％和97.2％，第二年病患存活率分別為98％和95.6％，第三年病患存活率分別為97％和90％。境內與境外腎臟移植第一年移植腎的存活率分別為和96％和83.9％，第二年移植腎的存活率分別為94％和79.1％，第三年移植腎的存活率分別為94％和75.9％。
境內與境外腎臟移植第一年每增加1％的病患存活成本分別為5,339元和14,350元，第二年每增加1％的病患存活成本分別為3,247元和3,385元，第三年每增加1％的病患存活成本分別為2,949元和3,849元。境內與境外腎臟移植第一年每增加1％移植腎的存活成本分別為5,450元和16,625元，境內與境外腎臟移植第二年每增加1％移植腎的存活成本分別為3,385元和4,092元，境內與境外腎臟移植第三年每增加1％移植腎的存活成本分別為3,043元和4,564元。
本研究結論為境外腎臟移植三年的直接成本比境內腎臟移植高，病患存活率和移植腎的存活率比境內腎臟移植低，因此境內腎臟移植比境外腎臟移植者具成本效性。

關鍵字

腎臟移植 ； 成本效性分析 ； 境內與境外

並列摘要

Renal transplants may save the expenditure of dialysis a lot and it can also prolong life and improve quality of life. Many patients with dialysis waiting renal transplants in Taiwan, therefore some patients travel overseas for renal transplants .The health insurance does not pay for the foreign renal transplant surgery, but they must bear the consequent medical expenses on continuous patients care. This research conducts the cost-effectiveness analysis from the health insurer perspective and to compare the foreign and the domestic renal transplants with indirect cost and outcome.
The data source of the cost and outcome were obtained form the National Health Insurance Research Database. The study recruited 100 patients with domestic kidney transplants and 249 patients with foreign kidney transplants. After Taiwan domestic and the foreign kidney transplants, the first year direct cost respectively is NT＄356,632 and NT＄394,857 , the second year respectively is NT＄318,230 and NT＄391,177 , and the third year respectively is NT＄286,082 and NT＄346,416 .
Within the patients survival rate of Taiwan domestic and the foreign kidney transplants, the first year respectively is 98％ and 97.2％, the second year respectively is 98％ and 95.6％ , and the third year respectively is 97％ and 90％. Within the survival rate of grafts in Taiwan domestic and the foreign kidney transplants, the first year respectively is 96％ and 83.9％, the second year respectively is 94％ and 79.1％ , and the third year respectively is 94％ and 75.9％.
Within Taiwan domestic and the foreign kidney transplants the first year to increase 1％ of the survival rate cost respectively NT＄5,339 and NT＄14,350, the second year to increase 1％ of the survival rate cost respectively NT＄3,247 and NT＄3,385, and the third year to increase 1％ of the survival rate cost respectively NT＄2,949 and NT＄3,849. Within Taiwan domestic and the foreign kidney transplants the first year to increase 1％ of the survival rate of graft cost respectively NT＄5,450 and NT＄16,625, the second year to increase 1％ of the survival rate of graft cost respectively NT＄3,385 and NT＄4,092, and the third year to increase 1％ of the survival rate of graft cost respectively NT＄3,043 and NT＄4,564.
This research concludes that three-year direct cost for the foreign kidney transplant is high compared to the domestic kidney transplant. The survival rate and the graft survival rate are low compared to the domestic kidney transplant. In contrast with the foreign kidney transplant, the domestic kidney transplant is cost-effectiveness.

並列關鍵字

renal transplantation ； cost-effectiveness analysis ； domestic and foreign

參考文獻

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