目的:比較兩種過敏性鼻炎(AR)的手術輔助治療─ 雷射下鼻甲成形術(LT)和鼻中膈鼻道成形術(SMP),旨在:1.運用經濟評估比較各術式的效果及效益;2.探討影響效果及效益的主要預後因子。 方法:次級資料分析同組研究。運用全民健保資料庫2001至2004年承保抽樣歸人檔,選出因AR在耳鼻喉科接受LT或SMP者,以術前6或12個月為比較基期,排除術前6或12個月未曾因AR至門診就醫者。篩出符合者之所有AR門診申報記錄,並計算其手術前後各區段之總門診費用及次數。「成本」為手術當次門診或住院之合計金額,「效益」為術後節省的門診費用,「效果」為術後節省的門診次數。其它變項包括「手術」、「性別」、「年齡」、「術前門診費用」,和「術前門診次數」。最後,運用迴歸分析探討影響效果及效益的主要預後因子,並使用經濟評估的方式比較方案間的差異。 結果:若以6個月為區間,共有122位病患(LT 110人; SMP 12 人)。LT平均成本為4571.30元,平均效益成本比(BCR)為0.34,平均成本效果比(CER)為2401.22(元/次);SMP平均成本為23808.33元,平均BCR為0.07,平均CER為10801.84(元/次)。若以12個月為區間,共有109位病患(LT 98人; SMP 11人)。LT平均成本為4635.90元,平均BCR為0.42,平均CER為1889.41(元/次);SMP平均成本為23649.18元,平均BCR為0.09,平均CER為8715.98(元/次)。性別、年齡、術前門診費用、術前門診次數、效益,與效果等在LT和SMP兩組中並無顯著不同。但成本以SMP較高。LT和SMP均能減少術後的AR醫療費用,然而LT相對於SMP有較佳的成本效益比,而且在術後2年的追踪期間內LT同SMP仍維持其效益。術前門診次數是效果的主要預後因子;術前門診費用則是效益的主要預後因子。 結論:長期AR如果藥物治療鼻塞效果不佳,可施行輔助治療手術減輕症狀。若僅有下鼻甲肥厚LT應是首選,其治療過程較舒適、有較佳的成本效益比且持續的效果可逹2年以上。倘若合併有致病性的鼻中膈彎曲,可考慮SMP治療。
Objective: To compare outcomes for laser turbinoplasty (LT) and septomeatoplasty (SMP) for allergic rhinitis (AR). Methods: Secondary analysis was performed of National Health Insurance data from patients with AR who underwent LT or SMP from 2001 to 2004. Outcomes were defined as follows: cost was inpatient or outpatient expenditures for surgery, benefit was saved postoperative outpatient expenditures, effectiveness was the number of postoperative outpatient visits saved. Results: Over 6 months, there were 122 patients: 110 for LT and 12 for SMP. For LT, the average cost, benefit-cost ratio (BCR), and cost-effectiveness ratio (CER) were NT$4571.30, 0.34, and NT$2401.22 per visit, respectively. For SMP, the average cost, BCR, and CER were NT$23808.33, 0.07, and NT$10801.84 per visit, respectively. Over 12 months, there were 109 patients: 98 for LT and 11 for SMP. For LT, the average cost, BCR, and CER were NT$4635.90, 0.42, and NT$1889.41 per visit, respectively. For SMP, the average cost, BCR, and CER were NT$23649.18, 0.09, and NT$8715.98 per visit, respectively. LT provided more appropriate BCR and CER than SMP. Preoperative outpatient visits were the major prognostic determinant for effectiveness. Preoperative outpatient expenditures were the major prognostic determinant for benefit. Conclusions: LT should be considered first to alleviate nasal obstruction refractory to medication if only chronic hypertrophic inferior turbinates are present. However, SMP would be more appropriate if additional pathologic deviation of the nasal septum is observed.