末期腎臟病之文獻計量初探

近年來接受腎臟替代療法的末期腎臟病患數在世界先進國家都快速增加，形成各國醫療支出之重擔。而關於末期腎臟病之研究，各國皆有針對不同主題介入作研究；台灣之末期腎臟病高盛行率與發生率及其所帶來的每年健保透析費用的龐大支出，對台灣社會以及醫療有其重要意涵，若能針對全球末期腎臟病的研究趨勢予以分析，應可提供國內相關領域研究者參考，探討對國際社會有意義之台灣經驗。本研究使用文獻計量的方式來搜尋SCIE資料庫中世界各國對於末期腎臟病相關發表文獻研究，進而加以分析其中關於成本議題之重要發展方向，並整理該文獻所使用之研究方法。再從此中利用摘要、主題與關鍵字搜尋與成本相關之研究，逐一確認是否針對末期腎臟病與成本所做之研究。結果為在1991-2006年間，完全符合本研究立意之末期腎臟病成本相關研究共有82篇，逐一分類後得出各類主題於各年度的發表數量。研究結果發現，其中以1.腎臟替代療法間、2.血液透析場所、3.紅血球生成素與4.高血壓心臟衰竭用藥等介入所作的成本經濟評估就共49篇佔總量近60%；而與器官移植相關介入ESRD成本效果的主題較為分散，其他支付制度相關、腹膜透析相關、院內感染相關、糖尿病合併相關與其他零星主題等介入ESRD成本議題研究所佔篇數不高，無法成為ESRD成本相關研究主題之主流探討。趨勢結果呈現，未來國內關於ESRD成本相關研究可對國內適用之不同透析方式作成本效果分析(CEA)，並可更深入評估不同透析方式病患之總醫療費用；若將腎臟移植與各透析方式作經濟評估時，則可考慮使用成本效用分析(CUA)。在相關藥物對ESRD成本影響之研究，紅血球生成素之研究呈現飽和狀態，故可思考ESRD併發症其他治療藥物(如VitaminD對腎骨病變治療預防等)之影響，以及近期較受重視高血壓用藥減緩糖尿病腎病變患者進入末期腎臟病之預防成本效益分析，提供政策參考。在本研究中，瞭解文獻計量學之限制，建議未來使用此方法評估研究績效需更保守，且仍需由其他ESRD臨床研究發掘出具前瞻意義之方向。

關鍵字

末期腎臟病；文獻計量；經濟評估；成本效果；成本效用；成本分析

並列摘要

Recently the End-Stage renal disease (ESRD)patients who accept the Renal Replacement Therapy have increased quickly in advanced countries, and then such the countries have burdened the huge medical expenditure. There are many different topics intervene the ESRD researches in these countries. However, the high prevalence and incidence of ESRD and high dialysis expenditure of Taiwan, there are important implications to Taiwan and medical treatment, so if we analyze the global trend of the ESRD related research, maybe we could provide the result to the researchers in domestic, discussed the Taiwan’s experience which is meaningful to the international . We searched about the global ESRD related literatures by Bibliometrics method in the SCIE database, and found the cost-related researches by using abstract, topic and keayword, analyzed every layer, and then studied the major developing trend and sorted methods of these literatures about cost evaluation. There are 82 literatures during 1991-2006 which are conformed completely to our study’s purpose, and we sort out all kinds of intervention and quantities in every year in these literatures one by one. We find that 1.comparing in the renal replacement therapies, 2.comparing hemodialysis places, 3.EPO and 4.antihypertensive drugs are take turns the four dominant interventions, and these literatures quantity is approaching 60% of our ESRD economic evaluation database. And the interventions about organ transplantation are scatter, others such like reimbursement related, peritoneal dialysis related, nosocomial infection related, diabetic comorbided with ESRD related and other fragmentary topics intervening ESRD economic evaluations researches are infrequent and could not become the trend. The result of trend shows that we could analyze the cost-effectiveness in the different applicative dialysis ways in domestic about the ESRD cost-related domain in the future, and evaluate the total medical costs of these patients of different dialysis ways. And if the renal-transplantation is joined with to be compared, we could use the cost-utility analysis. The researches about how drugs-related impacting on the ESRD cost, the EPO-related research has been during the period of recession. And then we could think about the effect of other ESRD complication drugs on cost, such likes Vitamin D could prevent the ESRD) ,and analyze the cost effectiveness of antihypertensive-drugs be valued recently which could slow down the diabetes pre-ESRD patients into ESRD affect cost to provide for the policy. In our study, we understand the limits of Bibliometrics method, and suggest that you have to be prudent when using such the method to evaluate a research performance, and find the meaningful direction by other ESRD clinical researches.

並列關鍵字

End-Stage renal disease (ESRD) ； Bibliometrics ； economics evaluation ； cost effectiveness ； cost utility ； cost analysis

參考文獻

Alexander, C.M., Lyle, P.A., Keane, W.F., Carides, G.W., Zhang, Z.X. and Shahinfar, S. (2004), Losartan and the United States costs of end-stage renal disease by baseline albuminuria in patients with type 2 diabetes and nephropathy. Kidney International, 66), S115-S117.

Arnold, W. and Alexander, S. (1997), Cost, work, reimbursement, and the pediatric nephrologist in the United States medicare End-Stage Renal Disease Program. Pediatric Nephrology, 11 (2), 250-257.

Besarab, A. (1993), Optimizing Epoetin Therapy in End-Stage Renal-Disease - the Case for Subcutaneous Administration. American Journal of Kidney Diseases, 22 (2), 13-22

Bruns, F.J., Seddon, P., Saul, M. and Zeidel, M.L. (1998), The cost of caring for end-stage kidney disease patients: An analysis based on hospital financial transaction records. Journal of the American Society of Nephrology, 9 (5), 884-890.

Burgess, E.D., Carides, G.W., Gerth, W.C., Marentette, M.A. and Chabot, I. (2004), Losartan reduces the costs associated with nephropathy and end-stage renal disease from type 2 diabetes: Economic evaluation of the RENAAL study from a Canadian perspective. Canadian Journal of Cardiology, 20 (6), 613-618.

國際替代計量

末期腎臟病之文獻計量初探

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