經皮冠狀動脈介入性治療之醫療成本效益分析及相關因素探討

Medical economic evaluation of percutaneous coronary intervention

詹貴川(Kuei-Chuan Chan)

指導教授 ： 白佳原

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2016年)

摘要

冠狀動脈心臟病(Coronary artery disease, CAD)為全球第一大死因且為最常見之心血管疾病，其會表現出心絞痛及心肌梗塞甚至猝死；由於，國人近年來生活型態及飲食習慣改變且人口快速老化，使得罹患心血管疾病之風險提高。目前心血管疾病位居國內第二、三大死因；對此，預防心血管疾病之發生或給予疾病患者適切的治療便成為我國公共衛生及醫療體系之重要議題，同時也會增加國內之醫療照護及資源。在冠狀動脈心臟病的治療上，從早期之藥物治療及冠狀動脈繞道手術至現今最常用以治療且效果彰顯之經皮冠狀動脈介入治療術（Percutaneous coronary intervention ,PCI）；然而，國內探討經皮冠狀動脈介入治療術之手術在醫療資源的投入及消耗上之研究仍顯不足；因此，本研究目的為利用作業基礎成本法分析治療冠狀動脈心臟病患者之經皮冠狀動脈介入性治療手術所耗費之醫療成本，以提供相關醫療單位未來決策規劃上之建議參考，並作為投入經費之考量以達成最佳收益與支出的依據。本研究於中部醫學中心心導管室納入868位PCI手術個案，蒐集其性別、年齡、疏通血管數量等相關資料，並針對PCI手術之設備、人事及手術本身之成本進行分析。結果顯示PCI手術平均每人成本為84,886元，平均每條血管則為71,139元，而PCI手術健保給付之收益僅為71,415元，不敷成本。建議健保應針對不同病患在手術實際之耗材、血管支架使用狀況進行給付，並可增加塗藥支架之給付以降低血管再阻塞率以提高病患之生活品質，以降低醫療成本和增加社會經濟效益。

關鍵字

冠狀動脈心臟病 ； 經皮冠狀動脈介入治療術 ； 心導管 ； ABC作業基礎成本法 ； 經濟效益分析

並列摘要

Coronary artery disease is one of the leading causes of death worldwide. Because the population aging problem and dietary habits of Taiwanese have been changed in recent years, the risk of cardiovascular disease was increased and it is the second and third leading cause of death in Taiwan. The treatment of coronary artery disease includes prevention, medical treatment, coronary artery bypass surgery and percutaneous coronary intervention. To maintain a good quality of medical service and a reasonable payment system simultaneously, the present study is to investigate the relationship between patients undergoing percutaneous coronary intervention (PCI) and its medical and socio-economic cost performance by using activity-based costing. 868 subjects with CAD were recruited from the cardiovascular center in Chung Shan Medical University Hospital. Data analysis includes sex, age, and other PCI retaliated information. Our study calculated the cost of facilities, staff, and PCI. The results showed that the average of PCI cost was 84,886 NT dollars per person and 71,139 per vessel. The payment from National Health Insurance was 71,415 NT dollars. It suggested that National Health Insurance payment of PCI should be adjusted in accordance to actual surgery supplies in different patients. Further, the drug-eluting stent should be completely paid to reduce vascular restenosis rate, which can reduce health care cost and increase social and economic benefits.

並列關鍵字

coronary artery disease ； percutaneous coronary intervention, stent ； activity-based costing, economic evaluation

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