三高與非三高族群冠狀動脈心臟病終身成本之比較

Comparisons and Analysis of Coronary-Heart-Disease Lifetime Cost for People with and without Hyperglycemia, Hyperlipidemia and Hypertension

陳怡珍(Yi-Jhen Chen)

指導教授 ： 陳慧芬

中原大學/電機資訊學院/工業與系統工程研究所/碩士(2016年)

https://doi.org/10.6840/cycu201600632

摘要

本研究利用健保資料庫針對三高及非三高族群進行冠狀動脈心臟病終身成本之分析，藉此瞭解三高症候群是否會對冠狀動脈心臟病患者及健保造成嚴重的負擔。
本研究利用1999年至2008年全民健保資料庫中承保抽樣歸人檔的資料，國際疾病分類標準代碼如下：糖尿病為250.xx，高血壓為401.xx~405.xx，高血脂症為272.xx，冠狀動脈心臟病為410.xx~414.xx。將1999年至2001年設為觀察期，首先篩選有就診紀錄且無三高或冠狀動脈心臟病者，並刪除資料不全者後，人數共為609,944人。實驗期為2002至2008年，將有三高症候群者設為病例組；控制組則為無三高症候群者，採用配對法選取與病例組實驗對象有相同性別且生日、第一次就診日相近者為控制組。
研究方法包含兩部分：發生率與冠狀動脈心臟病之計算。對於冠狀動脈心臟病發生率的估算方式為冠狀動脈心臟病人數除以個案人年。對於冠狀動脈心臟病終身成本的計算方式，我們參考Taylor et al. (1996)等人終身成本估算方法並採用Proudfit et al. (1983)等人提出的冠狀動脈心臟病存活率。冠狀動脈心臟病終身成本包含直接醫療成本和病患的間接成本，直接醫療成本由掛號費、醫師診療費、藥物費、影像檢查費、復健費、實驗室檢查費、病房費及其他費用算得。間接成本估算方式為因冠狀動脈心臟病而看門診或者住院所喪失的生產力。上述門診及住院只考慮因為冠狀動脈心臟病而就醫的成本。
研究結果顯示，冠狀動脈心臟病發生率方面，三高族群為3.5%而非三高族群為0.98%。平均看診次數以及住院天數方面，三高族群為73.52天/人及13.2天/人；非三高族群為76.93天/人及12.22天/人。
終身成本方面，若只考慮冠狀動脈心臟病者，三高族群為102,831元/人；非三高族群為96,918元/人，兩者差異不大，因為在冠狀動脈心臟病上，三高與非三高患者用藥並無太大差異。
若考慮族群中所有人，平均一人花費在冠狀動脈心臟病上的終身成本，三高族群為12,333元/人，非三高族群為5,480元/人。由此可見，三高族群冠狀動脈發生率較高，因此對社會醫療成本造成較大負擔。
在敏感度分析方面，年金折扣率若從2%增加至3%，三高與非三高族群終身成本約減少了0.015%與0.019%。冠狀動脈心臟病存活率若降低了30%，三高與非三高族群終身成本與原來的終身成本相比皆減少約30%。

關鍵字

高血糖 ； 高血脂 ； 高血壓 ； 終身成本 ； 健保資料庫 ； 冠狀動脈心臟病

並列摘要

This research aims to model the lifetime cost of coronary heart disease (CHD) for people with 3H (hypertension, hyperglycemia, and hyperlipemia). The purpose of this study is to study the burden on CHD patients and National Health Insurance Bureau the national insurance medical cost caused by 3H.
We use the NHIRD (National Health Insurance Research Database) data from years 1999 to 2008 for model fitting and cost analysis. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes used are: 250.xx for hyperglycemia, 401.xx-405.xx for hypertension, 272.xx for hyperlipemia and 410.xx-414.xx for CHD. The first 3 years (1999 – 2001) are set as the observation period. We select the patient data recoded in these 3 years but without 3H or CHD symptoms record, and delete data without complete information. The total population is 609,944. The next 7 years (2002 – 2008) are set as the experimental period. The patients with 3H symptoms in the experimental period are set as the case group. We then use matched-pair method to select patients without 3H, called the control group, by matching the gender exactly, birth date closely, and first-visit date closely of the patients in the case group.
The methodology of this study consists of two parts: estimate the CHD incidence rate and calculate the CHD lifetime cost. We estimate the CHD incidence rate by dividing the number of CHD cases by the person-years of all cases. To calculate the CHD lifetime costs, we modify the method by Taylor et al. (1996) and use the CHD survival rate by Proudfit et al. (1983). The CHD lifetime cost includes the direct medical cost and indirect cost. The direct medical cost includes the ward fees, physician medical fees, drug costs, rehabilitation costs, imaging inspection fees, laboratory fees, registration fees and others. The indirect cost includes the loss due to patients’ lost productivity during outpatient and inpatient medication period. Only the outpatient and inpatient medical costs for CHD are considered in this research.
The results show that the overall CHD incidence rates for 3H and non-3H groups are 3.5% and 0.98%, respectively. The average number of ambulatory-care days and hospital days for the 3H group per person are 73.52 days and 13.2 days, respectively, and those for the non-3H groups per person are 76.93 days and 12.22 days, respectively.
If we consider only cases having CHD during the experimental period, the average CHD lifetime costs per person for the 3H and non-3H groups are 102,831 and 96,918 dollars, respectively. Since the mediccation costs for the two groups do not differ much, the CHD lifetime costs for the two groups are similar.
If we consider all cases in the two groups, the average CHD lifetime costs per person for the 3H and non-3H groups are 12,333 and 5,480 dollars, respectively. This result shows that the 3H group with a higher CHD incidence rate causes a larger burden on the society medical cost.
Finally, we conduct a sensitivity analysis for the present-value discount rate and coronary heart disease survival rate. When the present-value discount rate increases from 2% to 3%, the CHD lifetime cost decreases 0.015% and 0.019% approximately for the 3H and non-3H groups, respectively. When the survival rate decreases 30%, the CHD lifetime cost also decreases approximately 30% from its original value for both groups.

並列關鍵字

Hyperglycemia ； Hyperlipemia ； Hypertension ； Lifetime cost ； NHIRD ； Coronary heart disease

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