預防老人跌倒居家環境改善之成本效益分析

The Cost-benefit Analysis of Home Environmental Improvement to Prevent Elderly Falls

唐美蓮(Mei-lien Tang)

指導教授 ： 葉玲玲博士

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

跌倒是老年人口中普遍存在的健康問題，且為老人意外死亡的主要原因。每年約有三分之ㄧ的老人發生至少一次的跌倒，其中有一半為重複跌倒者。老人發生跌倒後可能造成輕微傷害，如瘀青、擦傷，亦可能造成嚴重傷害，如頭部外傷、骨折等。跌倒造成身體傷害導致日常生活功能障礙、行動不便，也增加長期照顧的需求。因此跌倒所帶來的衝擊，不僅是醫療支出增加，也因長期照顧需求上升而增加社會照顧成本。美國65歲以上老人，因跌倒傷害所耗費的醫療費用約佔所有醫療費用的6%。
然而跌倒是可以預防的，透過適當的介入措施如規律的運動、適當的營養、定期藥物諮詢與評估、居家環境的改善、行為教育可以有效減少老人跌倒的發生率。及早介入預防老人跌倒的發生，可以減少老人因跌倒而導致的失能、依賴及生命損失，更可以減少傷害性跌倒所增加的醫療費用。但是關於介入措施是否具有成本效益的相關研究較少，因此本研究從公部門角度探討居家環境改善對於預防老人跌倒的成本效益。
本研究以決策樹分析進行居家環境改善對於預防老人跌倒的成本效益分析。成本項目為所投入方案的成本，依據文獻回顧與國內相關補助方案，收集居家環境改善成本。效益項目為因居家環境改善減少的跌倒醫療費用，利用次級資料收集跌倒相關傷害的醫療費用。決策樹模型中的參數主要根據台灣的文獻回顧而得。將所投入的居家環境改善成本除以所減少的醫療費用，即得居家改善方案的成本效益值。
研究結果發現台灣65歲以上老人的跌倒醫療費用平均為40,372元。跌倒傷害情形以骨折最多，其中以股骨頸骨折所佔比率最高。決策樹分析結果，全國跌倒傷害的醫療費用推估為51.4億元，經由居家環境改善可以減少22.5億元。以全國居家環境改善的成本推估為192億元，則成本效益值為-8.57元，意味每減少一元的跌倒醫療費用需要投入8.57元的成本。若居家環境改善的接受改善率在10%以下，則成本效益值小於1，表示效益大於成本。
本研究僅計算跌倒傷害的醫療費用，對於老人本身的長期照顧費用、時間成本、生活品質，或是照顧者的時間成本、生產力損失，並未有實際數據進行計算，因此低估了跌倒成本。再者本研究結果乃利用文獻回顧的參數與次級資料，透過模型而得，因此需要進一步的實證研究以提供更精確的分析。

關鍵字

老人跌倒 ； 居家環境改善 ； 醫療費用 ； 決策樹 ； 成本效益分析

並列摘要

Unintentional falls are a common occurrence and a major cause of unintentional death among older adults. Approximately one third of persons aged 65 and above fell at least once a year. 50% of those who fell might fell again. Falls may result in both minor injuries, such as bruises or abrasions, and serious injuries, such as head injury, fracture or other serious soft tissue injuries. Impairement and disable activity function resulted in fall-releated injuries, which increase in the needs of long term care. The impact of eldeerly falls is not only augmentation of medical expenditure but also social economic cost. Fall-related injuries accounted for 6% of all medical expenditures among elderly age 65 and above in the United States.
Effectively fall preventive strategies could reduce incidence of elderly falls, such as regular exercise, appropriciate nutrition, regular reassessment of drugs, home improvement and behavioral education. Prevention of falls is likely to lessen disability, dependence and loss of life. The fall-related medical expenditure is also decreased with fewer injurious falls. According to literatures, the fewer studies concerned with cost-benefit of preventive programs. The aim of this study is to find out the cost benefit of home environmental improvement to prevent elderly falls from the perspective of the public sector.
The cost benefit of home environmental improvement was analyzed by using a decision analytic model. The cost data included home environmental assessment and modification, and the data was from literature or government subsidy in Taiwan. The benefit data was the extent of the decline of fall-related medical expenditures after the intervention. By using secondary data, the medical expenditure of fall-related injuries was analyzed. The parameters of our decision model were determined on available data from the published literature, the priority on Taiwanese data. Cost-benefit ratio was estimated as the cost per one unit fall-related expenditure prevented.
The result of fall-related medical expenditure among the elder aged 65 and above was NT$40,372. Fractures were the most common fall-related injury and the propotion of femoral neck fracture was the highest. According to the decision model, the national fall-related medical expenditure was NT$5.14 billion and it decreased in NT$2.25 billion after home improvement. At the estimation of national cost of intervention, NT$19.2 billion, the cost-benefit ratio was -8.57. It meant that the cost per fall-related medical expenditure prevented was NT$8.57. If the propotion of execution for home improvement was 10%, the CB ratio was less than NT$1. This indicated benefit was greater than cost.
This study only took into account the fall-related medical expenditure without considering the long-term-care cost, the time cost or the quality of life of the elderly and the productivity or time loss of cargeiver; hence the total economic cost of the falls might be underestimated. And then the results of the cost benefit analysis are based on a model constructed from various data sources and assumptions, further research is required to provide evidence-based data before definitive policy conclusions.

並列關鍵字

elderly fall ； home environmental improvement ； medical expenditure, ； decision tree, ； cost benefit analysis

參考文獻

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