乳癌確診後之初期罹病成本與相關因子之探討－以台大醫院病患為例

A Study on the Costs of Breast Cancer Shortly after Diagnosis and Associated Factors-Using Patients from National Taiwan University Hospital as an Example

蔡宜樺(Yi-Hua Tsai) ； 楊銘欽(Ming-Chin Yang) ； 季瑋珠(Wei-Chu Chie)

《中華公共衛生雜誌》 17卷3期 (1998/06) Pp. 242-252

https://doi.org/10.6288/CJPH1998-17-03-12

摘要

根據衛生署癌症登記的資料顯示，台灣地區乳癌之發生率和盛行率正逐年增加中，為瞭解乳癌病患因罹患乳癌而導致之醫療花費及生產力損失，本研究以民國81年6月初至82年5月底台大醫院新確診之乳癌病人為研究對象，分析其確診半年內住院、門診費用及因治療乳癌所導致之成本。研究樣本共計146人，問卷回收率為76.7%，重要發現如下，(1)乳癌病患多為第二期，所有患者均接受過切除手術，且治療種類以3種者最多；(2)以社會的觀點來估算罹病成本，發現每位病患住院期間及出院後6個月內之直接（醫療）成本平均值為126,528.9元，間接（以人力資本法得到之生產力損失及交通成本、義乳購置費用）成本之中估計為103,292.1元，罹病成本之中估計為231,097.1元；(3)在無形成本方面，有半數以上之受訪患者因治療乳癌而有不舒服的現象，且乳癌越後期，越容易疲倦、體力差；而無論是直接、間接、罹病或與形成本，乳癌越後期，成本越高；(4)在多變項複迴歸分析方面，國小程度者直接成本較低、乳癌越後期、治療種類越多，直接成本越高；65歲以上者，因假設無生產能力，故間接成本最低，居住地離台北市越遠及治療種類越多者，間接成本越高；國小程度者罹病成本較低、居住地離台北市越遠、乳癌越後期及治療種類越多者，其罹病成本越高；在無形成本方面，居住地離台北市越遠、治療種類越多，病患越容易疲倦、體力差。根據本研究結果，吾人建議衛生機關加強民眾早期發現乳癌、早期治療之衛生教育，並加強醫療資源之均衡分布，以減低病患區域外就醫所導致之非醫療成本，進而減少個人、家庭及社會的損失。

關鍵字

乳癌 ； 罹病成本

並列摘要

According to the Cancer Registry of Taiwan, the incidence rate and prevalence rate of breast cancer has been increasing rapidly. The purpose of this study was to estimate expenditures for medical care and other costs resulted from treatment of breast cancer during the first half year after the diagnosis was made. New cases of breast cancer were collected in National Taiwan University Hospital from June 1992 to May, 1993. One hundred and forty six new cases were identified as research subjects, and 76.7% responded to the questionnaire.
Major results are as follows: (1) Most of the patients were in stage Ⅱ. All of the patients received surgery and most of them received 3 types of treatment. (2)The average direct (medical) cost starting from admission to six months after discharge was NT$ 126,528.9 per patient. The average middle estimate of indirect cost (production lost° Atraffic cost and other relaxed expenditures) was NT$ 103,292.1. The average middle estimate of total cost was NT$ 231,097.1. (3) More than half of the patients felt uncomfortable after receiving treatments for breast cancer. The later stage the patients were, the more fatigue the patients felt. (4) Elementary school education level was related to a lower, later stage and more items of treatment were related to a higher direct cost. Patients older than 65 years had a lower, those who lived in areas more distance from Taipei had a higher indirect cost .Elementary school education level was related to a lower, more distance from Taipei and later stage of the disease were related to a higher total cost. Those who lived in areas more distance from Taipei and more items of treatment were related to a higher intangible cost.
The authors suggest that in order to reduce costs of treatment of breast cancer to the individual, family and society, the health authority should enhance the health education about early detection and early treatment of breast cancer, and a more equal allocation of health care resources.

並列關鍵字

breast cancer ； costs of illness