預防保健的成本效益評估：以乳癌篩檢為例

A cost-benefit Analysis of Preventive Care: The Case of Breast Cancer Screening

文羽苹(Yu-Ping Wen) ； 許玫玲(Mei-Ling Sheu)

《台灣公共衛生雜誌》 24卷6期 (2005/12) Pp. 519-528

https://doi.org/10.6288/TJPH2005-24-06-06

摘要

目標：以乳房X光攝影為例，討論成本效益分析在全民健保預防保健政策評估的應用及限制。方法：採用衛生署癌症資料，藍忠孚與梁玲郁的「失能調整人年」DALY數據與健保支付標準，利用Maciosek等作者提出篩檢預期效益的計算方式，估計不同假設下乳房X光攝影篩檢乳癌的成本與效益。結果：成本效益分析顯示，二階段策略能降低篩檢成本，使篩檢符合成本效益的要求，高單價、低篩檢敏感度、偽陽性等因素可能使全面性乳房X光攝影乳癌篩檢有效益不敷成本之虞。結論：成本效益的分析可作為預防保健決策的一環，其重點在利用明確的方法與資訊，使各種意見可以得到充分討論。雖然在目前假設下全面篩檢不符成本效益，分析顯示，若能提高篩檢敏感度或降低篩檢單價，預防篩檢之預期效益將可以提高。我們建議健保相關政策亦可以利用成本效益分析，作為決策的重要工具。

關鍵字

成本效益分析 ； 預防保健政策 ； 乳癌 ； 失能調整人年

並列摘要

Objective: Use mammograms as an example to demonstrate the application and limitation of cost-benefit analysis on the preventive care policy of the National Health Insurance of Taiwan. Methods: Use the Cancer Report of the Department of Health (DOH), Disability-Adjusted Life Years (DALY) estimated by Lan and Liang, payment schedule of the Bureau of National Health Insurance (BNHI), and the methods of Maciosek et al. to estimate the benefits and costs of mammograms. Results: Cost-benefit analysis results suggest that a two-step screening strategy can effectively reduce costs and pass the cost-benefit test. High price, low sensitivity, and false positives tend to make it financially unworthy to indiscriminately screen for breast cancer in all women aged 50 to 69 by mammograms. Conclusions: Cost benefit analysis provides a framework for decision-making. Its strength lies in its systematic use of information, thus different opinions can be thoroughly discussed. While a full-scale mammogram does not currently pass the cost-benefit test, the analysis indicates that the expected benefits of screening can be increased through an increase in test sensitivity or a reduction in screening price. We recommend that policy-makers use cost-benefit analysis in the future to systematically examine the potential gains and losses of health care policies.

並列關鍵字

cost-benefit analysis ； prevention policy ； breast cancer ； DALY

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