加護病房成本效益

The Cost-effectiveness of Intensive Care

唐高駿(Gau-Jun Tang) ； 薛貴霞(Kuei-Hsia Hsueh) ； 蔡建和(Chien-Ho Tsai) ； 陳秀丹(Shew-Dan Chen)

《中華民國急救加護醫學會雜誌》 16卷4期 (2005/12) Pp. 139-145

https://doi.org/10.30018/JECCM.200512.0001

摘要

加護病房照護的費用昂貴，且不成比例地消耗醫療保健裡相當數量可利用的資源。它包括固定成本如加護病房中生命徵象監視系統；以及變動成本如護理人力、專業診斷和治療、藥物、耗材、影像診斷、實驗室檢驗等。這些費用被一些因子影響，如病例組合、疾病嚴重度、住院類型、住院天數、和不同的臨床處置等。加護病房費用最大和最明顯的部分是護理的人力，佔總加護病房費用達40%。
對更好的醫療保健的需求是無止盡的，特別是對重病的患者而言，合併昂貴新技術和藥物以拯救或延長生命的決定，會受費用支出、政治力量、歧視、搶救和行善所影響，新療法之使用不再單由治療疾病之有效度來判斷，而且必須考慮其成本效益。成本效益的定義為在與相關二個不同計劃或療法其費用的淨改變比率，除以效用時淨變化（健康結果上）而來。簡言之，一種新治療的成本效益是用以治療增加每一人命年(life-year gained)的費用。例如最近甫上市之活化蛋白C治療嚴重敗血症病人，其增加每一人命年的費用是美金＄24484（單一療程為美金＄6800），被視為相關成本效益。其他新治療方法，如中心靜脈導管以抗生素浸潤過及經皮氣管造口術，相較於傳統治療而言則是另一具吸引力的選擇，雖然直接成本增加，但證明是比傳統治療有效。所有加護病房工作者除了竭盡所能救治患者，在考量有限的醫療資源，和使用無止盡新且昂貴的支持和治療生命的武器之間，必須仔細地評估成本效益和避免徒勞治療在消耗最大醫療資源的患者。

關鍵字

成本效益 ； 加護病房 ； 作業基礎成本

並列摘要

The cost of intensive care is extraordinarily high and this aspect of healthcare consumes a disproportionate amount of available resources. These costs are made up of fixed costs such as the intensive care unit (ICU) facility and the life-support equipment, as well as variable costs such as nursing labor, professional diagnosis and treatment, drugs, consumables, diagnostic imaging, laboratory tests, etc. These costs are influenced by factors such as the case mix, the severity of illness, the type of admission, the length of stay, and variations in clinical practice. The largest and most obvious component of ICU costs is nursing labor, which represents up to 40% of total ICU cost.
The demand for better healthcare is endless, especially for the critically ill patients. The decision to incorporate expensive new technology and medication in order to save or prolong life is influenced by the cost, political power, discrimination, rescue and beneficence. The use of new therapies can no longer be judged solely on their effectiveness when treating illnesses, but also must be measured in terms of their cost effectiveness.
Cost-effectiveness is defined as the ratio of the net change in costs (numerator) associated with two different programs or therapies divided by the net change in effect (health outcome). In short, the cost effectiveness of a new treatment is the cost incurred when using the treatment per each life-year gained. One example is the cost per life-year gained when treating severe sepsis patients with recently marketed Activated Protein C at US$6800 per treatment and a total cost of US$24484; this was regarded as relatively cost effective. Other new treatment methods such as antibiotic-impregnated central venous catheters and percutaneous tracheostomy also represent attractive alternatives to conventional treatment. Thus, although these direct costs have been increased, the treatments have proved to be more cost-effective than conventional therapy.
As intensivists, we have vowed to do everything possible to save the lives of patients. Unfortunately, with limited medical resources, and with an endless supply of new and expensive life supporting and therapeutic weapons available, all intensivists have to carefully evaluate the cost-effectiveness of the novel therapies and avoid the futile treatment of patients, which can result in the consumption of a large part of limited medical resources.

並列關鍵字

cost-effectiveness ； intensive care ； activity-based costing