Title

下段輸尿管結石以輸尿管鏡碎石與體外震波碎石治療成本效益:傾向分數配對之研究

Translated Titles

Cost Effectiveness of Ureteroscopic Lithotripsy vs. Extracoporeal Shockwave Lithotripsy among Lower Third Ureteral Stone Patients: A Propensity Score Matching Analysis

Authors

蘇進明

Key Words

下段輸尿管結石 ; 輸尿管鏡碎石術 ; 體外震波碎石術 ; 成本效益分析 ; lower third ureteral stone ; ureteroscopic lithotripsy (URSL) ; extracoporeal shock wave lithotripsy (ESWL) ; Cost Effectiveness Analysis

PublicationName

高雄醫學大學醫務管理暨醫療資訊學系碩士在職專班學位論文

Volume or Term/Year and Month of Publication

2020年

Academic Degree Category

碩士

Advisor

許弘毅

Content Language

繁體中文

Chinese Abstract

研究目的 輸尿管結石是一個常見而且有高復發率的疾病,隨著發生率的增加,下段輸尿管結石需要以輸尿管鏡碎石和體外震波碎石術的需求也增加,臨床上對於兩種術式成本效益分析的實證很少。本文的目的是對於下段輸尿管結石患者,以輸尿管鏡碎石術和體外震波碎石術治療的成本效益分析。 研究方法 本研究採回溯性資料分析,搜集台灣南部某區域教學醫院於2017年1月至2020年12月720位下段輸尿管結石,接受輸尿管鏡碎石術和體外震波碎石術患者,研究特徵是以傾向分數配對,控制人口學及臨床特性,比較兩種治療方式的醫療費用及效益,進而評估成本效益。經濟上的評估,本研究以健康提供者的角度,病人於接受治療後追蹤一個月,以結石廓清率作為評估方式。邊際成本效益比值是比較兩種不同治療方式的治療費用與結石廓清率的比值。以成本效益可接受曲線來解釋在不同的願意支付金額額度下的成本效益。 研究成果 研究期間輸尿管鏡碎石術的總醫療費用及廓清率分別是31,580.6元及92.3%,體外震波碎石術是32,147.9元及77.6%,不論結石大小(小於1公分或大於等於1公分),輸尿管鏡碎石術有比較好的臨床療效及成本效益,邊際效益每增加1個百分點的廓清率可以節省3859.5元。 結論 輸尿管鏡碎石術相較於體外震波碎石術,不論在結石廓清率及成本節省方面都是比較好的。下段輸尿管結石的患者,輸尿管鏡碎石應優先考慮輸尿管鏡碎石術做為第一線的治療方式。

English Abstract

Objective Ureteral stone is a common disease with high recurrence rate. The rising incidence of lower third ureteral stone disease has led to an increase need for Ureteroscopiclithotripsy (URSL) and Extracoporeal Shock Wave Lithotripsy (ESWL), but evidence of cost-effectiveness is scarce. Our aim was to evaluate the cost effectiveness of URSL and ESWL in patients with lower third ureteral stones. Methods A total of 720 patients with lower third Ureteral Stones treated with two different strategies (URSL vs ESWL) between January 2017 and December 2019 in one southern hospital in Taiwan. The study characteristics were then compared between the URSL subjects and a propensity score-matched ESWL subjects drawn from the same population base. The economic evaluation adopted under the National Health Insurance payment system investigating the relative costs of the two treatment strategies to health providers’ viewpoint over the 1 month follow-up. The effectiveness parameter was the stone free rate (SFR), defined as the absence of lower third ureteral stone. The incremental cost effectiveness ratio (ICER) was calculated as the ratio of the difference in costs to the difference in SFR between the treatment strategies. A cost-effectiveness acceptability curve was graphed to determine the probability of cost effectiveness at different willingness-to-pay ceiling ratios. Results During the study period, the total medical cost, SFR for URSL and ESWL were NT$ 31580.6 and NT$32147.9, 92.3% and 77.6% respectively. The URSL was more effective and cost effectiveness than ESWL of treatment for lower third ureteral stones regardless of size (less than 1cm or equal to or larger than 1 cm). The Incremental Costs-effectiveness Ratio (ICER) was NT$3859.5 costs saving per 1% SFR increased. Conclusions and Implications URSL was more efficient in terms of stone free rate and cost saving than ESWL. URSL should be considered as first-line therapy for patients with lower third ureteral stones.

Topic Category 醫藥衛生 > 醫院管理與醫事行政
健康科學院 > 醫務管理暨醫療資訊學系碩士在職專班
社會科學 > 管理學
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