下咽癌患者於不同治療方式之成本效益分析

Cost-effectiveness analysis of the treatment for hypopharyngeal carcinoma.

金廷芸(Ting-Yun Chin)

指導教授 ： 白佳原 ； 李亞欣

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2010年)

https://doi.org/10.6834/CSMU.2010.00143

摘要

目的：下咽癌是頭頸部惡性腫瘤中預後最壞的腫瘤之一，發病早期症狀不明顯也不具特異性，發現時往往已為晚期。主要治療方式有手術、放射/化學治療，但治療結果與預後均差。過去文獻多著重於臨床結果之差異，本研究欲探究下咽癌醫療費用及其成本效益，以健保局角度探討下咽癌於不同治療方式之成本效益分析。
方法與資料：資料來源為癌症特殊資料庫-健康保險研究資料庫，以2003年至2007年全國下咽癌新病例為研究對象(以ICD9-CM前三碼為148之編碼為主)，經篩選後研究樣本為3,126人。將治療方式分為兩類：1.手術為主2.放射/化學治療為主。以描述性統計瞭解五年間下咽癌病患之人口統計，並採t-test與ANOVA比較兩種治療方式之醫療費用及存活天數之關係，以及利用成本效益分析瞭解兩種治療方式之差異。
結果：五年間之下咽癌患者，以男性居多(97.31%)，多分佈於41歲以上(95.78%)，醫學中心(67.27%)與區域醫院(27.38%)之病患比例最高，治療方式以手術為主之比例(62.51%)高於放射/化學治療(37.49%)。手術之平均費用(約40萬)明顯高於放射/化學治療(約20萬)；平均存活天數也以手術(542.60天)高於放射/化學治療(469.08天)，但Cox對比涉險模式進行存活分析之結果，兩種治療方式並無顯著差異(p>0.05)，且追蹤2003年1、2、3、4年存活率，卻發現，其2至4年兩種治療方式之存活率並無顯著差異(P>0.05)；在成本效益方面，發現放射/化學治療之成本效益(1,127.8元)會較手術(1,899.9元)為佳，意即支持放射/化學治療之患者多活一天之醫療費用為1,127.8元。
結論與建議：兩種治療方式之存活率並無差異，就健保所支付之醫療費用來看，放射/化學治療確實較符合成本效益，意即，患者每多活一天所需之醫療費用會低於手術治療。本研究建議，未來應多增加此方面之研究探討，並建議臨床醫師對於晚期下咽癌患者可優先考慮放射/化學治療之方式。

關鍵字

下咽癌 ； 手術 ； 放射/化學治療 ； 成本效益分析

並列摘要

Objective: Cancer of hypopharynx carries with it one of the worst prognoses of all the cancers in the head and neck. Because the primary symptoms are unobvious and unspecified, patients delay or hospital delay are common among hypopharyxn cancer patients. Therefore most patients are often diagnosed with advanced stage at diagnosis. Surgery, radiotherapy and chemotherapy are mainly treatments of this cancer. However, the outcomes of different treatments were no significant among these treatments. Most studies focused of the clinic outcomes. The purpose of this study is to investigate the cost -effectiveness of the different treatments in hypopharyxn cancer.
Materials and Methods: Data were accrued from the National Health Insurance Research Database of cancer. All new hypopharyxn cancer in Taiwan diagnosed between years 2003 and 2007 were included in the study, total with 3,126 cases. Two groups of treatment, Surgery group and Radiotherapy/ Chemotherapy group. This study compared the differences of cost and survival days between two treatment groups. Furthermore, we compared the differences of cost-effectiveness between two treatment groups.
Results: During 5 years, 97.31% patients were men, 95.78% were more than 41years old. Most of patients were located in the medical center (67.27%) and regional hospital (27.38%). Total of 62.51% patients were treated with surgery, and 37.49% in the radiotherapy/ chemotherapy group. Average cost of surgery group (about USD 12 million) was higher than radiotherapy/ chemotherapy group (about USD 6 million). Average survival days of surgery group (542.60 days) was longer than the other (649.08 days). However, there was no significant difference between two treatment groups of the overall 2-4 years survival rates of 769 cases in 2003(p>0.05). Finding the cost-effectiveness of radiotherapy/ chemotherapy group ($1,127.8 per day) was better than surgery group ($1,899.9 per day). It means that if patients treated with radiotherapy/ chemotherapy lives one more day, the cost is NT 1,127.8 which is lower than patients in surgery group.
Conclusions: Although patients with surgery treatment had lower cost and longer survival, there was no significant difference between two treatment groups in the overall survival rates after following-up for 769 new cases in 2003. Furthermore, the cost-effectiveness of radiotherapy/ chemotherapy group was better than surgery group. We therefore suggest that radiotherapy/ chemotherapy can be a first selection for patients with hypopharyngeal advanced cancer.

並列關鍵字

hypopharyngeal cancer ； surgery ； radiotherapy/ chemotherapy ； cost-effectiveness

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