中風終身成本分析－三高與非三高族群之比較

Lifetime-Cost Analysis for Stroke－Comparisons of People with and without Hyperglycemia, Hyperlipidemia and Hypertension

吳柏衡(Po-Heng Wu)

指導教授 ： 陳慧芬

中原大學/電機資訊學院/工業與系統工程研究所/碩士(2015年)

https://doi.org/10.6840/cycu201500792

摘要

本研究主要目的為估算三高族群與非三高族群之中風發生率及終身成本，並進行比較。中風會對健保局以及病患個人造成很大的負擔，並且已有研究指出三高族群比起非三高族群更容易得到中風。Taylor等人在1996年發表利用美國資料來估算中風終身成本，從中風年齡算到99歲。本研究所使用的資料來源為1999年至2008年的健保資料庫，將1999年至2001年這三年期間作為觀察期，選擇這三年中無任一種三高以及無中風的病例，並刪除資料不全者，人口數為745,006人。本研究首先選出三高族群的樣本資料稱為病例組，為了進行比較，我們採用配對法，挑選出非三高族群的樣本資料為控制組。
　　研究方法中對於中風發生率的估算方式為中風人數除以個案人年。對於中風計算終身成本，我們參考Taylor等人的終身成本計算方式以及中風存活率。中風終身成本包含直接醫療成本和病患的間接成本，直接醫療成本由病房費、醫師診療費、藥物費、復健費、影像檢查費、實驗室檢查費、掛號費、及其它費用算得。間接成本估算方式為因中風而看門診或者住院所喪失的生產力。上述門診及住院只考慮因為中風而就醫的成本。
　　研究結果顯示三高族群與非三高族群的整體中風發生率為3.27%以及0.628%，且三高族群各個年齡層的中風發生率皆高於三高族群。
　　三高族群與非三高族群所有個案中，平均一人花費在中風上的終身成本為12,781元/人以及3,030元/人。三高族群的平均直接成本為12,189元/人，平均間接成本為592元/人。非三高族群的平均直接成本為2,952元/人，平均間接成本為78元/人。
　　若只考慮中風病患，三高族群與非三高族群中風病患平均終身成本為161,587元/人以及70,420元/人，三高族群的平均直接成本為154,100元/人，平均間接成本為7,488元/人，平均門診的天數為10天/人，平均住院天數為7天/人。非三高族群的平均直接成本為68,613元/人，平均間接成本為1,806元/人，平均門診的天數為2天/人，平均住院天數為6天/人。
　　本研究針對年金折扣率以及中風存活率進行敏感度分析，結果顯示當年金折扣率越高終身成本越低，當中風存活率越高終身成本越高。

關鍵字

高血糖 ； 高血脂 ； 高血壓 ； 終身成本 ； 健保資料庫 ； 中風

並列摘要

This study aims to model the lifetime cost of stroke for people with and without 3H (hyperglycemia, hyperlipidemia and hypertension). The medical cost due to stroke causes great burden for patients and National Health Insurance Bureau. Existing literature shows that people having 3H is more likely to have stroke than people without 3H. In 1996, Taylor et al. used US data to estimate the stroke lifetime cost from age of onset for stroke to 99 years old. For this study, we use NHIRD data from 1999 to 2008. The first 3 years are set as the observation period to exclude patients with 3H or stroke and delete missing data. The population size is 745,006 people. In this study, we first select 3H sample data as case data. For comparison, we then adopt the matched- pair method to selected non-3H sample data as control data.
In this study, we estimate the stroke incidence rate by dividing the number of stroke cases by the person-years of all cases. To calculate the stroke lifetime costs, we modify the method by Taylor et al. The stroke lifetime cost include direct medical costs and indirect costs. Direct medical costs include the ward fees, physician medical fees, drug costs, rehabilitation costs, imaging inspection fees, laboratory fees, registration fees, and other costs. Indirect costs include the patients’ lost productivity during outpatient and inpatient medication period. Only the outpatient and inpatient medical costs for stroke are considered.
Our results show that the overall stroke incidence rate are 3.27% and 0.628% for the 3H group and non-3H group, respectively. For all age categories, the stroke incidence rate is higher for the 3H group than for the non-3H group.
Considering all cases, the average stroke lifetime costs per person are NTD$12,781 and NTD$3,030 for 3H and non-3H groups, respectively. The average direct and indirect costs the 3H group are NTD$12,189 and NTD$592. Direct and indirect costs the non-3H group are NTD$2,952 and NTD$78.
If we only consider cases having stroke during the study period, the average stroke lifetime costs per person are NTD$161,587 and NTD$70,420 for the 3H and non-3H groups, respectively. The average direct cost, indirect cost, number of ambulatory-care days and number of hospital days for the 3H group are NTD$154,100, NTD$7,488, 10 days and 7 days. The average direct cost, indirect cost, number of ambulatory care days and number of hospital days for the non-3H group are NTD$68,613, NTD$1,806, 2 days and 6 days.
Finally we conduct sensitivity analysis for the present-value discount rate and stroke survival rate. When the present-value discount rate increases, the lifetime cost decreases. When the survival rate increases, the lifetime cost also increases.

並列關鍵字

hyperglycemia ； hyperlipidemia ； hypertension ； lifetime cost ； NHIRD ； stroke

參考文獻

[4] 李龍騰、陳建仁、索任、陸坤泰、林瑞雄 (1997)。肺結核與肺癌:病例對照研究。台灣醫學 2，176-184。

[7] 廖建彰、李采娟、林瑞雄、宋鴻樟 (2006)。2000年台灣腦中風發生率與盛行率的城鄉差異。台灣衛誌 25(3)，223-230。

[6] 陳淑媛、余幸司、陳國熏、郭宗禮、陳建仁 (1993)。烏腳病盛行地區居民之早期砷暴露和皮膚癌之病例對照研究。台灣衛誌 12(1)，1-9。

[1] 王美純、廖珮伶、廖炎智、林四海、陳政友 (2008)。飲食行爲與罹患攝護腺癌之相關性探討-以某醫學中心攝護腺癌患者爲例之配對病例對照研究。 健康促進暨衛生教育雜誌 (28)，65-81。

[8] Bergman, L., Meulen, J.H., Limburg, M, Habbema, J.D. (1995). Costs of medical care after first- ever stroke in The Netherlands. Stroke 26(10), 1830-1836.