患有良性前列腺肥大之患者的醫療費用支出探討

Abstract

良性前列腺肥大（Benign prostatic hyperplasia）為中老年男性相當常見的疾病，其症狀主要為頻尿、尿流速變慢、夜尿、急尿、尿失禁以及尿液滯留，對於患者的生活品質以及腎臟功能有一定的影響，而夜尿也會提高老年男性跌倒的風險，隨者全民健保推行後的醫療服務普及與醫療照護能力的提升，我國最近幾年的老年人口占比逐年提升，可以預見的是台灣在老年男性的醫療成本支出未來也是會持續增加，而以良性前列腺肥大在老年男性的高盛行率來看，國家未來在良性前列腺肥大的醫療成本支出將會增加。本研究之目的是希望能利用我國全民健康保險研究資料庫，探討患有無良性前列腺肥大的男性國民的醫療支出有無不同。 在依據中華民國台灣的國民的全民健康保險就醫資料庫，來調查患有與無良性前列腺肥大（Benign prostatic hyperplasia）之患者的醫療就醫利用之支出的差異。本研究總共收集7413位良性前列腺肥大患者，和7413位無良性前列腺肥大的年齡匹配患者。主要分析的結果變量為病患在一年內的使用醫療服務的比率，其中包括病患門診訪問次數，因為醫療因素而住院之天數以及相關門診診察和住院治療費用。除此之外，我們將醫療服務分為泌尿科醫療和非泌尿科疾病之就醫清況進行分析。 經由本大數據之研究的分析，我們發現，在病患的門診泌尿科醫療利用的使用情況，患有良性前列腺肥大患者接受的門診就醫次數較多（7.84次 vs 0.52次，p值<0.001）且花費明顯較高的門診診療成本（新台幣11279.04元vs 1030.88元，p值<0.001），另外在住院方面，患有良性前列腺肥大患者的住院時間較長（0.55 vs 0.11，p值<0.001），以及相關之住院費用較高（新台幣4517.68 vs 970.24元，p值<0.001）總和來說患有良性前列腺肥大患者的就醫醫療總成本為新台幣15796.72元，相較於無良性前列腺肥大患者的泌尿科相關就醫醫療總成本為新台幣2031.44元顯著較高。至於在非泌尿科的醫療就醫使用情況，良性前列腺肥大患者族群也有更多的門診就醫次數為49.11次而未患有良性前列腺肥大為24.79次 (p值<0.001），較高的門診總就醫診療費用（新台幣54394.08元vs 新台幣30744.48元，p值 <0.001），較長的住院的日數為(3.72天vs 2.04天，p值<0.001），更昂貴的所有醫療住院費用（新台幣25681.04元vs新台幣14735.52元，p值<0.001），以及明顯更高的醫療服務總成本（新台幣80893.76元vs 新台幣45480元，p值<0.001）。更進一步分析，我們還發現良性前列腺肥大患者族群的平均總體的醫療成本比無良性前列腺肥大之族群的平均成本高出約兩倍。經由這個數據分析，我們得出結論，不論在泌尿科相關或非泌尿科相關的醫療需求來說，良性前列腺肥大患者的醫療就醫利用率明顯地高於無良性前列腺肥大的患者。(台幣兌美元匯率1:29) 本研究發現在男性族群中，患有良性前列腺肥大的男性的醫療就醫支出明顯較高。因此本研究建議國家衛生單位以及臨床醫療護理人員應對男性國民教育良性前列腺肥大的症狀以及可能併發症並對患者進行定期追蹤與身體檢查，並注意患者是否有泌尿道或其他器官系統合併症的相關症狀，以適時轉介至適當之醫療專科進行治療。

Benign prostatic hyperplasia (BPH) is one of the common diseases in ageing men, the symptoms included urinary frequency weak urine flow rate nocturia urgency urinary incontinence and urine retention. BPH has marked impact on the patients’ quality of life and renal function. In addition, nocturia is associated with higher risk of fall in older men. After the introduction of the national health insurance, the access to medical service is much easier and the medical care quality improvement the proportion of ageing population increased gradually. We can expect that the cost of medical service for older men will be increasing. As the high prevalence of BPH, we believe that the cost for management of BPH will also be increasing. This study aimed to investigate difference between BPH and non-BPH men using a large population-based dataset in Taiwan. This study used the Taiwan Longitudinal Health Insurance Database 2000. We included a total of 7413 patients with BPH and 7413 age-matched patients without BPH were included. The outcome variable was 1-year utilization of healthcare services including the number of outpatient visits, inpatient days, and the costs of outpatient and inpatient treatments. In addition, we separated healthcare services into urology services and non-urology services for analysis. We found that as to the utilization of outpatient urological services, patients with BPH had more outpatient services (7.84 vs 0.52, P< 0.001), higher outpatient costs (US$372 vs US$34, P< 0.001), a longer length of inpatient stay (0.55 vs 0.11, P< 0.001), higher in-patients costs (US$149 vs US$32, P< 0.001), and higher total costs (US$521 vs US$67, P< 0.001) than the comparison group. As for nonurological services, patients with BPH also had more outpatient services (49.11 vs 24.79, P< 0.001), higher outpatient costs (US$1794 vs US$1014, P< 0.001), a longer length of in-patient stay (3.72 vs 2.04, P< 0.001), higher inpatient costs (US$874 vs US$486, P< 0.001), and higher total costs (US$2668 vs US$1500, P< 0.001) compared to comparison patients. We also found that the average total cost was about 2-fold greater for patients with BPH than comparison patients. We found higher healthcare utilization by patients with BPH than comparison patients. We suggest that the education of BPH regarding the symptoms, complications provided by health policy departments of government, medical doctors and nurses should be encouraged. In addition, BPH patients should receive regular followup and health checkup to identify other organ-system disorders.