健走訓練對社區老人健康生活品質與成本效用影響之探討

Abstract

如何減緩醫療保健支出的成長與提升醫療有關的生活品質，是目前許多國家面臨的重大挑戰，醫療成本效用分析，則是作為有效分配有限醫療資源的指引。本研究的目的即是要了解健走對社區老人之生活品質的影響，並探討健走訓練後之品質調整後的存活年數(QALY)及其成本效用。本研究以基隆市65歲以上老人為母群體，採前瞻性隨機控制之臨床試驗，進行健走訓練對社區老人健康生活品質與成本效用之探討。本研究分成實驗組與對照組，實驗組接受12週健走訓練並於訓練前後進行生活品質及成本的調查，對照組則未接受健走訓練。本研究以SF-36作為測量生活品質的工具，另外再將SF-36數值轉換成健康效用指數(health utility index)，配合成本調查的結果，計算出成本效用比率(ICUR)，以進行健走訓練對老人成本效用的分析。 本研究實驗組與控制組各有38人完成前後測試，結果發現12週的健走訓練在生活品質中身體功能、社會功能、因情緒問題造成的角色限制、精神健康等四方面均能呈現顯著的進步；12週的健走訓練，可以增進老人的品質調整後存活年數 ( 0.248+ .034 QALY)，其ICUR值為389092元/QALY。由本研究結果可推論老人健走訓練是符合經濟考量的介入性措施。

Objective : How to decrease the growth of medical and health-care expenditure is the most important challenge in many countries.Cost utility analysis provides a guide of making decisions among the limited medical resources. The purpose of the study was to evaluate the health related quality of life, quality-adjusted life years (QALYs) and cost utility of walk training on community-dwelling elderly. Design : A prospective randomized controlled clinical trial. Methods : The aged 65 and older in Keelung were included in this study. An experiment group received the 12-week walk training and interview of SF-36 and cost before and after the training. A control group received no treatment. A conversion was applied to the SF-36 to derive a preference-based health related quality of life (health utility index), QALYs and the incremental cost-utility ratio (ICUR). Results: 38 older adults in each group finished this study completely. The aged in the training group demonstrated significant improvement in physical functioning, social functioning, role limitaion due to emotional problems and mental health among the domains of SF-36. 0.248+0.034 QALYs were derived in the training group.Thus the ICUR was NT 389,092/ QALY. Conclusions: Our results suggest that walk training on community-dwelling elderly can show a positive trend toward economic considerations.