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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 黃崇興 | |
dc.contributor.author | Chang-Hao Yang | en |
dc.contributor.author | 楊長豪 | zh_TW |
dc.date.accessioned | 2021-06-08T06:56:52Z | - |
dc.date.copyright | 2009-07-24 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-07-21 | |
dc.identifier.citation | 一、 中文參考資料
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Ophthalmology. 2003 Jul;110(7):1297-305. 三、網站資料: 中華民國行政院衛生署衛生統計資訊網, 衛生統計( 二) 生命統計 http://www.doh.gov.tw/statistic/index.htm 中央健保局網站: http:/www. nhi.gov.tw/uidex.asp. 中央健康保險局: 全民健康保險支付標準 http://www.nhi.gov.tw/20download/index download.htm 2003/4/7 中央健康保險局: 眼科審查汱意事項及白內障手術事前審查作業規定 http://www.nhi.gov.tw/02hospital/hospital 33.htm 2003/4/7 實證醫學入口網站 : WWW.CCH.ORG.TW/EMB www.hint.org.tw www.cebm.net www.cochrane.org 電子期刊資料庫: www.pubmed.com www.hint.org.tw/cgi-bin/ovidweb/ovidweb.cgi | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/25904 | - |
dc.description.abstract | 健康照護是人類的基本需求,也是作為衡量一個現代化國家整體發展進步程度的重要指標。根據觀察,許多工業化國家在經濟成長使國民所得提高後,一般消費者對醫療保健的需求也隨之增加。加上科技進步使得國民平均壽命延長與生育率的改變,人口結構老化所產生長期健康照護問題,均可能面臨國民醫療保健費用不斷增加的趨勢,且有產生惡性循環的財政危機。在資源之利用有限的情況下,如何能合理地分配資源作妥善的利用而不浪費,同時讓人民感受到獲得充分的照顧而感到滿足,將是在21世紀人們必須慎重面對的課題。這種問題美國特別嚴重,歐美先進國家亦是如此,台灣在全民健保實施多年之後,同時也面臨相同的問題,這種問題急待解決,如果曠日持久,醫療照護終將成為社會民生問題的重大負担。
要解決問題必須仰賴科學的理論及方法,近二十年來為解決醫療照護的問題,應用經濟學的理論而發展出來的醫療經濟學及葯物經濟學益受重視,在國外已有學者專注於此種新興科學的研究,反觀國內此項研究仍處於萌芽階段,至於在眼科疾病的研究方面,則尚未開始。 所以本研究針對三種可以嚴重影響國人視力的疾病:白內障、年性黃斑部病變、高度近視合併黃斑部脈絡膜新生血管,應用葯物經濟學的原理,針對目前或是即將發展之治療方式進行成本效用分析。 白內障手術以決策樹模型分析、以成本與品質校正生活年(QALY)之比值為評估標準,研究發現在現行之全民健保給付政策下,民眾可以獲得符合成本效用原則的手術結果。我們以馬可夫鏈模型評估抗血管新生藥物在治療高度近視合併黃斑部脈絡膜新生血管之成本效用。兩種藥物Ranibizumab 及 Bevacizumab 在治療上具有相似的效用,但在成本上差異頗大,Ranibizumab 具有較高的成本。我們亦以馬可夫鏈模型評估不同的Ranibizumab 注射次數對於治療老年性黃斑部病變之成本效用。研究發現改變注射時間及次數可以達到相似的效用而顯著減少成本。 本研究發現藉由成本效用分析的結果可以用來比較各種治療方式的優劣。同時在健保費用不斷高漲而健保經費資源有限的情況下,以此種分析方法可以作為日後健保訂定葯物、手術給付價格,乃至於健保政策擬定上的參考。 | zh_TW |
dc.description.abstract | Value-based medicine incorporates the most valid evidence-based medicine and takes it to a higher level by incorporating patient-based preferences to measure the “value” conferred by an intervention. This value is then amalgamated with the resources expended on an intervention to produce a cost utility analysis, the hallmark instrument providing the foundation for value-based medicine. Value-based medicine is becoming increasingly important in the evaluation of health care interventions, including many within ophthalmology.
Within this thesis, cost-utility analysis was applied to analyze three most important eye diseases in Taiwan; cataract, high myopia associated with macular choroidal neovascularization, and age-related macular degeneration. Initial cataract surgery, compared with observation, resulted in a mean gain of 1.63 QALYs per patient. A 3% annual discount rate was used to account for the benefit over time, yielding 1.17 QALYs gained. The mean cost of treatment of each patient totaled $25,993. The cost divided by the discounted benefit resulted in $22,216/QALY gained for this procedure. Markov chain model was used to evaluate the effect of two anti-angiogenic agents, Ranibizumab and Bevacizumab, on macular choroidal neovascularization in high myopic patients. Cost-utility analysis revealed that Ranibizumab and Bevacizumab had similar treatment effect on visual utility in a three-year treatment duration. However, the cost of Ranibizumab was more expensive than Bevacizumab. Markov chain model was also used to evaluate the effect of change treatment regimens of Ranibizumab injection on patients of age-related macular degeneration associated with choroidal neovascularization. Within a five-year treatment duration, changing the dosing schedule of Ranibizumab injection from 12 injections per year to 6 injections per year, significantly reduced the cost without affecting the therapeutic efficacy. In an era of burgeoning technology, characterized by an ever increasing number of costly and confusing diagnostic tests and therapeutic interventions, decision analysis has an increasing role. It is anticipated that cost-utility analysis will play a major role in health care within the coming decades. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T06:56:52Z (GMT). No. of bitstreams: 1 ntu-98-P96743007-1.pdf: 954892 bytes, checksum: a21afc9135fe9ac4ee4b47072bb4fb58 (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 口試委員審定書 ii
誌謝 iii 中文摘要 iv 英文摘要 vi 目 錄 viii 圖目錄 x 表目錄 xi 第一章 緒 論 1 1.1、研究背景 1 1.2、研究動機 12 1.3、研究目的 14 1.4、論文結構 15 第二章 文獻探討 17 2.1、引言 17 2.2、實證醫學 20 2.3、以價值為基礎之醫學(value-based medicine) 27 2.4、醫療之經濟學評估方法 29 2.5、成本效用分析(Cost-utility analysis) 31 第三章 白內障手術之成本-效用分析 43 3.1、 前言 43 3.2、 研究步驟與方法 45 3.3、 結果 51 3.4、 總結 52 第四章 玻璃体內注射Ranibizumab 或Bevacizumab 以治療高度近視黃斑部脈絡膜新生血管之成本效用分析 53 4.1、 前言 53 4.2、 研究步驟與方法 55 4.3、 結果 58 4.4、總結 61 第五章 玻璃体內注射Ranibizumab 以治療老年性黃斑部病變脈絡膜 新生血管之成本效用分析 62 5.1、 前言 62 5.2、 研究步驟與方法 66 5.3、 結果 70 5.4、 總結 72 第六章 討論與分析 73 6.1 研究結果之分析及討論 73 6.2 研究限制 80 6.3 結論 80 參考文獻 82 附錄 90 | |
dc.language.iso | zh-TW | |
dc.title | 由實證醫學到以價值為基礎之醫學:應用成本-效用分析於眼科疾病之研究 | zh_TW |
dc.title | From Evidence-Based Medicine to Value-Based Medicine:
Application of Cost-Utility Analysis for Ophthalmic Diseases | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳明豐,葉明義 | |
dc.subject.keyword | 實證醫學,成本效用分析,葯物經濟學,決策樹,馬可夫鏈,白內障手術,老年性黃斑部病變,高度近視黃斑部脈絡膜新生血管, | zh_TW |
dc.subject.keyword | Value-based medicine,Evidence-based medicine,Cost-utility analysis,Decision tree analysis,Markov chain,Cataract,High myopia associated macular choroidal neovascularization,Age-related macular degeneration, | en |
dc.relation.page | 92 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2009-07-22 | |
dc.contributor.author-college | 管理學院 | zh_TW |
dc.contributor.author-dept | 高階公共管理組 | zh_TW |
顯示於系所單位: | 高階公共管理組 |
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