請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/28235
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳秀熙(Hsiu-Hsi Chen) | |
dc.contributor.author | Po-Chien Huang | en |
dc.contributor.author | 黃柏堅 | zh_TW |
dc.date.accessioned | 2021-06-13T00:03:18Z | - |
dc.date.available | 2010-11-22 | |
dc.date.copyright | 2007-08-08 | |
dc.date.issued | 2007 | |
dc.date.submitted | 2007-07-30 | |
dc.identifier.citation | 中文文獻:
于大雄:泌尿道常見疾病診療共識初勘。台灣泌尿科醫學會訊、第一五五期,頁25-31,2006 台灣泌尿科醫學會 http://www.tua.org.tw 行政院內政部統計資訊服務處http://sowf.moi.gov.tw/stat/ 行政院中央健康保險局,全民健保統計年報, 民國94年 http://www.nhi.gov.tw 行政院主計處 http://www.dgbas.gov.tw 行政院衛生署,民國94年死因統計年報 http://www.doh.gov.tw 李瀛輝,黃榮慶,陳明村,張心湜:性別與年齡在上尿路結石流行病學所扮演之角色。中華泌尿醫誌、第三卷,頁824-830,1992 李瀛輝,張心湜,陳明村,黃榮慶:臺灣南部地區尿路結石流行病學之研究。中華泌尿醫誌、第五卷,頁1-6,1994 黃季怡:輸尿管結石治療的成本與效果分析—以某台北市立醫院為例。國立台灣大學碩士論文,2000 英文文獻: Abdulhadi, M. H., Hall, P. M., Streem, S. B., Abdulhadi, M. H., Hall, P. M., and Streem, S. B.: Can citrate therapy prevent nephrolithiasis? Urology, 41: 221, 1993. Abe, T., Akakura, K., Kawaguchi, M., Ueda, T., Ichikawa, T., Ito, H. et al.: Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol, 19: 768, 2005. Andankar, M. G., Maheshwari, P. N., Saple, A. L., Mehta, V., Varshney, A., Bansal, B. et al.: Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy. J Postgrad Med, 47: 177, 2001. Bagley, D. H.: Expanding role of ureteroscopy and laser lithotripsy for treatment of proximal ureteral and intrarenal calculi. Curr Opin Urol, 12: 277, 2002. Bierkens, A. F., Hendrikx, A. J., De La Rosette, J. J., Stultiens, G. N., Beerlage, H. P., Arends, A. J. et al.: Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol, 81: 31, 1998. Biri, H., Kupeli, B., Isen, K., Sinik, Z., Karaolan, U., Bozkirli, I. et al.: Treatment of lower ureteral stones: extracorporeal shockwave lithotripsy or intracorporeal lithotripsy? J Endourol, 13: 77, 1999. Borghi, L., Meschi, T., Guerra, A., Novarini, A., Borghi, L., Meschi, T. et al.: Randomized prospective study of a nonthiazide diuretic, indapamide, in preventing calcium stone recurrences. J Cardiovasc Pharmacol, 22 Suppl 6: S78, 1993. Borghi, L., Meschi, T., Amato, F., Briganti, A., Novarini, A., Giannini, A. et al.: Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol, 155: 839, 1996. Borghi, L., Meschi, T., Schianchi, T., Briganti, A., Guerra, A., Allegri, F. et al.: Urine volume: stone risk factor and preventive measure. Nephron, 81 Suppl 1: 31, 1999. Borghi, L., Schianchi, T., Meschi, T., Guerra, A., Allegri, F., Maggiore, U. et al.: Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med, 346: 77, 2002. Brauer, C. A., Rosen, A. B., Greenberg, D., Neumann, P. J., Brauer, C. A., Rosen, A. B. et al.: Trends in the measurement of health utilities in published cost-utility analyses. Value Health, 9: 213, 2006. Brazier, J., Deverill, M., Green, C., Harper, R., Booth, A., Brazier, J. et al.: A review of the use of health status measures in economic evaluation. Health Technol Assess, 3: i, 1999. Briggs, A. H., O'Brien, B. J., Blackhouse, G., Briggs, A. H., O'Brien, B. J., and Blackhouse, G.: Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Annu Rev Public Health, 23: 377, 2002. Chandhoke, P. S.: Economics of urolithiasis: cost-effectiveness of therapies. Curr Opin Urol, 11: 391, 2001. Chandhoke, P. S.: When is medical prophylaxis cost-effective for recurrent calcium stones? J Urol, 168: 937, 2002. Chang, C. P., Huang, S. H., Tai, H. L., Wang, B. F., Yen, M. Y., Huang, K. H. et al.: Optimal treatment for distal ureteral calculi: extracorporeal shockwave lithotripsy versus ureteroscopy. J Endourol, 15: 563, 2001. Chapman, G. B., Decision Making in Health Care. Theory, Psychology, and Applications. Cambridge University Press, 2000 Chen, H. H., Duffy, S. W., Tabar, L.: A markov chain method to estimate the tumour progression rate from preclinical to clinical phase, sensitivity and positivie predictive value for mammography in breast cancer screening. The Statistician, 45:307-317, 1996 Cost-Effectiveness Analysis Registry Website: http;//www.tufts-nemc.org/cearegistry Curhan, G. C., Willett, W. C., Rimm, E. B., Stampfer, M. J., Curhan, G. C., Willett, W. C. et al.: A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med, 328: 833, 1993. Dushinski, J. W., Lingeman, J. E., Dushinski, J. W., and Lingeman, J. E.: Urologic applications of the Holmium laser. Tech Urol, 3: 60, 1997. Eden, C. G., Mark, I. R., Gupta, R. R., Eastman, J., Shrotri, N. C., Tiptaft, R. C. et al.: Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on success rates. J Endourol, 12: 307, 1998. Efstathiou, S. P., Pefanis, A. V., Tsioulos, D. I., Zacharos, I. D., Tsiakou, A. G., Mitromaras, A. G. et al.: Acute pyelonephritis in adults: prediction of mortality and failure of treatment. Arch Intern Med, 163: 1206, 2003. Ettinger, B. and Ettinger, B.: Recurrent nephrolithiasis: natural history and effect of phosphate therapy. A double-blind controlled study. Am J Med, 61: 200, 1976. Ettinger, B. and Ettinger, B.: Recurrence of nephrolithiasis. A six-year prospective study. Am J Med, 67: 245, 1979. Ettinger, B., Tang, A., Citron, J. T., Livermore, B., Williams, T., Ettinger, B. et al.: Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N Engl J Med, 315: 1386, 1986. Ettinger, B., Citron, J. T., Livermore, B., Dolman, L. I., Ettinger, B., Citron, J. T. et al.: Chlorthalidone reduces calcium oxalate calculous recurrence but magnesium hydroxide does not. J Urol, 139: 679, 1988. Ettinger, B., Pak, C. Y., Citron, J. T., Thomas, C., ms-Huet, B., Vangessel, A. et al.: Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J Urol, 158: 2069, 1997. Farkas, A., Peteri, L., Lorincz, L., Salah, M. A., Flasko, T., Varga, A. et al.: Holmium:YAG laser treatment of ureteral calculi: A 5-year experience. Lasers Med Sci, 21: 170, 2006. Fine, J. K., Pak, C. Y., Preminger, G. M., Fine, J. K., Pak, C. Y., and Preminger, G. M.: Effect of medical management and residual fragments on recurrent stone formation following shock wave lithotripsy. J Urol, 153: 27, 1995. Fong, Y. K., Ho, S. H., Peh, O. H., Ng, F. C., Lim, P. H., Quek, P. L. et al.: Extracorporeal shockwave lithotripsy and intracorporeal lithotripsy for proximal ureteric calculi--a comparative assessment of efficacy and safety. Ann Acad Med Singapore, 33: 80, 2004. Fuchs, G. J., Yurkanin, J. P., Fuchs, G. J., and Yurkanin, J. P.: Endoscopic surgery for renal calculi. Curr Opin Urol, 13: 243, 2003. Glowacki, L. S., Beecroft, M. L., Cook, R. J., Pahl, D., Churchill, D. N., Glowacki, L. S. et al.: The natural history of asymptomatic urolithiasis. J Urol, 147: 319, 1992. Hofbauer, J., Hobarth, K., Szabo, N., Marberger, M., Hofbauer, J., Hobarth, K. et al.: Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis--a prospective randomized study. Br J Urol, 73: 362, 1994. Hsu, T. C., Chen, J., Huang, H. S., Wang, C. J., Hsu, T. C., Chen, J. et al.: Association of changes in the pattern of urinary calculi in Taiwanese with diet habit change between 1956 and 1999. J Formos Med Assoc, 101: 5, 2002. Hautmann, S., Friedrich, M. G., Fernandez, S., Steuber, T., Hammerer, P., Braun, P. M. et al.: Extracorporeal shockwave lithotripsy compared with ureteroscopy for the removal of small distal ureteral stones. Urol Int, 73: 238, 2004. Hendrikx, A. J., Strijbos, W. E., de Knijff, D. W., Kums, J. J., Doesburg, W. H., Lemmens, W. A. et al.: Treatment for extended-mid and distal ureteral stones: SWL or ureteroscopy? Results of a multicenter study. J Endourol, 13: 727, 1999. Honeck, P., Hacker, A., Alken, P., Michel, M. S., Knoll, T., Honeck, P. et al.: Shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective study. Urol Res, 34: 190, 2006. Hosking, D. H., Erickson, S. B., Van den Berg, C. J., Wilson, D. M., Smith, L. H., Hosking, D. H. et al.: The stone clinic effect in patients with idiopathic calcium urolithiasis. J Urol, 130: 1115, 1983. Hosking, D. H., Smith, W. E., McColm, S. E., Hosking, D. H., Smith, W. E., and McColm, S. E.: A comparison of extracorporeal shock wave lithotripsy and ureteroscopy under intravenous sedation for the management of distal ureteric calculi. Can J Urol, 10: 1780, 2003. Hubner, W. A., Irby, P., Stoller, M. L., Hubner, W. A., Irby, P., and Stoller, M. L.: Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol, 24: 172, 1993. Iguchi, M., Umekawa, T., Ishikawa, Y., Katayama, Y., Kodama, M., Takada, M. et al.: Clinical effects of prophylactic dietary treatment on renal stones. J Urol, 144: 229, 1990. Keeley, F. X., Jr., Tilling, K., Elves, A., Menezes, P., Wills, M., Rao, N. et al.: Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones. BJU Int, 87: 1, 2001. Kocvara, R., Plasgura, P., Petrik, A., Louzensky, G., Bartonickova, K., Dvoracek, J. et al.: A prospective study of nonmedical prophylaxis after a first kidney stone. BJU Int, 84: 393, 1999. Karlsen, S. J., Renkel, J., Tahir, A. R., Angelsen, A., Diep, L. M.: Extracorporeal shockwave lithotripsy versus ureteroscopy for 5- to 10-mm stones in the proximal ureter: Prospective effectiveness patient-preference trial. J Endourol, 21: 28,2007. Kupeli, B., Biri, H., Isen, K., Onaran, M., Alkibay, T., Karaoglan, U. et al.: Treatment of ureteral stones: comparison of extracorporeal shock wave lithotripsy and endourologic alternatives. Eur Urol, 34: 474, 1998. Kuo, R. L., Aslan, P., Abrahamse, P. H., Matchar, D. B., Preminger, G. M., Kuo, R. L. et al.: Incorporation of patient preferences in the treatment of upper urinary tract calculi: a decision analytical view. J Urol, 162: 1913, 1999. Lam, J. S., Greene, T. D., Gupta, M., Lam, J. S., Greene, T. D., and Gupta, M.: Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol, 167: 1972, 2002. Lee, Y. H., Huang, W. C., Tsai, J. Y., Huang, J. K., Lee, Y. H., Huang, W. C. et al.: The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: a midterm followup study. J Urol, 161: 1453, 1999. Lee, Y. H., Huang, W. C., Tsai, J. Y., Lu, C. M., Chen, W. C., Lee, M. H. et al.: Epidemiological studies on the prevalence of upper urinary calculi in Taiwan. Urol Int, 68: 172, 2002. Lee, Y. H., Tsai, J. Y., Jiaan, B. P., Wu, T., Yu, C. C., Lee, Y. H. et al.: Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones. Urology, 67: 480, 2006. Lindqvist, K., Holmberg, G., Peeker, R., Grenabo, L., Lindqvist, K., Holmberg, G. et al.: Extracorporeal shock-wave lithotripsy or ureteroscopy as primary treatment for ureteric stones: a retrospective study comparing two different treatment strategies. Scand J Urol Nephrol, 40: 113, 2006. Lotan, Y., Gettman, M. T., Roehrborn, C. G., Cadeddu, J. A., Pearle, M. S., Lotan, Y. et al.: Management of ureteral calculi: a cost comparison and decision making analysis. J Urol, 167: 1621, 2002. Lotan, Y., Cadeddu, J. A., Roerhborn, C. G., Pak, C. Y., Pearle, M. S., Lotan, Y. et al.: Cost-effectiveness of medical management strategies for nephrolithiasis. J Urol, 172: 2275, 2004. Lotan, Y., Cadeddu, J. A., Pearle, M. S., Lotan, Y., Cadeddu, J. A., and Pearle, M. S.: International comparison of cost effectiveness of medical management strategies for nephrolithiasis. Urol Res, 33: 223, 2005. Mays, N: Relative costs and cost-effectiveness of extracorporeal shock-wave lithotripsy versus percutaneous nephrolithotomy in the treatment of renal and ureteric stones. Soc Sci Med, 32: 1401, 1991. McFarlane, P. A., Bayoumi, A. M., Pierratos, A., Redelmeier, D. A., McFarlane, P. A., Bayoumi, A. M. et al.: The impact of home nocturnal hemodialysis on end-stage renal disease therapies: a decision analysis. Kidney Int, 69: 798, 2006. Menon, M., Resnick M.I.: Urinary lithiasis: etology, diagnosis, and medical management. In: Walsh P. C., Retik, A. B., Vaughan E. D. Jr., Wein, A. J.: Campbell’s Urology, 8th, Saunders co., Philadelphia, PA, 2002. Ohkawa, M., Tokunaga, S., Nakashima, T., Orito, M., Hisazumi, H., Ohkawa, M. et al.: Thiazide treatment for calcium urolithiasis in patients with idiopathic hypercalciuria. Br J Urol, 69: 571, 1992. Pace, K. T., Weir, M. J., Tariq, N., Honey, R. J., Pace, K. T., Weir, M. J. et al.: Low success rate of repeat shock wave lithotripsy for ureteral stones after failed initial treatment. J Urol, 164: 1905, 2000. Pak, C. Y.: Citrate and renal calculi. Miner Electrolyte Metab, 13: 257, 1987. Parker, B. D., Frederick, R. W., Reilly, T. P., Lowry, P. S., Bird, E. T., Parker, B. D. et al.: Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser. Urology, 64: 1102, 2004. Parks, J. H., Coe, F. L., Parks, J. H., and Coe, F. L.: The financial effects of kidney stone prevention. Kidney Int, 50: 1706, 1996. Pearle, M. S., Roehrborn, C. G., Pak, C. Y., Pearle, M. S., Roehrborn, C. G., and Pak, C. Y.: Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis. J Endourol, 13: 679, 1999. Pearle, M. S., Nadler, R., Bercowsky, E., Chen, C., Dunn, M., Figenshau, R. S. et al.: Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. J Urol, 166: 1255, 2001. Pertel, P. E., Haverstock, D., Pertel, P. E., and Haverstock, D.: Risk factors for a poor outcome after therapy for acute pyelonephritis. BJU Int, 98: 141, 2006. Peschel, R., Janetschek, G., Bartsch, G., Peschel, R., Janetschek, G., and Bartsch, G.: Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study. J Urol, 162: 1909, 1999. Petitti D. A.:Meta-analysis, decision analysis, and cost-effectiveness analysis : methods for quantitative synthesis in medicine. 2nd. New York : Oxford University Press, 2000 Redelmeier, D. A., Detsky, A. S., Redelmeier, D. A., and Detsky, A. S.: A clinician's guide to utility measurement. Prim Care, 22: 271, 1995. Rous, S. N., Turner, W. R., Rous, S. N., and Turner, W. R.: Retrospective study of 95 patients with staghorn calculus disease. J Urol, 118: 902, 1977. Scholz, D., Schwille, P. O., Sigel, A., Scholz, D., Schwille, P. O., and Sigel, A.: Double-blind study with thiazide in recurrent calcium lithiasis. J Urol, 128: 903, 1982. Segura, J. W., Preminger, G. M., Assimos, D. G., Dretler, S. P., Kahn, R. I., Lingeman, J. E. et al.: Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol, 158: 1915, 1997. Spiegelhalter, D. J. and Best, N. G.: Bayesian approaches to multiple sources of evidence and uncertainty in complex cost-effectiveness modelling. Stat Med, 22: 3687, 2003. Straub, M., Strohmaier, W. L., Berg, W., Beck, B., Hoppe, B., Laube, N. et al.: Diagnosis and metaphylaxis of stone disease. Consensus concept of the National Working Committee on Stone Disease for the upcoming German Urolithiasis Guideline. World J Urol, 23: 309, 2005. Strauss, A. L., Coe, F. L., Deutsch, L., Parks, J. H., Strauss, A. L., Coe, F. L. et al.: Factors that predict relapse of calcium nephrolithiasis during treatment: a prospective study. Am J Med, 72: 17, 1982. Streem, S. B., Yost, A., Mascha, E., Streem, S. B., Yost, A., and Mascha, E.: Clinical implications of clinically insignificant store fragments after extracorporeal shock wave lithotripsy. J Urol, 155: 1186, 1996. Strohmaier, W. L., Schubert, G., Rosenkranz, T., Weigl, A., Strohmaier, W. L., Schubert, G. et al.: Comparison of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of ureteral calculi: a prospective study. Eur Urol, 36: 376, 1999. Tiselius, H. G., Ackermann, D., Alken, P., Buck, C., Conort, P., Gallucci, M. et al.: Guidelines on urolithiasis. Eur Urol, 40: 362, 2001. Torrance, G. W. and Torrance, G. W.: Measurement of health state utilities for economic appraisal. J Health Econ, 5: 1, 1986. Turk, T. M., Jenkins, A. D., Turk, T. M., and Jenkins, A. D.: A comparison of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi. J Urol, 161: 45, 1999. Wasserstein, A. G., Stolley, P. D., Soper, K. A., Goldfarb, S., Maislin, G., Agus, Z. et al.: Case-control study of risk factors for idiopathic calcium nephrolithiasis. Miner Electrolyte Metab, 13: 85, 1987. Wolf, J. S., Jr., Carroll, P. R., Stoller, M. L., Wolf, J. S. J., Carroll, P. R., and Stoller, M. L.: Cost-effectiveness v patient preference in the choice of treatment for distal ureteral calculi: a literature-based decision analysis. J Endourol, 9: 243, 1995. Wu, C. F., Shee, J. J., Lin, W. Y., Lin, C. L., Chen, C. S., Wu, C. F. et al.: Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol, 172: 1899, 2004. Wu, C. F., Chen, C. S., Lin, W. Y., Shee, J. J., Lin, C. L., Chen, Y. et al.: Therapeutic options for proximal ureter stone: extracorporeal shock wave lithotripsy versus semirigid ureterorenoscope with holmium:yttrium-aluminum-garnet laser lithotripsy. Urology, 65: 1075, 2005. Yendt, E. R., Cohanim, M., Yendt, E. R., and Cohanim, M.: Prevention of calcium stones with thiazides. Kidney Int, 13: 397, 1978. Yip, S. K., Lee, F. C., Tam, P. C., Leung, S. Y., Yip, S. K., Lee, F. C. et al.: Outpatient treatment of middle and lower ureteric stones: extracorporeal shock wave lithotripsy versus ureteroscopic laser lithotripsy. Ann Acad Med Singapore, 27: 515, 1998. Zanetti, G., Seveso, M., Montanari, E., Guarneri, A., Del, N. A., Nespoli, R. et al.: Renal stone fragments following shock wave lithotripsy. J Urol, 158: 352, 1997. Zeng, G. Q., Zhong, W. D., Cai, Y. B., Dai, Q. S., Hu, J. B., Wei, H. A. et al.: Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi. Asian J Androl, 4: 303, 2002. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/28235 | - |
dc.description.abstract | 一、研究背景及目的
針對輸尿管結石在急性期及慢性期的處理,目前已發展出多樣性的治療方式,亦有標準化的臨床指引,其決策皆以臨床經驗上的治療成功率及醫療專家意見為依據,往往忽略了患者本身的主體性、對治療的接受程度及需付出之機會成本。在面對不同預防及治療選擇時,如何在多種治療組合中求得合理且符合成本效益的臨床策略,乃目前極欲解決的問題。此外,在醫療資源有限的情況下,以社會的角度評估輸尿管結石治療及介入預防的成本效用分析,亦為目前重要的課題。 本研究以實證的資料,結合病人的偏好,以社會的角度,針對輸尿管結石患者,分別評估在急性期及慢性期間最具成本效用的治療及預防結石復發之模式,以作為臨床決策之參考。本研究有以下三個主要研究目的: (一) 針對輸尿管結石治療及預防策略,做一連串系統性文獻回顧,進行輸尿管鏡碎石術及體外震波碎石術在結石清除率上的整合性分析(meta-analysis)。 (二) 利用標準博奕法測量患者對治療的偏好程度 (patient preference),以作為患者在輸尿管結石治療及預防模式中各階段之效用值,並比較不同狀態的效用值大小,並探討解釋效用值變異的因素。 (三) 利用文獻回顧結果及實證資料,建立多階段之疾病處理模型,並針對不同的治療策略及預防模式,進行決定性模式(deterministic analysis)及機率性模式(probabilistic analysis)之成本效用分析,以找出不同情境下最符合成本效益的臨床決策。 二、研究方法 進行文獻回顧,依研究類型分為隨機對照組研究及比較性研究,將結石依部位及大小進行分層,分別進行輸尿管鏡碎石術及體外震波碎石術的結石清除的整合性分析,並估計這二種治療方式之結石清除率及相對效能的估算。 同時,以面訪的方式進行患者偏好度的測量,依據標準博奕法之精神,利用參考狀態的測量,以改良式的標準博奕法測量方式,求得各狀態之相對效用值,再以轉換公式求得絕對效用值,以分辨不同狀態下微小的偏好度差異。進一步利用數值轉換及線性回歸分析,分析影響效用值之相關因子。 接著,由上述整合性分析結果、德菲法求得之專家意見及文獻回顧所得參數的估計,建立結石之急性連續治療模型及慢性結石復發之疾病進展模式。 最後,利用馬可夫模式,建立輸尿管結石急性期及慢性期的成本效用決策樹模型,以蒙地卡羅模擬(Monte Carlo simulation)技術,考慮因機會產生的第一級不確定性及並考慮參數本身所造成的第二級不確定性,進行500個樣本大小為5000人之樣本模擬。由模擬出來的成本及效用參數,分別進行決定性模式分析及機率模式分析的成本效用分析。除了針對不同狀況的輸尿管結石治療策略,逐一比對以選擇最佳的治療方式外,亦針對結石預防的方法進行比較分析,以評估是否需進行特殊性結石預防或定期追蹤治療。 三、主要研究結果 (一) 利用整合性分析結果求得以體外震波碎石術作治療時,依近端結石大小由大至小排列時,其治療成功率為分別為0.303,0.409及0.440。遠端結石而言,由大至小排列時,其治療成功率為分別0.726,0.777及0.831。以輸尿管鏡碎石術作治療時,依近端結石大小由大至小排列,其治療成功率為0.550,0.649及0.649。對於遠端結石而言,依大到小之治療成功率為0.864,0.893,及0.931。 (二) 效用值測量以改良式標準博奕法,針對樣本醫院泌尿科門診共267名結石患者,以隨機抽樣進行問卷訪談,共完成89份有效問卷。分析參考測量的血液透析狀態效用值為0.399±0.343。急性治療中狀況效用值,包括期待性藥物治療(0.935±0.096),體外震波碎石術(0.930±0.098),輸尿管鏡碎石術的效用值(0.914±0.106),及手術治療的效用值(0.846±0.165)。慢性期之狀況包括,無特殊預防(0.959±0.090),生活飲食型態改變(0.974±0.076),定期追蹤(0.971±0.079),及藥物預防(0.955±0.088)。解釋效用值變異的因子包括性別、教育程度及歷經輸尿管鏡碎石手術的經驗。 (三) 對於大型結石而言,若結石處於近端或遠端輸尿管時,均建議以輸尿管鏡碎石為首選治療,合併以輸尿管鏡碎石為挽救治療。對於中型結石而言,若結石位於近端或遠端,均建議使用期待性治療,結石未排出者輔以輸尿管鏡處理結石,為最佳選擇。對於小型結石而言,不論結石位於近端或遠端輸尿管,應選擇以期待性治療為主,若結石未排出時,再採取輸尿管鏡碎石術處理之模式。 (四) 就結石復發預防而言,以結石復發次數為治療結果,分析發現生活飲食調整、藥物預防或接受定期檢查並進行預防性體外震波碎石術,均是符合成本效益的決策,而以生活飲食調整預防為最佳的預防策略。當採用生活品質校正存活時間為結果變項分析成本效用時,發現所有的策略中,僅有生活飲食調整為唯一符合成本效用的預防策略。 四、結論 本研究發展出一種創新的標準博奕法以測量各種與輸尿管結石有關的健康狀態之效用值,其中使用到的整合性分析方法在成本效益分析中的重要性在於可增加資料的強度,並降低重要參數所造成的第二級不確定性。而在考慮個人特質及其主觀意識之臨床個人決策模式時,應採用機率性成本效益分析模式。總結而言,本研究利用正式的成本效用分析,以實證醫學為基礎的觀點提供依輸尿管結石不同部位及大小之下所對應的最佳臨床指引。 | zh_TW |
dc.description.abstract | Introduction
While treatment guidelines for ureteral stone are well established, the decision is often based on the expert opinion and clinical tacit knowledge. Very few studies take the patients’ preference into account and the clinical decision making can make better choice. The aims of this study were to perform meta-analysis of the stone clearance rate of ureteroscopic lithotripsy (URSL) and extracorporeal shock wave lithotripsy (ESWL) by using systemic review, to apply standard gamble method to evaluate the patient preference by utility measurement on every treatment and prevention strategy in ureteral stone management, and finally to use a multi-state disease progressive model to evaluate the cost-effectiveness of every treatment and prevention strategies by deterministic and probabilistic methods. Materials and Methods In the literature review, the published studies were divided into randomized control trials and comparative studies according to the study design. The stone clearance rate and relative effectiveness between URSL and ESWL were estimated by the stratification of stone site and size. The utility values of clinical treatment and prevention conditions were measured by modified standard gamble method. The novel method different from conventional standard gamble method includes setting reference state and ranking the target states. After defining the relative utility values, the absolute utility values (with anchor states of complete health and death) were calculated by chaining transformation method. The modified method may even detect difference between minor clinical conditions. For evaluating the associating factors, the value transformation and linear regression analysis were conducted in this study. Incorporating the results of literature review and expert opinion retrieved by Delphi method, the disease progressive models for acute and chronic phases were established. The cost-utility analysis with the constructed Markov chain model was performed by using Monte Carlo simulation in TreeAge®. Two levels of uncertainty were taken into account in the current probabilistic approach, the first-order uncertainty for chance variability and the second-order uncertainty for parameter uncertainty. The available treatment and prevention strategies were evaluated to define the most cost-effective decision. Main Results 1. The meta-analysis revealed the stone clearance rate of ESWL for large, medium, and small stones were 0.303, 0.409, and 0.440 for proximal stones and 0.726, 0.777, and 0.831 for distal ones. The results of URSL for large, medium, and small stones were 0.550, 0.649, and 0.649 for proximal stones and 0.864, 0.893, and 0.931 for distal ones. 2. In a total of 267 cases from urological clinic, 89 were sampled to complete the utility measurement. The utility value of hemodialysis state, as the reference state, was 0.399±0.343. In acute phase condition, the utility values of expected medical treatment (0.935±0.096), ESWL (0.930±0.098), URSL (0.914±0.106), and invasive surgical treatments (0.846±0.165) were measured. The utility value of chronic conditions were also reported: no prevention (0.959±0.090), life style modification (0.974±0.076), regular surveillance (0.971±0.079), and long term medical prophylaxis (0.955±0.088). The associating factors were gender, education level and experience of URSL. 3. For large ureteral stone, the best treatment strategy was the combination of URSL as primary and salvage therapy. For medium stone, the best method was expectant management with URSL as following treatment choice. For small stone, the best strategy was expectant management with applying URSL for residual stones. 4. By the outcome of recursive events, the life style modification, medical prophylaxis and regular surveillance were cost-effective. In considering the willingness to pay as one quarter GNP (NTD 132000), the best choice is life style modification only. However, taking quality-adjusted life time as the outcome parameter, only life style modification was cost-effective. Conclusion In this study, a novel modified standard gamble method was develop to evaluate the patient preference to treatment and prevention conditions in ureteral stone management. The result was constructed into the cost-utility analysis. By considering individual utility, we adopted the probabilistic approach in cost-utility analysis to establish the clinical guideline for ureteral stone treatment and prevention. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T00:03:18Z (GMT). No. of bitstreams: 1 ntu-96-R94846015-1.pdf: 1292403 bytes, checksum: a7e955a7288511c72ed727dd2b17123e (MD5) Previous issue date: 2007 | en |
dc.description.tableofcontents | 口試委員會審定書.................................... i
中文摘要............................................ iii 英文摘要............................................vii Manuscript I: Modified Standard Gamble Method for Utility Measurement for Ureteral Stone Management............0-1 Manuscript II: Cost-utility Analysis of Acute Ureteral Stone Management.....................................0-11 Manuscript III: Cost-effectiveness Analysis of Prevention of Ureteral Stone: Comparison of Prophylactic Medication, Surveillance, and Life Style Modification............0-33 第一章 緒論..........................................1-1 第一節 前言......................................1-1 第二節 研究動機..................................1-2 第三節 研究目的..................................1-3 第二章 文獻探討......................................2-1 第一節 尿路結石特性..............................2-1 第二節 輸尿管結石之治療決策......................2-4 第三節 輸尿管結石之預防決策......................2-11 第四節 輸尿管結石的病患偏好研究..................2-15 第三章 材料與方法....................................3-1 第一節 研究流程..................................3-1 第二節 文獻資料整合分析..........................3-3 第三節 病患偏好測量..............................3-8 第四節 疾病進展模型..............................3-15 第五節 成本效用分析..............................3-34 第四章 研究結果......................................4-1 第一節 體外震波碎石術及輸尿管鏡碎石術於結石清除率之整 合性分析結果..............................4-1 第二節 效用值測量結果............................4-3 第三節 基本參數推估結果..........................4-5 第四節 急性結石處理決策的成本效用分析............4-19 第五節 慢性結石預防決策的成本效用分析............4-48 第五章 討論..........................................5-1 第一節 本研究的重要發現..........................5-1 第二節 決策模型的臨床應用........................5-3 第三節 效用值測量方法............................5-5 第四節 資料可靠度................................5-6 第五節 本研究之方法學特色........................5-8 第六節 研究限制..................................5-10 第六章 結論..........................................6-1 參考文獻.............................................7-1 附錄.................................................8-1 | |
dc.language.iso | zh-TW | |
dc.title | 輸尿管結石處理成本效用分析 | zh_TW |
dc.title | Cost-Utility Analysis of Ureteral Stone Management | en |
dc.type | Thesis | |
dc.date.schoolyear | 95-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 余宏政(Hong-Jeng Yu) | |
dc.contributor.oralexamcommittee | 陳世乾(Shyh-Chyan Chen),張淑惠(Shu-Hui Chang),楊銘欽(Ming-Chin Yang) | |
dc.subject.keyword | 輸尿管結石,整合性分析,醫療決策分析,成本效用分析,馬可夫模式,病患偏好,效用, | zh_TW |
dc.subject.keyword | Ureteral stone,Meta-analysis,Medical decision making,Cost-utility analysis,Markov model,Patient preference,Utility., | en |
dc.relation.page | 225 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2007-07-31 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-96-1.pdf 目前未授權公開取用 | 1.26 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。