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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳秀熙 | |
dc.contributor.author | Hou-Ling Lung | en |
dc.contributor.author | 龍厚玲 | zh_TW |
dc.date.accessioned | 2021-06-16T08:11:30Z | - |
dc.date.available | 2014-10-20 | |
dc.date.copyright | 2014-10-20 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-02-19 | |
dc.identifier.citation | 1. U_S_ Preventive Services Task Force Recommendation Statement. Newborn hearing screening: recommendations and rationale.
2. Joint Committee on Infant Hearing. Position statement. Int J Ped Otorhinolaryngol 1995;32:265-74 3. Yoshinaga-Itano C, Sedey AL, Coulter DK, et al. Language of early- and later-identified children with hearing loss. Pediatrics 1998;102:1161-71. 4. Northern JL, Downs MP: Hearing in Children.4 th ed. Baltimore: Williams & Wilkins,1991:263 5. Kennedy C, McCann D, Campbell MJ, Kimm L, Thornton R. Universal newborn screening for permanent childhood hearing impairment: an 8-year follow-up of a controlled trial. Lancet 2005;366(9486):660–662 6. Robson et al. Congenital hearing impairment., Pediatr Radiol 2006;36: 309–324 7. Mehl AL et al. Newborn hearing screening: the great omission. Pediatrics 1997;101(1): 84 8. Mason et al. Universal Infant Hearing Screening by Automated Auditory Brainstem Response Measurement. Pediatrics 1998;101(2):221-228 9. Robin RJ. Diagnosis of deafness in infancy, Pediatr. Rev 1987:9;163–166 10. Wolff R et al, Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening, Arch Dis Child 2010;95:130–135 11. Lin HC, Shu MT, Chang KC, Bruna SM. A universal newborn hearing screening program in Taiwan. International Journal of Pediatric Otorhinolaryngology 2002;63:209–218 12. Keren et al. Projected Cost-Effectiveness of Statewide Universal Newborn Hearing Screening. PEDIATRICS 2002; 110(5):855-864 13. Robertson C, Aldridge S, Jarman F, et al. Late diagnosis of congenital sensorineural hearing impairment: why are detection methods failing? Arch Dis Child 1995;72:11–15. 14. Robson et al.,Congenital hearing impairment. Pediatr Radiol 2006;36: 309–324 15. Mason S, Davis A, Wood S, Farnsworth A Field sensitivity of targeted neonatal hearing screening using the Nottingham ABR Screener. Ear Hear 1998;19(2):91-102. 16. Lutman ME, Davis AC, Fortnum HM, Wood S. Field sensitivity of targeted neonatal hearing screening by transient-evoked otoacoustic emissions. Ear Hear 1997;18(4):265-76. 17. Screening for hearing impairment. US Preventive Services Task Force. In: Guideto Clinical Preventive Services. 2nd ed. Alexandria, Va: International Medical Publishing; 1996:933. 18. Herrmann BS, Thornton AR, Joseph JM. Automated infant hearing screening using the ABR: development and validation. Am J Audiol. 1995;4:6-14. 19. Weirather YP, Korth N, White KR, Downs D, Woods-Kershner N. Cost analysis of TEOAE-based universal newborn hearing screening. J Commun Disord 1997;30(6):477-92 . 20. Downs MP. Universal newborn hearing screening: the Colorado story. Int J Pediatr Otorhinolaryngol 1995;32:257-259. 21. Burke et al. The economics of screening infants at risk of hearing impairment: An international analysis. International Journal of Pediatric Otorhinolaryngology 2012;76 :212–218 22. Yoshinaga-Itano C. Coulter D. Thomson V. Developmental outcomes of children with hearing loss born in Colorado hospitals with and without universal newborn hearing screening programs. Seminars in Neonatology 2000;6(6):521-529 23. Yoshinaga-Itano C. Coulter D. Thomson V. The Colorado Newborn Hearing Screening Project: effects on speech and language development for children with hearing loss. Journal of Perinatology 2000;20:S132-137 24. Kennedy CR, McCann DC, Campbell MJ, et al. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med 2006;354:2131–2141 25. Grill E, Uus K, Hessel F et al. Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening. BMC Health Services Research 2006;6:14 26. Gemeinsamer Bundesausschuss. Gemeinsamer Bundesausschuss beschlieβtweitere Früherkennungsuntersuchung für Kinder. http://www.g-ba.de/informationen /aktuell/pressemitteilungen/244/ 27. Methods for economic evaluation of marketed medicines II: Conducting primary economic evaluation. Chin J Evid Based Med 2006;6:218–223 28. Decision-analytical modelling in health-care economic evaluations. Eur J Health Econ 2008;9:313–323 29. Porter et al.Using Benefit-Cost Ratio to Select Universal Newborn Hearing Screening Test Criteria. Eer & Hearing, 2009;30:447–457 30. Gorga et al.Cost-effectiveness and test-performance factors in relation to universal newborn hearing screening. Mental Retardation & Developmental Disabilities Research Reviews 2003,9(2):103-108 31. Huange et al. Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized? BMC Health Services Research 2012;12:97 32. Wake M, Poulakis Z, Hughes EK, Carey-Sargeant C, Rickards FW. Hearing impairment: a population study of age at diagnosis, severity, and language outcomes at 7-8 years. Arch Dis Child. 2005;90(3):238-44. 33. Pittman AL, Stelmachowicz PG. Hearing loss in children and adults: audiometric configuration, asymmetry, and progression. Ear Hear 2003;24(3):198-205. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/58327 | - |
dc.description.abstract | 研究背景
先天性聽力缺損發生率在世界各國約為千分之 1~3,遠高於其他新生兒先天性疾病發生率。罹患新生兒聽力缺損的病童,若無早期發現及矯治,其語言及非語言溝通能力將受影響,導致學習不良及社會適應障礙,生活品質終其一生將受持續性影響,亦將影響社會財政上的負擔。因此各國開始探討全面性新生兒聽力篩檢之可行性;然而實施全面性大規模篩檢將牽涉龐大之經費支出,如何對全面性新生兒聽力篩檢策略進行成本效益評估,對衛生政策決策者而言十分重要。 研究目的 本論文研究之主要目的是分別以馬可夫決策樹決定型模式及馬可夫決策樹隨機型模式成本效用分析方法,評估三種不同的全面性新生兒聽力篩檢策略。 研究方法 本研究針對臺灣地區新生兒世代共 20 萬人,研究設計以馬可夫決策樹模式針對全面性新生兒耳聲傳射法篩檢、全面性新生兒自動聽性腦幹反射法篩檢及不實施全面性新生兒聽力篩檢三種篩檢策略進行成本效用分析。有關效用及成本分析參數的來源主要來自文獻查證。效用評估乃利用聽力缺損之臨床語言測驗評估進行效用折算。另外考慮參數的不確定性,我們選用適合的統計分佈,運用蒙地卡羅模擬,進行5000 次的電腦模擬。結果的呈現是比較不同篩檢策略之下之增加成本效用比(incremental cost-utility ratio, ICUR)、成本效用接受曲線(acceptability curve)及淨利益值(net benefit)。 研究結果 成本效用分析結果發現不論是以OAE或aABR進行全面性新生兒聽力篩檢,相較於不進行聽力篩檢,兩種篩檢策略均是節省成本的。若以OAE 進行全面性新生兒聽力篩檢,相較於無篩檢,可節省27.5 美元的成本,且可多獲得0.0017的效用值,其增加成本效用比為-4800.89 (-24475.83, 15351.54)。實施aABR 篩檢策略,與無篩檢策略比較,可節省14.25 美元且多獲得0.031 的效用值,其增加成本效用比為-4111.23(-22540.02, 13774.97)。若實施aABR 篩檢策略,與OAE 篩檢策略比較需多花費13.24 美元,但多獲得0.0014 的效用值,其增加成本效用比為6273.2(-15421.2, 28936.5)。以機率性敏感度分析則發現,在成本效用接受曲線分析中,與不篩檢策略相較,aABR 有高達91%的機會是具成本效用的;且aABR 策略較OAE 策略有較高之增加淨利益。 結論 不論以 OAE 或aABR 篩檢工具進行全面性新生兒聽力篩檢,相較於不進行新生兒全面性聽力篩檢,都是節省成本的。本研究結果支持目前臺灣地區所推行利用 aABR 進行全面性新生兒聽力篩檢之策略,以社會觀點而言,基於實證醫學的基礎,本研究支持這個政策應持續執行。 | zh_TW |
dc.description.abstract | Background
Congenital hearing impairment is one of the most prevalent congenital anomaly, afflicting 1 to 3 per 1000 newborn infants. Without early recognition and intervention, patients’ language ability would be delayed, leading to suboptimal school performance and production loss, which further causing significant socio-economic cost. Universal newborn hearing screening (UNHS) has been suggested for early identification worldwide. However, enormous costs would be involved for a large-scale newborn hearing screening program. The grasp of the balance between utility and costs for the implementation of such universal newborn hearing screening is of importance to health decision-maker. Aim The objective was to propose a Markov decision tree model to perform deterministic and probabilistic cost-utility analysis of universal newborn hearing screening in Taiwan. Material and methods A Markov decision tree model was framed with three strategies: UNHS with otoacoustic emission (OAE) test, automatic acoustic brainstem reflex (aABR) test, and no UNHS (natural history model). The target population was all newborn babies in health insurance system in Taiwan. The parameters for analysis were derived from literatures. The utility was evaluated using scores of Clinical Evaluation of Language Fundamentals (CELF) test. By assigning the specific statistical distribution to each parameter, Monte Carlo simulation with 5000 trials was therefore applied to capture the parameter uncertainty. We then present the outcome in terms of incremental cost-utility ratios (ICURs), acceptability curve, and incremental net benefit (INB) under varying prevention strategies. Results Cost-utility analysis reveals UNHS with OAE and aABR were the two cost-saving strategies compared with no UNHS. For a hypothetical population of 200,000 newborns, the incremental cost-utility ratios for OAE and aABR against the no screening strategy were calculated as $-4800.89 (-24475.83, 15351.54) and $-4111.23(-22540.02, 13774.97) for per utility gained, respectively. The incremental cost-utility ratio for aABR against OAE was calculated as $6273.2(-15421.2, 28936.5) for per utility gained. aABR strategy demonstrates a up to 91% higher probability of being cost-utility compared with no screening demonstrated in acceptability curve, and higher incremental net monetary benefit compared with OAE. Conclusion Compared to no screening, UNHS with OAE and aABR are both cost-saving. aABR is the most economic one. These findings, although they are still uncertain, suggest a nationwide universal newborn screening for hearing loss with aABR, from societal viewpoint, can be continued under the evidence-based principle. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T08:11:30Z (GMT). No. of bitstreams: 1 ntu-103-P00849004-1.pdf: 1889572 bytes, checksum: 253ac0d8c945230382b0c167ebca2a9b (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 誌謝………………………………………………………………………1
中文摘要…………………………………………………………………2 Abstract 5 目錄 8 圖表目錄....................................................................................................9 第一章 前言 10 一、研究背景.......................................................................................10 二、研究動機及目的...........................................................................11 第二章 文獻回顧 14 一、先天性聽力缺損............................................................................14 二、新生兒聽力篩檢...........................................................................16 三、健康政策的經濟分析....................................................................21 四、全面性新生兒聽力篩檢之成本效用分析....................................24 第三章 研究步驟及方法 28 一、研究族群........................................................................................28 二、馬可夫決策研究設計....................................................................29 三、參數來源........................................................................................34 四、決定性(Deterministic)及隨機性(Stochastic)模式對於參數不確定性之處理..................................................................................................37 五、成本效用測量...............................................................................39 第四章 研究結果 43 一、決定性模式之成本效用分析.......................................................43 二、隨機性模式之成本效用分析........................................................61 第五章 討論 75 第六章 結論 81 參考文獻 82 | |
dc.language.iso | zh-TW | |
dc.title | 全面性新生兒聽力篩檢之隨機成本效用分析 | zh_TW |
dc.title | Probabilistic Cost-utility Analysis of Universal Newborn
Hearing Screening | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 邱淑媞,楊銘欽,李永凌,陳立昇 | |
dc.subject.keyword | 成本效用分析,馬可夫模式,決策樹,全面性新生兒聽力篩檢, | zh_TW |
dc.subject.keyword | cost-utility analysis,Markov model,decision tree,universal newborn hearing screening, | en |
dc.relation.page | 88 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2014-02-19 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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