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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 楊銘欽(Ming-Chin Yang) | |
| dc.contributor.author | Yu-Chieh Tseng | en |
| dc.contributor.author | 曾鈺潔 | zh_TW |
| dc.date.accessioned | 2021-06-16T16:25:41Z | - |
| dc.date.available | 2020-10-18 | |
| dc.date.copyright | 2020-09-01 | |
| dc.date.issued | 2020 | |
| dc.date.submitted | 2020-05-13 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/63160 | - |
| dc.description.abstract | 【研究目的】
以衛生福利部中央健康保險署之觀點，使用馬可夫模型評估使用塗藥球囊導管(drug-coated balloon, DCB)及傳統球囊導管(uncoated balloon, UCB)用於治療下肢動脈粥樣硬化(lower-limb atherogenesis)患者之成本效果分析(cost-effectiveness analysis, CEA)。 【研究背景】 使用塗藥球囊導管進行經皮穿刺血管腔內整形術可降低下肢動脈粥樣硬化患者再介入性治療率，並延長其再介入性治療時間。迄今為止，僅有針對美國、德國、英文、義大利及瑞士政府觀點之塗藥球囊導管成本效果分析研究，對於塗藥球囊導管在我國之成本效果尚未知。 【研究方法】 根據IN.PACT SFA II臨床試驗獲得之臨床結果，再透過我國全民健康保險研究資料庫得到我國在治療下肢動脈粥樣硬化之醫療費用，來進行週期(cycles)長度為一個月、期間(time horizon)為兩年之馬可夫模型模擬。 【研究結果】 儘管使用塗藥球囊導管進行經皮穿刺血管腔內整形術之費用會因特材費用較高，但因其再介入性治療率較低，在兩年追蹤後，塗藥球囊導管之總醫療費用會比傳統球囊導管低約新台幣30,000元，並可增加約0.01年之生活品質校正生命年。增額成本效益比值(ICER)顯示DCB為具有優勢(dominant)的介入。使用塗藥球囊導管治療下肢動脈粥樣硬化患者具有成本效果的機率在閾值為一個人均國內生產毛額（新臺幣801,037元）及三個人均國內生產毛額（新臺幣2,403,111元）時，分別為83.5%及90.6%。 【結論】 對於下肢動脈粥樣硬化患者來說，使用塗藥球囊導管進行經皮穿刺血管腔內整形術為效果較佳、成本較低之策略。與過去美國、英國、德國、義大利及瑞士經濟評估結果相同，塗藥球囊導管較傳統球囊導管為具有優勢(dominant)之治療策略。 | zh_TW |
| dc.description.abstract | [Objective]
The aim of this study was to use Markov model simulation to evaluate the cost-effectiveness of using drug-coated balloon (DCB) versus un-coated balloon (UCB) in percutaneous transluminal angioplasty (PTA) from the perspective of Taiwan National Health Insurance Administration, Ministry of Health and Welfare (the third pay payer). [Background] Using DCBs in PTA can reduce the rate of target lesion revascularizations (TLR) and extend the time of revascularizations of patients with lower-limb atherogenesis. Recent researches have reported the cost-effectiveness of using DCB versus UCB in PTA based on the views of the US, Germany, UK, Italian and Swiss governments. However, the cost-effectiveness of DCB angioplasty in Taiwan is unknown. [Methods] Cost-effectiveness was assessed as cost per quality-adjusted life-year (QALY) gained using a Markov model on the basis of empirical data from the IN.PACT SFA II trial and costs from National Health Insurance Reasearch Database. The cycle of the Markov model was one month long and the time horizon was two years. [Results] Initial costs were higher with using DCBs than UCBs in PTA, driven by higher costs of DCB itself. However, due to lower TLR, total medical costs of using DCBs were $30,000 per patient lower than patients treated with UCBs, whereas QALYs were about 0.01 greater with using DCBs than using UCBs in PTA after 24 months. Thus, the ICER showed that DCB was a dominant invervention. The probability that using DCBs is cost-effective compared with using UCBs was 83.5% using a threshold of 1 GDP ($801,037) per QALY gained and 90.6% at a threshold of 3 GDPs ($2,403,111) per QALY gained. [Conclusions] For patients with lower-limb atherogenesis, using DCBs in PTA is associated with better 2-year outcomes and lower costs compared with using UCBs in PTA. With similar results of the past cost-effectiveness analysis in the United States, United Kingdom, Germany, Italy, and Switzerland, the results of this study suggest that using DCBs is a dominant intervention compared with UCBs for treating PTA. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T16:25:41Z (GMT). No. of bitstreams: 1 ntu-109-R07848002-1.pdf: 2969246 bytes, checksum: e760e2c36dcfd50c7f92f4d01821d7d7 (MD5) Previous issue date: 2020 | en |
| dc.description.tableofcontents | 口試委員會審定書-i
致謝-ii 中文摘要-iii 英文摘要-v 目錄-vii 圖目錄-x 表目錄-xi 第一章 緒論-1 第一節 研究背景-1 第二節 研究動機與重要性-1 第三節 研究目的-2 第二章 文獻回顧-3 第一節 下肢周邊動脈疾病(peripheral artery disease, PAD)概述-3 一、 疾病定義與分類-3 二、 危險因子-4 三、 流行病學-7 四、 診斷與臨床表現-9 第二節 治療種類-12 一、 內科治療-13 二、 外科血管重建手術(surigical revascularisation)-17 第三節 塗藥球囊導管與傳統球囊導管臨床治療結果比較-19 第四節 塗藥球囊導管與傳統球囊導管經濟評估結果-21 第五節 文獻回顧小結-23 第三章 研究方法與材料-24 第一節 研究設計-24 第二節 醫療服務利用與成本資料來源-27 一、 資料來源-27 二、 研究對象-27 三、 選樣與資料處理流程-28 四、 研究變項與操作型定義-30 第三節 模型參數來源與操作型定義-35 一、 機率(probabilities)-35 二、 效用(utilities)-36 三、 成本(costs)-37 第四節 研究假設(assumptions)-40 第五節 分析方法-41 一、 描述性統計-41 二、 遞增成本效果比值(incremental cost-effectiveness ratio, ICER)-41 三、 敏感度分析-42 第四章 研究結果-46 第一節 研究對象基本特質-46 第二節 塗藥球囊導管與傳統球囊導管的成本效果分析-49 一、 決定性分析(deterministic analysis)-49 二、 臨床事件(clinical event)-50 三、 成本分佈(cost distribution)-52 第三節 情境分析(scenario analysis)-54 一、 初始年齡(initial age)-54 二、 塗藥球囊導管特材費用(DCB cost)-54 三、 評估期間(time horizon)-55 四、 折現率(discount rate)-56 五、 基礎效用值(baseline utility value)-57 六、 塗藥球囊導管之使用數量-58 第四節 敏感度分析(sensitivity analysis)-60 一、 單維敏感度分析(one way sensitivity analysis)-60 二、 機率敏感度分析(probability sensitivity analysis)-61 第五章 討論-64 第一節 研究發現-64 第二節 與過去隨機對照試驗研究相比-65 第三節 與過去成本效果分析研究相比-67 第四節 研究限制-69 一、 次級資料庫之資料限制-69 二、 無法取得塗藥球囊導管實際使用狀況-69 三、 模型的不確定性-69 四、 研究結果外推性-70 五、 未納入其他治療方式-70 六、 長期結果未知-70 第六章 結論與建議-71 第一節 結論-71 第二節 建議-72 參考文獻-73 附錄 1：健保給付傳統球囊導管彙整表-82 附錄 2：淺股動脈塗藥球囊導管自付差額品項彙整表-88 附錄 3：自費比價網各醫療院所提供之收費標準（108年8月8日下載）-91 附錄 4：隨機對照試驗(randomized controlled trials, RCTs)文獻比較表-1-116 附錄 5：隨機對照試驗(randomized controlled trials, RCTs)文獻比較表-2-120 | |
| dc.language.iso | zh-TW | |
| dc.subject | 下肢動脈粥樣硬化 | zh_TW |
| dc.subject | 塗藥球囊導管 | zh_TW |
| dc.subject | 血管整形術 | zh_TW |
| dc.subject | 經皮穿刺血管腔內整形術 | zh_TW |
| dc.subject | 成本效果分析 | zh_TW |
| dc.subject | cost-effectiveness analysis | en |
| dc.subject | drug-coated balloon | en |
| dc.subject | DCB | en |
| dc.subject | percutaneous transluminal angioplasty | en |
| dc.subject | PTA | en |
| dc.subject | lower-limb atherogenesis | en |
| dc.subject | CEA | en |
| dc.title | 塗藥球囊導管與傳統球囊導管用於治療下肢動脈粥樣硬化患者之成本效果分析 | zh_TW |
| dc.title | Cost-Effectiveness Analysis of using Drug-Coated Balloon Cather and Uncoated Balloon Cather in Percutaneous Transluminal Angioplasty for Lower-Limb Atherogenesis Patients | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 108-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 湯澡薰,譚家惠 | |
| dc.subject.keyword | 下肢動脈粥樣硬化,經皮穿刺血管腔內整形術,血管整形術,塗藥球囊導管,成本效果分析, | zh_TW |
| dc.subject.keyword | lower-limb atherogenesis,drug-coated balloon,DCB,percutaneous transluminal angioplasty,PTA,cost-effectiveness analysis,CEA, | en |
| dc.relation.page | 123 | |
| dc.identifier.doi | 10.6342/NTU202000819 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2020-05-14 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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| ntu-109-1.pdf 未授權公開取用 | 2.9 MB | Adobe PDF |
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