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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 楊銘欽(MING-CHIN YANG) | |
dc.contributor.author | Li-Shan Jian | en |
dc.contributor.author | 簡莉珊 | zh_TW |
dc.date.accessioned | 2021-06-17T03:11:35Z | - |
dc.date.available | 2020-08-26 | |
dc.date.copyright | 2020-08-26 | |
dc.date.issued | 2020 | |
dc.date.submitted | 2020-08-19 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69261 | - |
dc.description.abstract | 隨著現代癌症治療標靶藥物發展的日新月異,如何在最少的健保預算下增加晚期非小細胞肺癌EGFR陽性無法手術的病人,最多的無惡化存活期((Progression Free Survival, PFS)、較佳的生活品質校正年(quality adjusted life-years, QALYs)並增進健保資源的永續經營。本研究利用經濟評估的方法比較晚期非小細胞肺癌具有EGFR基因變異者之一線治療策略成本效用分析。 方法:由2014年至2017年全民健康保險資料庫及國民健康署癌症登記表全人口檔獲得晚期非小細胞肺癌具有EGFR基因變異者之真實資料,分析病人在接受三種標靶藥物Gefitinib、Erlotinib及Afatinib,三種一線不同治療策略的無惡化存活期與整體存活期(Overall Survival, OS),並利用文獻回顧取得在不同治療策略下病人的效用值(Utility),比較在三種一線治療標靶藥物治療下的存活情形與成本差異,進行成本效用分析及多維敏感度分析,計算其品質校正人年。 結果:與Gefitinib相比Erlotinib的ICER值為新台幣697,318元、Afatinib的ICER值為新台幣1,787,675。成本效果接受曲線(CEAC)結果顯示使用Erlotinib在願付價格為新台幣960,650元時具有成本效益的機率為50.1%,隨著願付金額的上升,使用Erlotinib治療策略的成本效益機率越高。Afatinib在一倍GDP(新台幣800,542元)時,具有成本效益的機率為40.8%,在願付價格為新台幣1,761,192元時具有成本效益的機率為50.1%。隨著願付金額的上升,使用Afatinib治療策略的成本效益機率越高。 結論:使用Erlotinib及Afatinib治療非小細胞肺癌EGFR陽性病人與Gefitinib相比當願付價格越高時,具有成本效益的機率越高。 | zh_TW |
dc.description.abstract | Objective: With the Pharmaceutical industry developed, cancer patients have more treatment choices to cope with the disease. In Taiwan, we have the National Health Insurance (NHI) which can ensure the insured that who have catastrophic illness can be taken good care of .But with limited resource, how to increase the QALY of patients and keep sustainable operation of NHIis issue. In this study, we did the cost-utilities analysis for first line treatments Gefitinib,Erlotinib and Afatinib with advanced (III IV) stage EGFR positive in non-small cell lung cancer (NSCLC) patients in Taiwan. To find out which first line target therapy treatment provide the patients more quality adjusted life-years (QALYs) and enhance the sustainable for National Health Insurance. Methods: The resource of data is from National Health Insurance Database and Taiwan's national cancer registry database between 2014 to 2017.We compared the difference of the overall survival (OS) ,progression free survival (PFS) and cost. The Wilcoxon rank-sum test, generalized estimating equation (GEE), Cox proportional hazards regression and Kaplan-Meier survival curve were used to compare the difference in the clinical outcomes and medical expenditures (cost).Incremental cost-effectiveness ratio (ICER) and quality adjusted life-years (QALYs) were calculated in the cost-utility analysis. This study also used the one-way sensitivity analysis and non-parametric bootstrap to discuss the distribution of ICER. Results: In the cost-utility analysis of the first-line treatment strategy for patients with advanced non-small cell lung cancer with EGFR mutation positive, compare to Gefitinib the ICER of Erlotinib and Afatinib are NTD697, 318 NTD1, 787,675 per QALY. In the CEAC, it would be 50.1% more cost effective of Erlotinib than Gefitinib with the WTP NTD 960,650. Afatinib would be 50.1% more cost effective than Gefitinib with the WTP NTD 1,761,192. Conclusions: As trategies of the first line treatments on advanced stage EGFR positive in non-small cell lung cancer in Taiwan, Erlotinib and Afatinib would be more cost effectiveness to Gefitinib with the higher WTP. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T03:11:35Z (GMT). No. of bitstreams: 1 U0001-1808202016104500.pdf: 3851244 bytes, checksum: dfa15209b9578f7f98ee19e36fe8e2d2 (MD5) Previous issue date: 2020 | en |
dc.description.tableofcontents | 致謝 I 目錄 II 表目錄 IV 圖目錄 V 摘要 VI ABSTRACT VII 第一章 研究背景 1 第1節 研究背景與動機 1 第2節 研究目的 2 第二章 文獻回顧 3 第1節 肺癌的流行病學 3 第2節 肺癌的致病因子與預防篩檢 11 第3節 晚期肺癌的現況與治療(療效比較) 13 3.1 ERLOTINIB的藥物研究 15 3.2 GEFITINIB的藥物研究 16 3.3 AFATINIB的藥物研究 17 第4節 標靶藥物的成本效益分析 20 第5節 成本效用分析 28 第6節 文獻回顧小結 32 第三章 研究設計 36 第1節 研究架構 36 第2節 資料來源及研究對象 42 第3節 研究變項及操作型定義 45 第4節 統計方法 57 第四章 研究結果 61 第1節 描述性統計分析結果 61 第2節 三種一線標靶藥物治療策略臨床結果比較 69 第3節 成本效用分析 77 3.1 遞增成本效果比值(INCREMENTAL COST-EFFECTIVENESS RATIO, ICER) 77 3.2 遞增成本效果比值(INCREMENTAL COST-EFFECTIVENESS RATIO, ICER) 82 3.3 敏感度分析(SENSITIVITY ANALYSIS) 87 第五章 討論 89 第1節 研究方法之討論 89 第2節 重要發現 90 第3節 研究限制 93 第六章 結論與建議 94 第1節 結論 94 第2節 建議 95 參考文獻 96 | |
dc.language.iso | zh-TW | |
dc.title | 晚期肺腺癌具有EGFR基因變異者之一線治療策略成本效用分析 | zh_TW |
dc.title | Cost-utility analysis of first-line treatments for patients with EGFR mutation-positive advanced-stage Lung adenocarcinoma in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 108-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 林芳如(FANG-JU LIN),譚家惠(CHIA-HUI TAN) | |
dc.subject.keyword | 晚期非小細胞肺癌,標靶藥物,成本效益評估,EGFR陽性, | zh_TW |
dc.subject.keyword | Gefitinib,Erlotinib,ICER,QALY,non-small cell lung cancer (NSCLC),cost utility analysis,cost effectiveness analysis, | en |
dc.relation.page | 104 | |
dc.identifier.doi | 10.6342/NTU202003992 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2020-08-19 | |
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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