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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 楊銘欽 | |
dc.contributor.author | I-Chia Lu | en |
dc.contributor.author | 魯怡佳 | zh_TW |
dc.date.accessioned | 2021-06-17T03:14:01Z | - |
dc.date.available | 2021-08-01 | |
dc.date.copyright | 2018-08-01 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-07-11 | |
dc.identifier.citation | 中文文獻
台灣流行病學會(2008)。 2007年台灣地區高血壓、高血糖、高血脂之追蹤調查研究。 全民健康保險署(2009)。 全民健康保險第6次年度藥品支付價格調整原則。 李品青(2014)。 我國健保藥品統計之發展與成果。 取自 https://e-survey.dgbas.gov.tw/signup/stat_conf/103y/Presentation/3-3%E6%88%91%E5%9C%8B%E5%81%A5%E4%BF%9D%E8%97%A5%E5%93%81%E7%B5%B1%E8%A8%88%E4%B9%8B%E7%99%BC%E5%B1%95%E8%88%87%E6%88%90%E6%9E%9C(open)_1030305.pdf 林惠玲、陳正倉(2004)。 統計學:方法與應用三版(下)。 法務部。 全民健康保險法。 取自 http://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=L0060001 法務部。 全民健康保險藥物給付項目及支付標準。 法務部。 全民健康保險藥品價格調整作業辦法。 取自 http://law.moj.gov.tw/LawClass/LawAllIf.aspx?PCode=L0060038 財團法人醫藥品查驗中心(2011) 中央健康保險局100年度科學及技術類委託研究案 糖尿病藥品之醫療科技評估報告。 國家衛生研究院(2011)。 承保抽樣歸人檔。 取自 https://nhird.nhri.org.tw/date_cohort.html 陳世雄(2013)。 健保藥價政策與藥價黑洞之探討─藥品費用分配比率目標制分析性研究 (碩士),國立臺北大學,台北。 陳建豪(2014)。第二型糖尿病新藥介紹。 健康電子報,74。 取自 http://epaper.ntuh.gov.tw/health/201401/project_3.html 黃文鴻(2008)。 全民健康保險藥品費用支出變動因素之分析 (DOH96-NH-1007)。 黃維瑄(2009)。 探討健保降血糖藥品之價量變動與市場競爭。 (碩士論文), 國立臺灣大學,台北。 臺北業務組醫療費用二科(2016)。 門診特定藥品重複用藥費用核扣方案。 衛生福利部(2011)。 健保藥價合理調整,同時保障民眾用藥權益。 取自 https://www.mohw.gov.tw/fp-3160-24993-1.html 衛生福利部(2017a)。 105年死因統計結果分析。 衛生福利部(2017b)。全民健康保險藥物給付項目及支付標準。 衛生福利部中央健康保險署。 全民健康保險藥品支付價格調整作業。 取自 https://www.nhi.gov.tw/Content_List.aspx?n=5158FB5300547E09&topn=3FC7D09599D25979 衛生福利部中央健康保險署(2013)。 健保試辦藥費支出目標制 強力管控藥費。 取自 https://www.nhi.gov.tw/News_Content.aspx?n=FC05EB85BD57C709&sms=587F1A3D9A03E2AD&s=D4530250726828B1 衛生福利部中央健康保險署(2016)。 藥品給付、價格訂定及調整Q&A。 衛生福利部中央健康保險署(2017a)。 2016年全民健康保險醫療費用前二十大疾病。 衛生福利部中央健康保險署(2017b)。 健保署公告106年藥價調整,平均調幅3.5%。 取自 https://www.nhi.gov.tw/News_Content.aspx?n=FC05EB85BD57C709&sms=587F1A3D9A03E2AD&s=0AC9060A0D2CE9E1 衛生福利部中央健康保險署(2018a)。 公告「全民健康保險藥品費用分配比率目標制」試辦第五年(106年)藥費核付金額超出目標值之額度暨107年藥品支付價格年度例行調整事宜。 (健保審字第1070076030號)。 取自 https://www.nhi.gov.tw/BBS_Detail.aspx?n=73CEDFC921268679&sms=D6D5367550F18590&s=D8FDA6BE2D717F72 衛生福利部中央健康保險署 (2018b, 2018/4/11)。 健保醫療資訊雲端查詢系統簡介。 取自 https://www.nhi.gov.tw/Content_List.aspx?n=B5612D76EB95D83D&topn=CA428784F9ED78C9 衛生福利部國民健康署(2016, 2017/1/9)。 世界糖尿病日由來與國內宣導響應. 取自 https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1090&pid=6426 衛生福利部統計處(2011)。 98年度全民健康保險醫療統計年報。 衛生福利部統計處(2014)。 102年度全民健康保險醫療統計年報。 賴昭男、顏銘傭、高東煒、羅慶徽、方文輝、周稚傑。(2010)。 以七年全民健保世代資料分析台灣地區糖尿病病患之用藥情形。 中華職業醫學雜誌, 17(1),45-58。 英文文獻 AACE/ACE. (2017). Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm-2017 executive summary. ENDOCRINE PRACTICE, 23(2). ADA. (2018). Standards of Medical Care in Diabetes. Diabetes Care, 41(Supplement 1). Addis, M. (2002). New approaches to analysing prescription data and to transfer pharmacoepidemiological and evidence-based reports to prescribers. Pharmacoepidemiology and Drug Safety, 11, 726. Ahrén, B. (2007). DPP-4 inhibitors. Best Practice & Research Clinical Endocrinology & Metabolism, 21(4), 517-533. Alan J. Garber, M. J. A., Joshua I. Barzilay, Lawrence Blonde, Zachary T. Bloomgarden, Michael A. Bush, Samuel Dagogo-Jack, Ralph A. DeFronzo, Daniel Einhorn, Vivian A. Fonseca, Jeffrey R. Garber, W. Timothy Garvey, George Grunberger, Yehuda Handelsman, Irl B. Hirsch, Paul S. Jellinger, Janet B. McGill, Jeffrey I. Mechanick, Paul D. Rosenblit, Guillermo E. Umpierrez. (2018). Consensus statement by the american association of clinical endocrinologists and american college of endocrinology on the comprehensive type 2 diabetes management algorithm-2018 executive summary. ENDOCRINE PRACTICE, 24(1), 91-120. Avraham Karasik, P. A., Harvey Katzeff, Michael J. Davies and Peter P. Stein. (2008). Sitagliptin, a DPP-4 inhibitor for the treatment of patients with type 2 diabetes: a review of recent clinical trials. Current Medical Research and Opinion, 24(2), 489-496. doi:10.1185/030079908X261069 C-W. Chiang, H.-F. C., C-Y. Chen, H-L. Wu and C-Y. Yang. (2006). Trends in the use of oral antidiabetic drugs by outpatients in Taiwan: 1997-2003. Journal of Clinical Pharmacy and Therapeutics, 31, 73-82. Chao-Han Liu, M.-K. Y., Chun-Yu Wang. (2013). Overviews of dipeptidyl peptidase-4 inhibitors. The Journal of Taiwan Pharmacy, 29(4). Chee-Ruey Hsieh, F. A. S. (2008). Adoption of pharmaceutical innovation and the growth of drug expenditure in Taiwan: Is it cost effective? . Value in Health, 11(2), 334-344. Chia-Hsuin Chang, Y.-D. J., Ching-Hu Chung, Low-Tone Ho, Lee-Ming Chuang. (2012). National trends in anti-diabetic treatment in Taiwan, 2000–2009. Journal of the Formosan Medical Association, 111, 617-624. Chih-Jen Chang, F.-H. L., Yi-Ching Yang, Jin-Shang Wu, Ta-Jen Wu, Muh-Shy Chen, Lee-Ming Chuang, Tong-Yuan Tai. (2000). Epidemiologic study of type 2 diabetes in Taiwan. Diabetes Research and Clinical Practice, 50 Suppl. 2, S49-S59. China(Taiwan), D. A. o. t. R. o. (2015). Executive summary: Clinical practice guidelines for diabetes care - 2015. Formos J Endocrinol Metab, 6 (Suppl), S1-S8. Hsu, C.-N. (2010). Efficient cost containment strategies for pharmaceutical expenditure. The Journal of Taiwan Pharmacy, 26(4), 9-16. Huang-Tz Ou, T.-Y. L., Chung-Yi Li, Jin-Shang Wu, Zih-Jie Sun. (2017). Incidence of diabetes-related complications in Chinese patients with type 1 diabetes: a population-based longitudinal cohort study in Taiwan. BMJ Open, 7(e015117). doi:10.1136/bmjopen-2016-015117 Hye-Young Kwon, B. Y., Brian Godman. (2015). Key components of increased drug expenditure in South Korea: Implications for the future. Value in Health Regional Issues, 6, 14-21. James R. Gavin III, M., PhD, K.G.M.M. Alberti, MD, Mayer B. Davidson, MD, Ralph A. DeFronzo, MD, Allan Drash, MD, Steven G. Gabbe, MD, Saul Genuth, MD, Maureen I. Harris, PhD, MPH, Richard Kahn, PhD, Harry Keen, MD, FRCP, William C. Knowler, MD, DrPH, Harold Lebovitz, MD, Noel K. Maclaren, MD, Jerry P. Palmer, MD, Philip Raskin, MD, Robert A. Rizza, MD, and Michael P. Stern, MD. (2003). Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 26(Suppl 1), S4-S20. Jason C Hsu, D. R.-D., Anita K Wagner, Ching-Lan Cheng, Yea-Huei Kao Yang, Fang Zhang and Christine Y Lu. (2015). Utilization of oral antidiabetic medications in Taiwan following strategies to promote access to medicines for chronic diseases in community pharmacies. Journal of Pharmaceutical Policy and Practice, 8(15). doi:10.1186/s40545-015-0035-5 Jing Wu, N. Y., Weiwei Xu. (2013). Increasing anti-infective drug expenditure in Tianjin, China: A decomposition analysis. Value in Health Regional, 2, 37-42. L.M. Chuang, S. T. T., B.Y. Huang, T.Y. Tai, The DIABCARE (Taiwan) Study Group. (2001). The current state of diabetes management in Taiwan. Diabetes Research and Clinical Practice, 54 Suppl. 1, S55-S65. Lundin, U. G. a. D. (2004). Why did drug spending increase during the 1990s? . Pharmacoeconomics, 22(1), 29-42. Meina Li, Y. Z., Chen Xue, Yuan Liu, Lulu Zhang. (2014). The problem of unreasonably high pharmaceutical fees for patients in Chinese hospitals: A system dynamics simulation model. Computers in Biology and Medicine, 47, 58-65. Merlis, M. (2000). Explaining the growth in prescription drug spending: A review of recent studies. Paper presented at the Pharmaceutical Pricing Practices, Utilization and Costs, Washington, DC. https://aspe.hhs.gov/explaining-growth-prescription-drug-spending-review-recent-studies Morgan. (2004). Drug spending in Canada: Recent trends and causes. Medical Care, 42(7), 635-642. NICE. (2015). Type 2 diabetes in adults: management NICE guideline NG28: NICE. Ou HT, C. K., Liu YM, Wu JS. (2017). Recent trends in the use of antidiabetic medications from 2008 to 2013: A nation-wide population-based study from Taiwan. J Diabetes, 9(3), 256-266. doi:10.1111/1753-0407.12408 Pathak R, B. M. (2010). Dipeptidyl Peptidase-4 (DPP-4) Inhibitors In the Management of Diabetes. Pharmacy and Therapeutics, 35(9), 509-513. Richard G. Frank, D. S. S. (1995). Generic entry and the pricing of pharmaceuticals. J Econ Manag Strategy, 6, 75-90. doi:10.3386/w5306 Shih-Wei Lai, C.-H. M., Kuan-Fu Liao, Fung-Chang Sung and Pei-Chun Chen. (2011). Risk of acute pancreatitis in type 2 diabetes and risk reduction on anti-diabetic drugs: a population-based cohort study in Taiwan. The American Journal of GASTROENTEROLOGY, 106, 1697-1704. Tahrani A, B. C., Del Prato S, Barnett AH. (2011). Management of type 2 diabetes: new and future developments in treatment. Lancet, 378, 182-197. Tong-Lu Lin, Y.-H. K. Y., Chao-Hsiun Tang, Huie-Mei Wu, Hui-Wen Cheng. (2007). An economic evaluation on the pharmaceutical expenditure of antihypertensive agents in Taiwan from 1997 to 2002. Journal of Food and Drug Analysis, 15(3), 233-241. Ulf Gerdtham, M. J., Bo Gunnarsson, Margareta Marcusson, Freddie Henriksson. (1998). The effect of changes in treatment patterns on drug expenditure. Pharmacoeconomics, 13(1 Pt 2), 127-134. Wei-Min Chu, H.-E. H., Kuang-Hua Huang, Yu-Tse Tsan, Yi-Sheng Liou, Yueh-Hsin Wang, Meng-Chih Lee, Yu-Ching Li. (2017). The prescribing trend of oral antidiabetic agents for type 2 diabetes in Taiwan. Medicine, 96(43). doi:10.1097/MD.0000000000008257 WHO. (2016). Global report on diabetes. WHOCC. (2018/2/15). Structure and principles. Retrieved from https://www.whocc.no/atc/structure_and_principles/ WHOCC. (2018, 2018/2/7). Definition and general considerations. Retrieved from https://www.whocc.no/ddd/definition_and_general_considera/ Ya-Ming Liu, Y.-H. K. Y., Chee-Ruey Hsieh. (2011). The determinants of the adoption of pharmaceutical innovation: Evidence from Taiwan. Social Science & Medicine, 72, 919-927. Yi-Der Jiang, C.-H. C., Tong-Yuan Tai, Jung-Fu Chen, Lee-Ming Chuang. (2012). Incidence and prevalence rates of diabetes mellitus in Taiwan: Analysis of the 2000-2009 Nationwide Health Insurance database. Journal of the Formosan Medical Association, 111, 599-604. Zvi Griliches, I. C. (1994). Generics and new goods in pharmaceutical price indexes. Am Econ Rev, 84, 1213-1232. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69371 | - |
dc.description.abstract | 目的:本研究旨在了解台灣口服降血糖藥品利用情形變化,並探討口服降血糖藥品費用支出之主要成長原因。
方法:使用全民健保研究資料庫2010年承保抽樣歸人檔,分析2009年至2013年各年度口服降血糖藥品之利用情形。利用非隨機解構式指數分析方程式,將藥費支出變化拆解為六項因素:處方數量、處方大小、藥品單價、學名藥替代、藥理類別、用藥種類。此六項因素中,處方數量、處方大小又可歸納為數量效應;藥品單價、學名藥替代又可歸納為價格效應;而藥理類別、用藥種類則可歸納為治療選擇效應。 結果:研究期間內,每年總藥品支出逐年上升,自2009年至2013年,由2億7,034萬元上升至3億990萬元,成長約15%。其中藥品費用支出成長歸因於六項因素的貢獻分別為:處方數量8.2%、處方大小20.5%、藥品單價-24.8%、學名藥替代17.1%、藥理類別25.7%、用藥種類-20.6%。將六因素歸納為三大因素後,數量效應使藥費支出增加30%,價格效應使藥費支出減少12.0%,治療選擇效應則使之減少0.2%。 結論:2009年至2013年,口服降血糖藥品費用的支出上升原因主要來自於藥理類別改變,推測其原因為新機轉藥物DPP-4 inhibitors納入健保所導致。建議未來健保署討論新藥納入給付時,須更謹慎評估新藥加入後對健保的財務衝擊。 | zh_TW |
dc.description.abstract | Objective: This study aimed to describe the trends in the use and spending on oral antidiabetic drugs and to explore factors that influenced expenditure variation in Taiwan during 2009-2013.
Methods: Data were extracted from National Health Insurance Research Database (NHIRD). Using a non-stochastic, index-theoretical method, changes in expenditures on oral antidiabetic drugs were decomposed into 6 cost-impact determinants: prescription volume, prescription size, price, generic use, therapeutic mix, and drug mix. These 6 determinants could be classified into 3 broad categories: (1) volume effects, (2) price effects, and (3) therapeutic choices. Results: The expenditure of oral antidiabetic drugs increased 15% from 2009 to 2013. The changes that can be attributed to these 6 determinants are as follows: change in prescription volume contributed 8.2%, change in prescription size contributed 20.5%, change in price contributed -24.8%, change in generic use contributed 17.1%, change in therapeutic mix contributed 25.7%, and change in drug mix contributed -20.6%. For 3 broad categories, volume effects increased 30%, price effect decreased 12.0%, and therapeutic choices slightly decreased 0.2%. Conclusions: From 2009 to 2013, the main driving factor of expenditure variation of oral antidiabetic drugs was therapeutic mix. This might be because DPP-4 inhibitors started to be reimbursed from 2009. It is suggested that when facing new drugs in the future, the National Health Insurance Administration needs to pay more attention to the budget impact of those new drugs to control the growth of drug expenditure. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T03:14:01Z (GMT). No. of bitstreams: 1 ntu-107-R05848003-1.pdf: 3834357 bytes, checksum: 7787bd781b59cd199e8c69272781e51c (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 口試委員審定書 i
誌謝 ii 中文摘要 iii Abstract iv 目錄 v 表目錄 vii 圖目錄 viii 第一章 緒論 1 第一節 研究背景及動機 1 第二節 研究目的 2 第三節 研究重要性 2 第二章 文獻探討 3 第一節 糖尿病簡介 3 第二節 台灣降血糖藥物利用分析 8 第三節 藥品費用支出指數分析方法 12 第四節 台灣健保藥品費用控制政策 20 第三章 研究材料與方法 23 第一節 研究設計與架構 23 第二節 研究變項及操作型定義 26 第三節 研究對象與資料來源 29 第四節 資料處理 31 第五節 統計分析 34 第四章 研究結果 37 第一節 2009-2013年口服降血糖藥品利用情形 37 第二節 以ATC 4th Level分類之藥品利用分析 40 第三節 以ATC 5th Level分類之藥品利用分析 46 第四節 藥品費用支出影響因素解構 54 第五章 討論 61 第一節 重要研究結果之討論 61 第二節 研究限制 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 74 附錄 82 附錄一 ATC 1st Level分類 82 附錄二 2016年5月1日降血糖藥品新給付規定 83 | |
dc.language.iso | zh-TW | |
dc.title | 口服降血糖藥品費用支出變動之影響因素解構 | zh_TW |
dc.title | Decomposition of factors influencing expenditure variation of oral antidiabetic drugs | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 董鈺琪,蕭斐元 | |
dc.subject.keyword | 口服降血糖藥品,藥費支出變動解構,非隨機解構式指數分析方程式,全民健保研究資料庫, | zh_TW |
dc.subject.keyword | oral antidiabetic drugs,drug expenditure decomposition,non-stochastic index-theoretical method,National Health Insurance Research Database, | en |
dc.relation.page | 86 | |
dc.identifier.doi | 10.6342/NTU201801418 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-07-11 | |
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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