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標題: | 臺灣癌症經濟負擔探討:2007至2017年之直接與間接成本分析 Economic burden of cancers in Taiwan: a direct and indirect cost estimate for 2007-2017 |
作者: | Shao-Yi Huang 黃紹宜 |
指導教授: | 蕭斐元(Fei-Yuan Hsiao) |
關鍵字: | 癌症,疾病負擔,成本分析,健康政策, cost-of-illness,cancer,economic,health policy, |
出版年 : | 2019 |
學位: | 碩士 |
摘要: | 研究背景:隨著醫療水平的提升,癌症的治療也日新月異,但昂貴的新穎醫療技術也帶來了更大的經濟負擔,在有限的資源之下,如何有效地分配資源成為重要的議題。瞭解目前癌症經濟負擔將有助於醫療資源分配上的政策決定,然而我國現有之相關研究,許多距今已年代久遠,且多以醫療照護機構或健康保險給付機構的立場進行分析,無法反映整體社會的觀點。
研究目的:本研究旨為分析臺灣十大高花費癌症之直接醫療成本與間接成本,且進一步探討藥品費用(尤其抗癌藥品)之分布比例及可能影響成本之因子,並同時比較癌症與其他疾病帶來之經濟負擔。 研究方法:本研究係以全國人口為基礎,並以社會觀點進行的成本分析研究,利用臺灣癌症登記檔及全民健康保險資料庫,篩選2007年至2014年新診斷之癌症與急性冠心症病患作為研究對象。本研究所納入之十大高花費癌症為肺癌、女性乳癌、大腸直腸癌、肝癌、口腔癌、前列腺癌、胃癌、食道癌、白血病及非何杰金氏淋巴瘤等固態腫瘤及血液腫瘤疾病。成本項目包含自診斷日起三年內與癌症或急性冠心症相關的直接醫療成本,以及因罹患該疾病無法工作或提早死亡所造成的生產力損失(間接成本)。直接醫療成本係加總自所有健保給付之門診及住院費用,包含診察費、藥費、病房費、醫學檢查費、手術費等,並另外計算其中所有藥品費用以及抗癌藥品費用以分析其所占比例;間接成本則加總自因罹病需要就醫或因病早逝而無法工作導致的薪資損失。各項成本計算完畢後,本研究亦選取診斷年齡、性別、診斷年代、腫瘤轉移、共病症、是否於醫學中心接受治療等可能影響癌症費用的因子進行成本動因分析。 研究結果:本研究共納入545,221位癌症病患及170,879位新發的急性冠心症病患作為本研究的研究對象。在癌症病患中,新診斷人數最多者為大腸直腸癌,新診斷人數最少者則為白血病及非何杰金氏淋巴瘤。平均直接與間接成本總和最高者為食道癌(2,453,246元),其次為白血病(1,745,292元)及口腔癌(1,695,017元),最低者則為前列腺癌(431,489)、女性乳癌(589,511元)及大腸直腸癌(708,107)。直接醫療成本在各癌症中占成本總和之24~78%,中位數最高者為食道癌(534,457元)、口腔癌(525,738元)及非何杰金氏淋巴瘤(420,084元),最低者則為肝癌(213,447)、前列腺癌(251,901)及大腸直腸癌(292,404元)。間接成本中以死亡相關間接成本為主,其中位數最高者為食道癌,最低者則為女性乳癌、大腸直腸癌、口腔癌、前列腺癌及非何杰金氏淋巴瘤。在直接醫療成本之中,所有藥品花費占總醫療成本約13~60%,若僅計算抗癌藥品花費則占總醫療成本約1~42%,在部分固態腫瘤如食道癌、口腔癌、肝癌等,其藥品花費較低,而在肺癌、白血病、非何杰金氏淋巴瘤等癌症則有較高的藥品花費。急性冠心症之平均直接與間接成本總和為435,609元,直接醫療成本中位數則為141,708元,不論直接醫療成本或間接醫療成本,與多數癌症相比皆更低。在癌症費用之成本動因分析中,年齡的增加會顯著減少癌症之疾病負擔總和,而男性、腫瘤轉移/晚期癌症的發生、共病症的增加、於醫學中心接受治療等因子,則會顯著增加癌症之疾病負擔總和。診斷年代對各癌症之影響並沒有一致結果,在肺癌、口腔癌及食道癌,2011年至2014年後期診斷者之疾病負擔總和顯著低於2007年至2010年診斷者,在女性乳癌、肝癌及白血病中後期診斷者顯著高於前期診斷者,其餘癌症則沒有顯著差異。 研究結論:在癌症新診斷後三年內的經濟負擔總和中,直接醫療成本與間接成本之金額及所占比例,在各個癌症會因癌症特性與治療型態而有很大的差異。本研究之分析結果能夠幫助政府主管機關瞭解我國癌症經濟負擔之現況,除了直接醫療成本之外,也提供整體社會觀點下癌症所造成之生產力損失,以利未來決策者安排資源分配時優先順序之評估,讓有限的醫療資源達到最大化的使用。 Aim/Objective: Cancers have incurred significant economic burden to patients, health sectors and society. Reliable estimates of such burden, particularly with the considerations of both direct and indirect costs of cancers, will therefore help to guide resource allocation. This study aimed to conduct a nationwide cost analysis on direct and indirect costs of the top ten costly cancers in Taiwan. Methods: Patients with newly diagnoses of acute coronary syndrome (ACS) and top ten costly cancers (i.e. lung cancer, female breast cancer, colorectal cancer, liver cancer, oral cancer, leukemia, prostate cancer, non-Hodgkin lymphoma, gastric cancer, and esophageal cancer) between 2007 and 2014 were identified from the Taiwan Cancer Registry (TCR) Database. Their direct medical costs were calculated from claims recorded in the National Health Insurance Research Database (NHIRD). Indirect costs, composed of productivity losses due to morbidity and mortality, were estimated from public data of life expectancy, average wage, and employment rate. Costs of the first three years after diagnosis were assessed in this study. Further cost driver analysis was conducted on factors including age at diagnosis, gender, year of diagnosis, tumor metastasis, comorbidities, treatment in medical center. Results: A total of 545,221 cancer patients and 170,879 ACS patients were analyzed in this study. The sum of direct and indirect costs of cancer was highest in esophageal cancer (USD 86,268), while was lowest in prostate cancer (USD 16,401). Mortality cost accounted for over 50% of the total economic burden in most cancers, except for prostate cancer (31%) and female breast cancer (40%) due to lower mortality rate and older age at death. The proportion of anti-cancer drug cost ranged from 1% to 42%, which was higher in lung cancer, leukemia and non-Hodgkin lymphoma, in contrast to lower proportion in liver cancer, oral cancer, gastric cancer, and esophageal cancer. Costs of ACS, including direct medical costs and indirect costs are lower than most cancers. Age at diagnosis significantly decreased costs of cancer, while male, tumor metastasis, comorbidities, treatment in medical center increased economic burden of most cancers. Year of diagnosis did not yield consistent results within different cancers. Conclusions: This study demonstrates the comprehensive economic burden of the top ten costly cancers in Taiwan. The proportion of direct and indirect costs varied by different cancers. These discrepancies are valuable references to optimize healthcare resource allocation. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78782 |
DOI: | 10.6342/NTU201901297 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床藥學研究所 |
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