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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 蕭斐元(Fei-Yuan Hsiao) | |
dc.contributor.author | Shao-Yi Huang | en |
dc.contributor.author | 黃紹宜 | zh_TW |
dc.date.accessioned | 2021-07-11T15:18:58Z | - |
dc.date.available | 2021-08-28 | |
dc.date.copyright | 2019-08-28 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-07-08 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78782 | - |
dc.description.abstract | 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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-07-11T15:18:58Z (GMT). No. of bitstreams: 1 ntu-108-R07451002-1.pdf: 2417354 bytes, checksum: 85e34728472f5c0d8bdcad65c54dc30c (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 致謝 i
中文摘要 iii ABSTRACT vi 目 錄 viii 表目錄 xii 圖目錄 xiii 第1章 緒論 1 第一節 研究背景與重要性 1 第二節 研究目的 3 第2章 文獻回顧 4 第一節 癌症疾病負擔之現況 4 2-1-1. 全球癌症負擔之現況 4 2-1-2. 我國癌症負擔之現況 5 第二節 癌症經濟成本分析 7 2-2-1. 疾病經濟成本之研究方法 7 2-2-2. 國外相關研究 9 2-2-3. 國內相關研究 15 2-2-4. 現有癌症經濟成本相關研究之限制 17 第三節 抗癌藥品於癌症經濟負擔之重要性 18 第四節 影響癌症費用之因子 20 第3章 研究方法 21 第一節 研究材料 21 3-1-1. 臺灣癌症登記檔 (Taiwan Cancer Registry Database) 21 3-1-2. 全民健康保險資料庫(National Health Insurance Research Database, NHIRD) 22 3-1-3. 死因統計檔 22 3-1-4. 行政院主計總處、內政部統計處、勞動部公開資訊 22 第二節 研究設計 23 第三節 研究倫理聲明 24 第四節 研究對象與追蹤期間 26 3-4-1. 癌症病患的納入及排除條件 26 3-4-2. 急性冠心症病患的納入及排除條件 27 3-4-3. 追蹤時間 28 第五節 成本分析 29 3-5-1. 直接與間接成本之追蹤期間總和 29 3-5-2. 與癌症或急性冠心症相關成本之定義 29 3-5-3. 直接醫療成本之定義與測量方法 31 3-5-4. 間接成本之定義與測量方法 33 3-5-5. 通貨膨脹之校正 34 第六節 癌症直接與間接成本之動因分析(Cost driver analysis) 36 第七節 統計分析 39 3-7-1. 描述性統計 39 3-7-2. 推論性統計 39 第八節 敏感性分析(Sensitivity analysis) 40 3-8-1. 癌症之每人每治療月平均花費 41 3-8-2. 癌症之每人接受抗癌藥品治療後第一年藥品花費 41 3-8-3. 癌症之診斷後生產力損失 41 第4章 研究結果 42 第一節 研究族群的建立 42 4-1-1. 癌症患者 42 4-1-2. 急性冠心症患者 42 第二節 研究族群基本特質描述 44 第三節 癌症與急性冠心症之直接醫療成本 47 4-3-1. 每人每月平均花費(Expenditures per patient per month) 47 4-3-2. 每人第一年內花費(First-year expenditures per patient) 49 第四節 癌症與急性冠心症之三年內直接與間接成本 51 4-4-1. 癌症與急性冠心症之直接與間接成本 51 4-4-2. 依診斷年分進行次群組分析之結果 55 第五節 癌症直接與間接花費之成本動因 61 4-5-1. 診斷年代 62 4-5-2. 診斷年齡及性別 62 4-5-3. 腫瘤遠處轉移的發生/晚期癌症 62 4-5-4. Charlson comorbidity 63 4-5-5 是否於醫學中心治療 63 第六節 敏感性分析 66 4-6-1. 每人每治療月平均花費 66 4-6-2. 癌症之每人接受抗癌藥品治療後第一年藥品花費 66 4-6-3. 癌症之診斷後生產力損失 69 第5章 討論 71 第一節 癌症之直接與間接成本 71 第二節 癌症與非癌症疾病間之比較 75 第三節 癌症費用之成本動因 76 第6章 研究優勢與限制 78 第一節 研究優勢 78 第二節 研究限制 79 第7章 結論與建議 81 第一節 結論 81 第二節 建議 82 7-2-1. 對於政府主管機關之建議 82 7-2-2. 對於臨床工作者之建議 82 7-2-3. 對於後續研究者之建議 83 附錄 84 參考文獻 91 | |
dc.language.iso | zh-TW | |
dc.title | 臺灣癌症經濟負擔探討:2007至2017年之直接與間接成本分析 | zh_TW |
dc.title | Economic burden of cancers in Taiwan: a direct and indirect cost estimate for 2007-2017 | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 楊銘欽(Ming-Chin Yang),柯博升(Bor-Sheng Ko) | |
dc.subject.keyword | 癌症,疾病負擔,成本分析,健康政策, | zh_TW |
dc.subject.keyword | cost-of-illness,cancer,economic,health policy, | en |
dc.relation.page | 95 | |
dc.identifier.doi | 10.6342/NTU201901297 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2019-07-08 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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