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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 鍾國彪 | |
| dc.contributor.author | Kai-Hsin Lin | en |
| dc.contributor.author | 林凱信 | zh_TW |
| dc.date.accessioned | 2021-06-08T05:03:58Z | - |
| dc.date.copyright | 2011-03-03 | |
| dc.date.issued | 2011 | |
| dc.date.submitted | 2011-02-15 | |
| dc.identifier.citation | [1]Ho WL, Lin KH, Wang JD, et al. Financial burden of national health insurance for treating patients with transfusion-dependent thalassemia in Taiwan. Bone Marrow Transplant 2006; 37:569–574.
[2]Viprakasit V, Lee-Lee C, Chong QT, et al. Iron chelation therapy in the management of thalassemia: the Asian perspectives. Int J Hematol 2009;90:435–445. [3]Porter JB. Monitoring and treatment of iron overload: state of the art and new approaches. Semin Hematol 2005;42:S14–S18. [4]Morris CR, Singer ST, Walters MC. Clinical hemoglobinopathies: iron, lungs and new blood. Curr Opin Hematol 2006;13:407–418. [5]Olivieri NF, Brittenham GM. Iron-chelating therapy and the treatment of thalassemia. Blood 1997;89:739–761. [6]Cabantchik ZI, Breuer W, Zanninelli G, Cianciulli P. LPI-labile plasma iron in iron overload. Best Pract Res Clin Haematol 2005;18:277–287. [7]Fausel CA. Iron chelation therapy in myelodysplastic syndromes. Am J Health Syst Pharm 2010;67:S10–S14. [8] Inati A. Recent advances in improving the management of sickle cell disease. Blood Rev 2009;23:S9–S13. [9]Cohen AR, Galanello R, Pennell DJ, et al. Thalassemia. Hematology Am Soc Hematol Educ Program. 2004. p14–34. [10] Neufeld EJ. Oral chelators deferasirox and deferiprone for transfusional iron overload in thalassemia major: new data, new questions. Blood 2006;107:3436–3441. [11]Stumpf JL. Deferasirox. Am J Health Syst Pharm 2007;64:606–616. [12]Porter JB. Optimizing iron chelation strategies in beta-thalassaemia major. Blood Rev 2009;23:S3–S7. [13]Wonke B, Wright C, Hoffbrand AV. Combined therapy with deferiprone and desferrioxamine. Br J Haematol 1998;106:252–253. [14]Piga A, Roggero S, Vincinguerra T, et al. Deferiprone: new insight. Ann NY Acad Sci 2005;1054:169–174. [15]Peng CT, Wu KH, Wu SF, et al. Deferiprone or deferoxamine vs. combination therapy in patients with beta-thalassemia major: a case study in Taiwan. Hemoglobin 2006;30:125–130. [16]Kolnagou A, Kontoghiorghes GJ. Effective combination therapy of deferiprone and deferoxamine for the rapid clearance of excess cardiac iron and the prevention of heart disease in thalassaemia. The Protocol of the International Committee on Oral Chelators. Hemoglobin 2006;30:239–249. [17]Daar S, Pathare AV. Combined therapy with desferrioxamine and deferiprone in beta thalassaemia major patients with transfusional iron overload. Ann Hematol 2006;85:315–319. [18]Roberts DJ, Brunskill SJ, Doree C, et al. Oral deferiprone for iron chelation in people with thalassaemia. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004839. doi:10.1002/14651858.CD004839.pub2. [19]Beutler E, Hoffbrand AV, Cook JD. Iron deficiency and overload. Hematology Am Soc Hematol Educ Program. 2003. p40–61. [20] Exjade○R (deferasirox) Prescribing Information. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936, USA. December 2007. [21]Delea TE, Sofrygin O, Thomas SK, et al. Cost effectiveness of once-daily oral chelation therapy with deferasirox versus infusional deferoxamine in transfusion-dependent thalassaemia patients: US healthcare system perspective. Pharmacoeconomics 2007;25:329–342. [22] Petitti DB. Meta-analysis, decision analysis, and cost-effectiveness analysis: methods for quantitative synthesis in medicine. Oxford: Oxford University Press 2000. [23] Cappellini MD, Cohen A, Piga A, et al. A phase III study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with beta-thalassemia. Blood 2006;107:3455–3462. [24]Dubey AP. Sudha S. Parakh A. Deferasirox: the new oral iron chelator. Indian Pediatr 2007;44:603–607. [25]Drummond MF, Sculpher MJ, Torrance GW, editors. Methods for the Economic Evaluation of Health Care Programmes. New York, NY: Oxford University Press, Inc.: 2005. [26]Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Medical Decision Making 1993;13:322-38. [27]Lin KH, Meng YL, You SB, et al. Factors related to thalassemia major patients with serum ferritin level higher than 2500 ng/ml and their biosocial guiding plan. In: Lin HC, edi. Internal conference on genetic medicine and promoting healthcare for rare disorders. Taichung: Bureau of Health Promotion, Department of Health, Taiwan; 2007. p153–172. [28]Fischer R, Longo F, Nielsen P, et al. Monitoring long-term efficacy of iron chelation therapy by deferiprone and desferrioxamine in patients with beta-thalassemia major: application of SQUID biomagnetic liver susceptometry. Br J Haematol 2003;121:938–948. [29]Chern JP, Lin KH, Su YN, et al. Impact of a national betathalassemia carrier screening program on the birth rate of thalassemia major. Pediatr Blood Cancer 2006;46:72–76. [30]Fausel CA. Iron chelation therapy in myelodysplastic syndromes. Am J Health Syst Pharm 2010;67(7 Suppl 2):S10–S14. [31]Weinstein MC, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices. Modeling studies. Value Health 2003;6:9–17. [32]McLeod C, Fleeman N, Kirkham J, et al. Deferasirox for the treatment of iron overload associated with regular blood transfusions (transfusional haemosiderosis) in patients suffering with chronic anaemia: a systematic review and economic evaluation. Health Technol Assess 2009;13(1):iii-iv, ix-xi, 1–121. [33]Hirth RA, Chernew ME, Miller E, et al. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 2000;20:332–342. [34]Ubel PA, Hirth RA, Chernew ME, et al. What is the price of life and why doesn’t ir increase at the rate inflation. Arch Intern Med 2003;163:1637-1641. [35]Levin, H. M., McEwan P. J.. Cost-effectiveness analysis：Methods and applications. California, Sage Publications. 2001 [36]Muennig P 'Designing and Conducting Cost-Effectiveness Analysis in Health and Medicine' Jossey-Bass San Francisco, CA 2002 [37]譚延輝，藥事經濟學入門，台北，九州圖書文物有限公司，2000 。 [38]Hunink M, Glasziou P, Siegel JE, et al. Decision Making in Health and Medicine: Integrating Evidence and Values. Cambridge: Cambridge University Press, 2001. [39]Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Making 1983;3:419-458. [40]蒲若芳，成本效性分析於台灣地區百日咳疫苗接種和慢性病毒性肝炎治療之應用，未發表的碩士論文，台北:台灣大學流行病學研究所博士論文，2002。 [41]Naimark D, Krahn MD, Naglie G, Redelmeier DA, Detsky AS. Primer on medical decision analysis: Part 5--Working with Markov processes. Med Decis Making 1997;17:152-9. [42]Retichin, S. M., Hillner, B. E.. The costs and benefits of a screening program to detect dementia in older drivers. Medical Decision Making 1994,14(4): 315-324. [43]Wimo, A., Mattson, B. , Krakau, I., Eriksson, T., Nelvig, A., Karlsson, G.. Cost-Utility Analysis of Group Living in Dementia Care. International Journal of Technology Assessment in Health Care,1995, 11(1): 49-65. [44]郭旭崧、張博論、羅世薰，乳癌高危險群篩檢評估計畫，行政院衛生署研究計畫DOH85-HP-010，1995 [45]張賢助，乳癌篩檢策略之決策與分析-大規模或選擇性乳癌篩檢，未發表的碩士論文，台北：國立台灣大學公共衛生學院預防醫學研究所，2002。 [46]劉沛，婦女實施乳癌篩檢之成本效果分析，未發表的碩士論文，台北：國防醫學院公共衛生學研究所，2005。 [47]張育偉，台灣地區引進人類乳突病毒疫苗之成本效果分析，未發表的碩士論文，台北：國立成功大學公共衛生研究所，2009。 [48]鐘威昇，台灣肺結核都治計畫的經濟評估，未發表的博士論文，台北：臺灣大學醫療機構管理研究所，2010。 [49]莊宇勝，本土失智症機構照護收容模式成本效果分析，未發表的碩士論文，台北：臺灣大學醫療機構管理研究所，2007。 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/23560 | - |
| dc.description.abstract | 研究目的：
利用藥物經濟學評估方法，探討易解鐵是否能有效將鐵質沉積排出病人身體，以及在台灣實行之經濟效用。 研究設計： 利用Markov model模擬方法，分析病人終身可能發生鐵沉積併發症或死亡的醫療費用，比較兩種藥物使用下之差異。 研究參數： 藥價由藥廠提供。 併發症之醫療費用從全民健康保險局資料庫整理而來。 研究結果： 從基本個案分析顯示，以易解鐵治療的病人比以deferoxamine治療的病人可望有較少的併發症發生率，而且壽命或品質調整壽命增長兩年或三年以上。但是，終身使用易解鐵的病人，比使用deferoxamine的病人，整體的醫療費用每人將增加36,291美元。將醫療費用和結果指標合在一起計算，增加費用利用率，平均每人增加每一年品質調整壽命，使用易解鐵者，必須多花費15,596美元。敏感度分析中可以看出，易解鐵的單價影響費用利用率最大。此外，延遲使用易解鐵，也會增加費用利用率。 研究結論： 比較打針的deferoxamine與口服的易解鐵兩種排鐵劑，口服的易解鐵不但臨床效果進步，而且生命的品質在合理的花費下也可提高。 | zh_TW |
| dc.description.abstract | Objective:
To propose a study, which employs the pharmaco-economic approach to prove that Exjade is not only effective medication in patients suffering from iron overload, but is also cost-effective if administered in Taiwan. Design: By using the Markov model provided by Norvatis, the lifetime occurrence of complications/death as well as costs will be simulated for patients treated with either Exjade or deferoxamine. Parameters: Drug costs: provided by Norvatis. Treatment costs for complications are from Bureau of the National Health Insurance (BNHI). Results: Results of base case analysis show that, if treated with deferasirox, patients were expected to have fewer incidences of complications and obtain two more life years or three more quality-adjusted life-years (QALYs) than those who treated with deferoxamine. However, the total medical cost during the lifetime under the circumstances of using deferasirox would be 36,291 USD more per patient than that of using deferoxamine. After combining cost and outcomes indicators to become an incremental cost-utility ratio, it is estimated that 15,596USD is needed for obtaining an additional QALY for each patient treated with deferasirox. Sensitivity analyses show that unit cost of deferasirox has the greatest impacts on the incremental cost-utility ratio. In addition, the incremental cost-utility ratio would increase if delaying the starting age of chelation therapy. Conclusions: Comparing to the injection type of deferoxamine, deferasirox could improve clinical outcomes as well as quality-of-life at a reasonable cost. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-08T05:03:58Z (GMT). No. of bitstreams: 1 ntu-100-R94843020-1.pdf: 573282 bytes, checksum: 0af2526519e5ac7fd7c3200caf153c96 (MD5) Previous issue date: 2011 | en |
| dc.description.tableofcontents | 第一章 緒論...................... 1
第二章 文獻探討................... 3 第一節 成本效果分析(CEA) .......... 4 第二節 成本效益分析(CBA)........... 5 第三節 成本效用分析(CUA)........... 5 第四節 馬可夫模式.................. 7 第五節 健康經濟評估與馬可夫模式相關文獻 10 第三章 研究方法與材料 .............. 14 第一節 Markov Model馬可夫模式...... 14 第二節 藥物成本參數................ 15 第三節 治療費用參數................ 15 第四節 遵從性參數.................. 16 第五節 公共衛生參數................ 16 第六節 其它參數.................... 17 第七節 分析計畫.................... 17 第四章 結果....................... 18 第一節 治療相關併發症之成本.......... 18 第二節 敏感度分析.................. 20 第五章 討論....................... 21 第六章 結論與建議.................. 23 參考文獻.......................... 24 圖表............................. 30 附錄............................. 38 附錄一：比較三種排鐵劑.............. 38 附錄二：鐵沉積量、年齡與併發症........ 39 附錄三：論文英文簡述................ 40 | |
| dc.language.iso | zh-TW | |
| dc.title | 易解鐵(Exjade®) 治療海洋性貧血病人鐵質沉積之藥物經濟評估 | zh_TW |
| dc.title | A Pharmaco-economic Evaluation of Exjade in Treating Patients with Iron Overload Caused by Thalassemia | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 99-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 楊銘欽,曾成槐 | |
| dc.subject.keyword | 海洋性貧血,易解鐵,排鐵劑,成本效益分析,藥物經濟學,健康品質存活, | zh_TW |
| dc.subject.keyword | thalassemia,deferasirox,deferoxamine,cost-effectiveness pharmoco-economics,quality-adjusted life year, | en |
| dc.relation.page | 65 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2011-02-15 | |
| 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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