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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 蘇喜(Syi Su) | |
dc.contributor.author | Chia-Lu Chen | en |
dc.contributor.author | 陳家祿 | zh_TW |
dc.date.accessioned | 2021-06-12T17:55:09Z | - |
dc.date.available | 2011-02-20 | |
dc.date.copyright | 2008-02-20 | |
dc.date.issued | 2008 | |
dc.date.submitted | 2008-02-02 | |
dc.identifier.citation | Afsar A J, Woods RL, Patel S, Rogan F and Wykes W, 2001 Economic costs of cataract surgery using a rigid and a foldable intraocular lens. Ophthal. Physiol. Opt. Vol.21, No. 4 pp. 252-267
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Ophthalmol. 91;644-648; 中華民國內政部統計處 ,民國88-95年台閔地區生命表,平均餘命查詢 民國96年12月網址http://www.moi.gov.tw/stat/index.asp 方一婷 2004.06.白內障手術後併發症及其危險因數探討 國立陽明大學醫管所碩士論文 司法院法學資料檢索系統 判決書查詢 民國96年12月網址 http://jirs.judicial.gov.tw/Index.htm 何守治. 1999 ,再論白內障手術重在復明 : Chinese Journal of Ophthalmology第2 期 No. 2 吳宗正 1995 迴歸分析-理論與應用 復文書局 張彧、謝清麟、王榮德。生活品質之效用測量。 許紋銘 李家福 蔡顯揚 李世煌 劉培元 1986 人工水晶體植入術 台中榮總三年之發展狀況 中華民國眼科醫學會會刊 (25):216-223 陳克華 2003 ;一個眼科醫師看唐代的白內障手術; 中眼會訊 12 月第26期 陳德照 陳清煌 朱僑明 1981前房型人工水晶體裝置術二百五十例之臨床結果 中華民國眼科醫學會會刊 (20):10-13 劉榮宏 高淑卿 林嘉理 李淑美 顏美媛 1986後房人工水晶體植入術 1500 例之分析 中華民國眼科醫學會會刊 (25):185-190 戴政、江淑瓊 2000. 生物醫學統計概論 翰蘆出版社 P255至P290 趙安年 林耕國 李建興 梁有松 陳墩祿 2000, 三種白內囊外摘除術術後眼內炎之報告 中華民國眼科醫學會報告 Vol 39 No1 p.9-p.15 李弘志王惠珠 林合鴻 許明木 蘇明揚 陳振武 1990; 高雄醫學院眼科之人工 水晶體植入術的概況 高雄醫學雜誌6:12-21 郭巾慈 江鈞綺 蔡宜佑 2007, Acute-onset endophthalmitis after catarct surgery (2005-2007) 中華民國眼科醫學會全國醫學年會報告 Poster No-54 蒲若芳 2002 ,成本效性分析於臺灣地區百日咳疫苗接種和慢性病毒性肝炎治療之應用臺灣大學公共衛生學院流行病學研究所博士論文 傅玲、徐南麗、陳雪芬、姚琪、鍾文珍 1993 影響手術成本與收費相關因素之採討(一):手術工時研究.榮總護理,10(4)p. 430一438。 盛禮約 1981 成本會計 台北:三民書局。 P. 01-103 張錦文 1993 建立醫院成本制度及其機制之規範 中國醫藥學院醫務管理學研究所, 行政院衛生署委託研究計劃。 張錦文 1994 醫院成本實證研究第二期 中國醫藥學院醫務管理學研究所, 行政院衛生署委託研究計劃。 賴揚仁 1989 成本分析在營院定價策略應用之研究 中國醫藥學院醫務管理學研究所碩士論文 蔡武甫 蘇崇宜 1993 白內障囊外摘除術中後囊破裂危險因子之評估 中華民國眼科醫學會雜誌 第32卷第1期 P49-54 陳英毅1989人工水晶體植入術 中華民國眼科醫學會會刊 (28):83-89 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/27087 | - |
dc.description.abstract | 目的:
從醫院的觀點出發,執行傳統白內障囊外摘除手術(ECCE)、超音波晶體乳化手術合併摺疊式軟式人工水晶體植入(FoldSoftPhaco)、超音波晶體乳化手術合併注射式軟式人工水晶體植入(InjSoftPhaco)等三種不同白內障手術方式下的成本效果分析。 方法: 本研究採回溯性縱向研究,以某所區域教學醫院眼科白內障手術患者為分析準則。研究族群:1997年至2005年間門診白內障手術病患,患者平均追蹤時間:28.5+25.7(SD)月(範圍1至106個月),全部由同一位資深主治醫師執行,共845例。 病患特性:第一眼手術或第二眼手術、年齡、 性別、手術眼位、病人術前視力(裸視與矯正視力)、眼球眼軸、眼前房深度、眼壓、角膜散光、白內障嚴重程度分級。眼部合併症:青光眼、視神經病變、角膜混濁、虹彩炎、視網膜黃斑病變、眼外傷手術等病史。 評估方式之選擇:區分四組: A組:第一眼手術無眼部合併症,共389例。 B組:第一眼手術有眼部合併症,共146例。 C組:第二眼手術無眼部合併症,共221例。D組:第二眼手術有眼部合併症,共56例。蒐集不同之白內障手術相關成本與術後結果,採決策樹軟體進行成本效果分析(cost effectiveness analysis;CEA)。 結果: [1]術後第三月手術屈光度誤差≦1D:不同白內障手術之比較, A組:無統計學上顯著差異P(X2m)=0.076。 B組:有統計學上顯著差異P(X2m)=0.001。 C組:有統計學上顯著差異P(X2m)=0.0045。 D組:無統計學上顯著差異P(X2m)=0.34。 [2]第三月手術誘發散光≦ 1 D:不同白內障手術,A組與D組有統計學上顯著差異,A組:P(X2m)= 0.003、B組:P(X2m)=0.06、C組:P(X2m)=0.07、D組:P(X2m)= 0.04。 [3]手術後矯正視力≧0.5:A組:ECCE:88.1% 、FoldSoftPhaco:94.6%、 InjSoftPhaco:92.2 %。無統計學上顯著差異P(X2m)=0.214。 B組:ECCE:63.9 % 、FoldSoftPhaco:87.1 %、 InjSoftPhaco :66.7 %。有統計學上顯著差異P(X2)=0.013。 C組:ECCE:81.8 % 、FoldSoftPhaco:95.2 %、 InjSoftPhaco:97.6%。有統計學上顯著差異P(X2m)=0.011 。 D組:ECCE:62.5 % 。FoldSoftPhaco:88.9%。 InjSoftPhaco:66.7%。無統計學上顯著差異P(X2m)=0.67。 [4]手術前後矯正視力改善LogMAR行數(≧一行): A組:ECCE:96.8% 、FoldSoftPhaco:95.3%、InjSoftPhaco:97.3%。B組:ECCE:96.8% 、FoldSoftPhaco:94.8%、 InjSoftPhaco:90.9%。 C組:ECCE:95.2% 、FoldSoftPhaco:97.5%、 InjSoftPhaco:91.7%。 D組:ECCE:100%、FoldSoftPhaco:92.0%、 InjSoftPhaco:100%。 [5]採決策樹進行成本效果分析(QALYs gain 依每年3%折現,折現5年,但成本不折現):以一個月25臺刀計算,平均單項成本(不含回診費用)ECCE為18,098台幣。FoldSoftPhaco為22,965台幣。InjSoftPhaco為 23,395台幣。 成本效果分析: A組:ECCE為34,900台幣/QALY,FoldSoftPhaco為34,171台幣/QALY 、InjSoftPhaco為34,383台幣/QALY。 B組:ECCE為 37,080台幣/QALY,FoldSoftPhaco為36,896台幣/QALY、InjSoftPhaco為44,976台幣/QALY。 C組:ECCE為49,136台幣/QALY,FoldSoftPhaco為45,318台幣/QALY、InjSoftPhaco為40,275台幣/QALY。 D組:ECCE為33,925台幣/QALY,FoldSoftPhaco為41,724台幣/QALY、InjSoftPhaco為35,817台幣/QALY。 結論: 本研究結果以某醫院平均一個月25臺白內障手術計算,三種不同之白內障手術比較,超音波晶體乳化手術因須投入更多之手術相關之儀器設備,因此在平均成本上皆高於傳統白內障手術。但以醫院的觀點,未有其它眼科合併症的A 、 C 兩組,其臨床追蹤效果與成本效果分析,超音波晶體乳化手術皆優於傳統白內障手術。有眼科合併症的B 、 D 兩組,由於病例變異大,未來仍需進一步分析。 | zh_TW |
dc.description.abstract | Purpose:
To compare the cost-effectiveness of three cataract surgical techniques (conventional extracapsular cataract extraction (ECCE),phacoemulsification with foldable three-piece hydrophobic acrylic soft intra-ocular lens(FoldSoftPhaco), Phacoemulsification with injection single-piece hydrophobic acrylic soft intra-ocular lens (InjSoftPhaco) in a public regional teaching hospital ,Taiwan,ROC. Setting: The consecutive series comprised 845 eyes , mean age was 72.2± SD 8.9 Y/O(27 through 98 Y/O), having ambulatory cataract surgery performed by one experienced extracapsular surgeon. The search was restricted to the years 1997 through 2005. Design: Computer-based decision analysis and Economic evaluation modeling of health care. These include cost-effectiveness analysis of cataract surgery in the first and second eyes. Methods: The patient's age, sex, axial length, anterior chamber depth, intraocular pressure, cornea astigmatism, pre-operative visual acuity, nuclear density, operation duration, per-operative complications, post-operative visual acuity and ocular comorbidity were documented. Average follow-up periods were 28.5±25.7(SD) months(1 through 106 months) All case-control comparisons were stratified into four subgroups: Group A:the first eye operation without ocular comorbidity, 389 cases。 Group B:the first eye operation with ocular comorbidity, 146 cases。 Group C:the second eye operation without ocular comorbidity , 221 cases。 Group D:the second eye operation with ocular comorbidity , 56 cases。 Data of the relevant cost and outcomes were collected. The compound data were connected with survival analysis ,time-trade-off (TTO)utility values, decision analysis, and econometric modeling to perform the cost effectiveness analysis(CEA). Results: [1]absolute value of the prediction error of Intraocular lens power calculation (3rd month)≦1D: comparison of three surgical techniques, Group A :no statistical significance P(X2m)=0.076 , Group B:had statistical significance P(X2m)=0.001, Group C:had statistical significance P(X2m)=0.0045 , Group D:no statistical significance P(X2m)=0.34 [2]absolute value of the surgical induced astigmatism (3rd month)≦1 D: comparison of three surgical techniques , Group A and Group D had statistical significance, Group A:P(X2m)= 0.003 ,Group B:P(X2m)=0.06 , Group C:P(X2m)=0.07 ,Group D:P(X2m)= 0.04 , [3] the post-operative visual acuity≧0.5 , comparison of three surgical techniques:Group A:ECCE:88.1% 、FoldSoftPhaco:94.6% , InjSoftPhaco:92.2 % ,no statistical significance P(X2m)=0.214 , Group B:ECCE:63.9 % , FoldSoftPhaco:87.1 %, InjSoftPhaco :66.7 % , had statistical significance P(X2)=0.013。 Group C:ECCE:81.8 % 、FoldSoftPhaco:95.2 %、 InjSoftPhaco:97.6% ,had statistical significance P(X2m)=0.011 , Group D:ECCE:62.5 % ,FoldSoftPhaco:88.9% , InjSoftPhaco:66.7% ,no statistical significance P(X2m)=0.67 , [4]the Log MAR line gained ≧one line: comparison of three surgical techniques: Group A:ECCE:96.8% ,FoldSoftPhaco:95.3% , InjSoftPhaco:97.3% ,Group B:ECCE:96.8% , FoldSoftPhaco:94.8% , InjSoftPhaco:90.9% , Group C:ECCE:95.2% , FoldSoftPhaco:97.5% , InjSoftPhaco:91.7% , Group D:ECCE:100%, FoldSoftPhaco:92.0%, InjSoftPhaco:100% , [5]The average cost of a cataract surgery for the hospital(not include costs of care)ECCE:NT 18,098 ,FoldSoftPhaco NT22,965 ,InjSoftPhaco NT 23,395 , Cost-Effectiveness Ratio(A 3% annual discount rate was used to account for the QALYs gain over 5 years, costs without discount): Group A: ECCE: NT34,900 $/QALY, FoldSoftPhaco: NT34,171 $ /QALY ,InjSoftPhaco: NT34,383 $ /QALY, Group B:ECCE: NT 37,080 $ /QALY, FoldSoftPhaco: NT36,896 $/QALY,InjSoftPhaco:NT 44,976 $/QALY, Group C:ECCE: NT 49,136$ /QALY, FoldSoftPhaco: NT 45,318 $/QALY,InjSoftPhaco: NT 40,275$ /QALY , Group D: ECCE:NT 33,925$ /QALY, FoldSoftPhaco: NT 41,724$ /QALY,InjSoftPhaco: NT 35,817 $/QALY Conclusions: Phacoemulsification needs additional cost for the machine (depreciation), replenishment of parts, and annual maintenance contract, and so phacoemulsification is more expensive than conventional extracapsular cataract extraction. However phacoemulsification had the advantages of effectiveness such as the lower prediction error of Intraocular lens power calculation , the lower surgical induced astigmatism , the more clear posterior capsule ,and the rapid visual recovery when compared to ECCE in the more than 3 months follow – up. In group A and C groups without ocular comorbidity, InjSoftPhaco and FoldSoftPhaco procedure were shown to be a highly cost-effective option compared with ECCE procedure. The cost-effectiveness of second-eye surgery (group C)diminished from first-eye cataract surgery(group A) , otherwise it needs further related factors analysis of effectiveness and costs in group B and D groups with ocular comorbidity due to wide variation in case-mix. | en |
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dc.description.tableofcontents | 口試委員會審定書 ................................. I
誌謝 ............................................ II 中文摘要 ....................................... III 英文摘要 ........................................ VI 第一章 緒論 第一節 研究背景與動機 ......................... 1 第二節 研究目的 ............................... 3 第二章 文獻探討 第一節 白內障及白內障手術之介紹 ............... 4 一、白內障的定義 ............................. 4 二、白內障的類型與嚴重度分級 ................. 4 三、白內障的形成原因 ......................... 5 四、白內障的症狀 ............................. 5 五、白內障的治療方式......................... 5 六、白內障的手術時機......................... 5 七、白內障手術的歷史發展..................... 5 八、常用的白內障手術方式................... 7 九、手術後的視力矯正..................... 7 十、常用的人工水晶體類型................. 7 十一、白內障手術國內外現況分析............. 8 第二節 白內障手術品質之實證研究 ............. 9 一、醫療照護與經驗曲線的相關性........... 9 二、白內障術中後囊破裂的實證 ...............12 三、白內障術後眼內炎的實證 .............. 16 四、白內障術後續發性白內障的實證.......... 17 五、白內障手術效果的實證 ................ 19 第三節 白內障手術的醫療經濟評估之實證....... 23 一、WHO對於醫療計劃或手術之成本分析的計算.. 23 二、基本的醫療成本分析與管理概念 ......... 23 三、醫療服務成本之分類..................... 26 四、確認觀點以進行不同方案的評價......... 28 五、醫療經濟評估模式 ..................... 28 六、決策分析模式(decision-analytic model) 30 七、不同的白內障手術成本效果分析之實證..... 35 第三章 研究方法 第一節 主要研究設計內容、研究架構與研究方法. 40 第二節 評估方式之選擇 ....................... 44 第三節 效果指標............................. 45 第四節 成本之蒐集 ........................... 46 第五節 架構模式:決策樹..................... 49 第六節 估計模式參數......................... 51 第七節 成本效果評估指標 ..................... 52 第八節 不確定性與敏感度分析 ................. 52 第九節 資料分析、報告結果及提出結論......... 52 第四章 結果 第一節 門診白內障手術的平均成本計算結果..... 54 第二節 不同白內障手術方式,手術併發症統計結果. 57 一、術中後囊破裂統計 ..................... 57 二、術後併發症(視網膜裂孔、術後眼壓高、術後 角膜水腫、術後眼內炎)的統計......... 58 三、術後併發症(續發性白內障須施行雷射後囊 切開術)的統計......................... 59 第三節 不同白內障手術之效果統計 ............. 62 一、四組類型的不同白內障手術之術前病患特性 與術後結果描述性統計................... 62 二、不同白內障手術之QALYs gained統計平均 值統計結果...............................73 第四節 決策樹分析的估計與假設 ............... 75 一、白內障手術健保給付費用與相關併發症處理 費用估算.................................75 二、術中併發症後囊破裂之成本估算結果..... 79 三、決策樹上設定之變項定義與假設......... 79 第五節 不同白內障手術成效之決策樹分析與結果.....81 一、Group A(第一眼手術,無眼部合併症).... 81 二、Group B(第一眼手術,有眼部合併症).. 90 三、Group C(第二眼手術,無眼部合併症).. 92 四、Group D(第二眼手術,有眼部合併症).. 94 五、四組病患不同白內障手術的增額成本效果比較 96 六、第一眼與第二眼白內障手術成本效果與不同的 折現時間的比較......................... 97 第五章 討論.........................................99 第六章 結論 .................................... 108 第七章 研究限制與建議 .......................... 110 參考文獻 ........................................ 111 圖目錄 圖1:國際LOCS III Scale系統白內障嚴重度分級 4 圖2:經驗曲線(一) 10 圖3:經驗曲線(二) 11 圖4:不同白內障手術方式的成本效果分析研究架構圖 … 41 圖5:不同白內障手術方式的成本效果分析決策樹說明 …50 圖6:三種不同白內障手術合併人工水晶體植入的成本結構比較 … 55 圖7:單月手數量與手術平均成本的關係 … 57 圖8:不同白內障手術方式,手術中後囊破裂之比較 58 圖9:不同白內障手術方式,須施行雷射後囊切開術之累積生存函數 60 圖10:不同白內障手術方式,須施行雷射後囊切開術之累積風險函數 61 圖11:不同白內障手術方式(未含術中後囊破裂)的併發症(視網膜裂孔、 術後眼壓高、術後眼內炎、續發性白內障須施行雷射後囊切開術)比較 61 圖12:四組病患之平均餘命比較 63 圖13:四組病患之平均眼軸比較 64 圖14:四組病患之術前矯正視力比較 64 圖15:四組病患之術後矯正視力比較 65 圖16:四組病患之醫師手術經驗比較 65 圖17:四組病患之白內障嚴重度比較 66 圖18:四組病患之增加效用值比較 66 圖19:四組病患之增加QALY值比較 67 圖20:四組病患之手術室停留時間比較 67 圖21:A組 不同白內障手術之效果(手術誘發散光)比較 68 圖22:B組 不同白內障手術之效果(手術誘發散光)比較 68 圖23:C組 不同白內障手術之效果(手術誘發散光)比較 69 圖24:D組 不同白內障手術之效果(手術誘發散光)比較 69 圖25:四組病患,不同白內障手術之效果(第三月手術誘發散光≦1D)比較 70 圖26:A組 不同白內障手術之效果(手術屈光度誤差)比較 70 圖27:B組 不同白內障手術之效果(手術屈光度誤差)比較 71 圖28:C組 不同白內障手術之效果(手術屈光度誤差)比較 71 圖29:D組 不同白內障手術之效果(手術屈光度誤差)比較 71 圖30:四組病患,不同白內障手術之效果(第三月手術屈光度誤差≦1D) 比較 72 圖31:Group A第一眼手術,無眼部合併症,三種白內障手術 CER 比較 81 圖32:Group A第一次白內障手術,無眼科合併症,平均成本單維敏感度分析 (InjSoftPhaco) 82 圖33:Group A平均成本雙維敏感度分析結果 82 圖34:Group A 單維敏感度分析;ECCE後囊破裂機率與CER 86 圖35:Group A 單維敏感度分析;FoldSoftPhaco後囊破裂機率與CER 86 圖36:Group A 單維敏感度分析;Inj SoftPhaco後囊破裂機率與CER 87 圖37:Group A:單維敏感度分析;ECCE 續發性白內障施打YAG雷射機率與 CER 87 圖38:Group A:單維敏感度分析 ;FoldPhaco 續發性白內障施打YAG雷射機 率與CER 88 圖39:Group A:單維敏感度分析;InjPhaco續發性白內障施打YAG雷射機 率與CER 88 圖40:Group A:單維敏感度分析;配鏡成本與CER 89 圖41:Group A:單維敏感度分析;FoldPhaco術後感染機率與CER89 圖42:Group B三種白內障手術 CER 比較 90 圖43:Group B 雙維敏感度分析結果 91 圖44:Group C第二眼手術,無眼部合併症,三種白內障手術CER比較 93 圖45:Group D第二眼手術,有眼部合併症,三種白內障手術 CER 比較 94 圖46:個案醫師超音波白內障手術的經驗曲線 100 表目錄 表1:國內外超音波白內障手術的比率 9 表2:眼科白內障手術併發症的機率(Powe 1994) 12 表3:Ohkawara醫師的經驗曲線(Ohkawara 2003) 13 表4:超音波白內障手術後囊破裂比例文獻回顧14 表5:白內障術前病患的特質評量表 15 表6:白內障手術引起眼內炎併發症之機率文獻 17 表7:AcrySof R(非親水性壓克力人工水晶體)續後性白內障,需要打YAG 雷射機率的文獻統計 18 表8:台北分局(94)年度白內障手術品質報告 22 表9: 測量法 (measurement)與決策分析模式的差別(Drummond 2005)31 表10:第一次白內障手術的成本�QALYs gained各國研究比較37 表11:不同國家第一次白內障手術成本比較 37 表12:特殊醫療處置之Cost/QALYs值 38 表13:眼科醫療處置之Cost/QALYs值39 表14:變項操作定義 42 表15:由視力推估Utility Values (Time Tradeoff Utility Values for patient with ocular disease) 45 表16:個案醫院眼科門診不同白內障手術之成本結構比率(以一個月25臺 刀計算) 55 表17:手術量與不同手術之單次平均手術成本(依估算)56 表18:不同白內障手術方式,手術室停留時間與併發症(後囊破裂)統計 58 表19:不同白內障手術方式(未含術中後囊破裂)的併發症統計59 表20:不同白內障手術方式之續發性白內障須施行雷射後囊切開術統計60 表21:不同白內障手術QALYs gained統計平均值 73 表22-1:不同白內障手術有併發症之QALYs gained估計假設(一) 74 表22-2:不同白內障手術有併發症之QALYs gained估計假設(二)74 表22-3:參考文獻,白內障手術併發症與估計之效用值(Utility Value)(from Brandon 2002) 75 表23:白內障手術與相關併發症處理費用(依民國96年台灣健保局區域醫 院給付規定) 76 表24:術中併發症後囊破裂成本估算結果 79 表25:為決策樹上設定之變項及其定義一覽表 79 表26:Group A,三種白內障手術CER值 81 表27:Group A雙維敏感度分析結果 83 表28:Group B,三種白內障手術CER值90 表29:Group C,三種白內障手術CER值 92 表30:Group D,三種白內障手術CER值 95 表31:四組病患的增額成本效果比 96 表32:不同的折現時間長短的敏感度分析(Sensitivity analysis varying the discount duration for QALYs gain) 98 表33:三種不同之白內障手術、藥物與耗材未重覆消毒使用的手術成本計算101 表34:與其他疾病治療成效之USD$�QALY 比較(USA 2000)104 表35: 本研究依整體指標(Overall Index)的綜合分析結果 108 附錄 附錄一:中華民國95年9月4日健保審字第0950068603-A號函122 附錄二:某區域醫院眼科門診手術量與單臺門診白內障手術成本估算 123 附錄三:傳統手術合併硬式人工水晶體植入與不同手術量之成本結構關係 126 附錄四:FoldSoftPhaco與不同手術量之成本結構關係 127 附錄五:超音波晶體乳化手術合併注射式軟式人工水晶體植入與不同手術 量之成本結構關係 127 附錄六:(A)第一次白內障手術,無眼科合併症,無後囊破裂 128 附錄七:(B)第一次白內障手術,有眼科合併症,無後囊破裂 130 附錄八:(C)第二眼白內障手術,無眼科合併症,無後囊破裂 132 附錄九:(D)第二眼白內障手術,有眼科合併症,無後囊破裂 134 附錄十:2000年美國白內障手術收費方式(Brandon 2003) 135 附錄十一:A至D組決策樹圖136 附錄十二:Group A,單維敏感度分析(InjSoftPhaco) 144 附錄十三:Group A單維敏感度分析,ECCE後囊破裂機率與CER144 附錄十四:Group A單維敏感度分析;FoldSoftPhaco後囊破裂機率與CER 144 附錄十五:Group A 單維敏感度分析;Inj SoftPhaco後囊破裂機率與CER 145 附錄十六:Group A;ECCE 續發性白內障施打YAG雷射機率與CER 145 附錄十七:Group A;FoldPhaco 續發性白內障施打YAG雷射機率與CER 145 附錄十八:Group A;InjPhaco 續發性白內障施打YAG雷射機率與CER 146 附錄十九:Group A;配鏡成本與CER 146 附錄二十:Group A FoldPhaco術後感染機率與CER 147 附錄二十一:Group B單維敏感度分析;ECCE 後囊破裂機率與CER 147 附錄二十二:Group B單維敏感度分析;FoldSoftPhaco 後囊破裂機率與CER 148 附錄二十三:Group B單維敏感度分析;InjSoftPhaco後囊破裂機率與CER 149 附錄二十四:Group 單維敏感度分析;ECCE續發性白內障施打YAG雷射 機率CER 149 附錄二十五:Group B單維敏感度分析;FoldSoftPhaco續發性白內障施打 YAG雷射機率與CER 150 附錄二十六:Group B單維敏感度分析;InjSoftPhaco續發性白內障施打YAG 雷射機率與CER 151 附錄二十七:Group B雙維敏感度分析結果 151 附錄二十八:Group B:單維敏感度分析;配鏡成本與CER 154 附錄二十九:Group B:單維敏感度分析;FoldPhaco術後感染機率與CER 155 附錄三十:Group C,平均成本雙維敏感度分析結果 156 附錄三十一:Crorp C單維敏感度分析;後囊破裂機率與CER 159 附錄三十二:單維敏感度分析;ECCE續發性白內障施打YAG雷射機率與 CER 160 附錄三十三:Group C:單維敏感度分析;FoldPhaco續發性白內障施打 YAG雷射機率與CER 161 附錄三十四:單維敏感度分析;InjPhaco續發性白內障施打YAG雷射機率 與CER 162 附錄三十五:單維敏度分析;Group C當配鏡成本與CER比較 162 附錄三十六:Group C:單維敏感度分析;FoldPhaco術後感染機率與CER 163 附錄三十七:Group D:單維敏感度分析;後囊破裂機率與CER164 附錄三十八:Group D: ECCE 續發性白內障施打YAG雷射機率與CER165 附錄三十九:Group D:單維敏感度分析;FoldSoftPhaco續發性白內障施 打YAG雷射機率與CER 166 附錄四十:Group D:單維敏感度分析;InjSoftPhaco續發性白內障施打 YAG雷射機率與CER 167 附錄四十一:Group D第二眼手術,有眼部合併症,配鏡成本與CER168 附錄四十二:Group D單維敏感度分析,FoldPhaco術後感染機率與CER168 附錄四十三:區域醫院白內障論病例計酬87.01.01至96.12.31.之健保給 付價格變化 169 附錄四十四:DRG(台灣3版)白內障論病例計酬(3901)住院給付依RW (權重)X SPR 169 附錄四十五:眼科健保白內障手術審查注意事項 171 附錄四十六:個案醫院 眼科門診白內障手術DRG臨床路徑表 172 附錄四十七:中華民國眼科醫學會提供之白內障手術前說明書 175 附錄四十八:中央健保局臺北分局(94)年度白內障手術品質報告 175 附錄四十九:健保提供「特殊功能人工水晶體」部分給付 176 附錄五十:Drummond「Methods for the economic evaluation of health care programmes」所列之十項批判問題 177 | |
dc.language.iso | zh-TW | |
dc.title | 不同的白内障手術之成本效果分析-以一所區域級教學醫院為例 | zh_TW |
dc.title | A Cost-Effectiveness Analysis of Different Cataract Surgery
-Take a Regional Teaching Hospital for Example | en |
dc.type | Thesis | |
dc.date.schoolyear | 96-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 郭人介,林隆光 | |
dc.subject.keyword | 白內障囊外摘除手術,超音波晶體乳化手術,摺疊式軟式人工水晶體植入,注射式軟式人工水晶體植入,成本效果分析, | zh_TW |
dc.subject.keyword | Phacoemulsification,extracapsular cataract extraction,foldable,injection,intra-ocular lens,cost-effectiveness analysis, | en |
dc.relation.page | 179 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2008-02-02 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 醫療機構管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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