老人接種肺炎鏈球菌疫苗之效益分析

Abstract

肺炎是引起國內老人住院及死亡的重要疾病，根據2005年行政院衛生署衛生統計，肺炎為全國十大死因第六位，可推估政府每年所需支付肺炎之醫療服務費用及民眾所花費照護之精神及所需費用極為龐大。國外研究報告指出接種肺炎鏈球菌疫苗可有效降低醫療利用、費用及死亡率等相關結果。目前國內僅台灣大學醫學院附設醫院李秉穎醫師進行此疫苗接種之保護效益分析，近期則無相關研究。 本研究目的為探討國內老人接種肺炎鏈球菌疫苗對醫療利用、醫療費用及死亡率之影響。研究資料來自台大醫院李秉穎醫師提供九二一地震後之災區老人接種肺炎鏈球菌疫苗之問卷調查資料，再串連全民健康保險之門診及住院醫療明細檔資料及行政院內政部死亡登記檔。以有接種疫苗為疫苗組及未接種疫苗為對照組二組，分別以接種第一年（2000年）、接種第二年（2001年）之門診、住院因肺炎鏈球菌相關疾病及所有門診與住院疾病之醫療利用、費用及死亡率進行比較，並進一步以迴歸模式分析接種疫苗之門診及住院醫療利用及費用情形。 研究結果發現，接種疫苗組在肺炎鏈球菌相關疾病之門診醫療利用及費用，皆較對照組高，但是在住院之住院次數、住院天數之醫療利用則較對照組為低。然而，因為肺炎鏈球菌相關疾病個案數過少，造成統計穩定性不足，結果推論尚待釐清。 進一步控制疫苗組之影響因素，對於所有疾病而言，發現接種疫苗組之所有門診就醫次數較對照組低2至7次（p值：<0.001），在所有疾病住院機率方面為對照組的0.71∼0.80倍，顯示接種疫苗對所有疾病之門診及住院次數是有顯著保護，但是在醫療費用方面皆較對照組高。對接種疫苗之死亡率方面，疫苗組與對照組之間並無顯著差異。 總結，接種疫苗對特定因肺炎鏈球菌相關疾病似乎並無保護效益，但是對所有疾病之門診及住院（在醫療利用上）有保護效益，但因受限於個案數不足，本研究結果尚待未來研究加以確認。

Pneumonia and its complications are dangerous factors to cause death or hospitalization of elders nowadays. According to the statistic data of Department of Health (DOH), pneumonia is in the sixth place among the first ten diseases that causing death. In other words, the expenditure of medical service by government and individuals is large. In other countries, studies about the relation between pneumonia streptococcus vaccine injection and medical spending reduction, death rate has been publishing continually. In Taiwan, Dr. Lee-Ping Ing from National Taiwan University Hospital (NTUH) is the only person doing research in this field. In this paper, we are going to discuss the benefit of cost effective, efficiency of death reduction and disease prevention of Pneumococcal Vaccination injection to elders in the region of Taiwan. This paper is discussing the relationship among Pneumococcal Vaccination injection to elders, medical utility rate, medical expenditure, and death rate. In addition, it combines three data sources each from Pneumococcal Vaccination injection survey in 921 earth quake area from Dr. Lee-Ping Ing, questionnaire from outpatient and inpatient from Bureau of National Health Insurance (NHI), and database of death toll from Ministry of Interior (MOI). These data are separated as received vaccine (experimentation group) and unreceived vaccine (comparison group). And we analyze those data by period (2000, 2001), medical utility rate relates with pneumonia streptococcus illness, expenditure, and death rate using statistic approach. The result has been derived shows that experimentation group has higher outpatient rate than comparison, but its inpatient rate is lower. The outpatient rate of experimentation can effectively reduce 2~7 (P-value < 0.001). Inpatient rate is 71~80% of comparison group. Above result shows experimentation has significant effect in reducing inpatient and out patient rate. But it also cost more medical expenditure. For death rate, there is no significant influence between experimentation and comparison group. Base upon this study, giving Pneumococcal Vaccination injection has not much influence reducing the death rate for pneumonia streptococcus related diseases. But it is beneficial for all illnesses in medical utility rate. Besides, due to insufficient samples, this result could not be verified until the future studies are done.