慢性C型肝炎病人不同藥物治療方式下之健康相關生活品質與醫療成本分析—以某醫學中心為例

Abstract

中央健康保險局為加強慢性Ｃ型肝炎病人藥物治療照護品質，於九十二年十月一日實施「全民健康保險加強慢性C型肝炎治療試辦計畫」。本研究之目的為依照不同藥物治療方式（長效型干擾素與短效型干擾素），以社會的觀點，分析病人因接受治療所使用的醫療成本（包括直接成本與間接成本）及治療期間之健康相關生活品質。研究方法為採用橫斷式研究，針對北部某醫學中心肝炎中心93年6月間正在接受治療之慢性C型肝炎病人45位進行研究。醫療成本主要來自醫院健保申報檔及請病人自填之結構式問卷，健康相關生活品質主要由病人按照通用生活品質量表（SF-12）、疲倦量表（FSI）以及醫院焦慮及憂鬱量表（HADS）之題目自填。本研究得到重要研究結果為： 一、慢性C型肝炎病人在接受治療期間之健康相關生活品質得分都較一般健康的人來的低。在SF-12量表中，本研究接受治療之慢性C型肝炎病人於治療期間之PCS平均得分為40.26，MCS為39.58；相較於美國常模（45-55歲一般人PCS及MCS平均得分為50分），治療期間之生活品質是較低的。而在疲倦狀態上，不論是在疲倦的程度、疲倦持續的時間以及疲倦對生活的影響上，與一般人相比都是比較差的。而在焦慮與憂鬱狀態上與一般人相較也是較差的。 二、接受長效型干擾素治療之病人，在SF-12之心理總和指標、疲倦量表之疲倦持續時間以及醫院焦慮及憂鬱量表中之憂鬱部分，顯著低於接受短效型干擾素治療之病人。 三、以單月醫療成本來說，長效型干擾素治療為27,261元，短效型干擾素治療為15,145元，長效型干擾素治療治療之成本平均約為短效型干擾素治療之1.8倍。若以申報費用來看，長效型干擾素治療平均為23,666元，短效型干擾素治療約為14,125元，其中藥費所佔比率最高，長效型為23,079元，短效型為13,652元；間接成本部分，長效型干擾素治療為1,618元，短效型干擾素治療為77元。 對於兩種藥物治療方式接近兩倍的差價，以及在藥物治療過程的確會因藥物的副作用而降低健康相關生活品質。因此，我們建議，若能在治療前確定病毒的基因型，並依不同基因型給予適當的藥物治療策略；如此一來，不僅可以讓病患得到妥善照顧，也可以讓健保局將多餘的醫療資源給更多需要照護的人使用，並可以讓病患免於治療失敗還要承受治療時藥物的副作用。

The Bureau of National Health Insurance implemented 'National Health Insurance experimental plan to strengthen the treatment for chronic hepatitis C patients' on October 1 2003 to enhance the care quality in drugs treatment for hepatitis C patients. The purpose of this study was to analyze, from the societal perspective, the medical cost (including direct cost and indirect cost) and Health-Related Quality of Life (HRQoL) during the period of treatment under different treatment strategies (peginterferon versus interferon). The method of this study was a cross-sectional interview survey. Study sample were 45 patients with chronic hepatitis C who were receiving treatment in a hepatitis research center of a medical center in the northern Taiwan. The medical cost mainly contained claims data provided by the hospital and personal expenses reported by patients according to a structured questionnaire. The HRQoL were measured by asking patients to fill out a structured questionnaire by themselves; the questionnaire contained the Short Form-12 (SF-12), the Fatigue Symptom Inventory (FSI), and the Hospital Anxiety and Depression Scale (HADS). Major results of this study are as follow: 1. Hepatitis C patients had the mean scores 40.26 in the PCS and 39.58 in the MCS of the SF-12 questionnaire. Their quality of life was lower than that of general people during the treatment. In the fatigue status, patients in the period of treatment were worse in fatigue intensity, duration, and interference with quality of life. The same results were observed in the anxiety and depression status. 2. The patients with peginterferon treatment strategy were significantly worse than interferon treatment strategy in MCS of SF-12, duration of FSI, and depression of HADS. 3. The total medical cost per month was NT$ 27,261 for peginterferon treatment strategy and NT$ 15,145 for interferon treatment strategy. Peginterferon treatment strategy was 1.8 times the cost of the interferon treatment strategy. In terms of insurance claims, the average cost of peginterferon treatment strategy was NT$ 23,666 while it was NT$ 14,125 for interferon treatment strategy. The cost of drugs had the highest proportion of health insurance claims, the cost of drug for peginterferon was NT$ 23,079 and NT$ 13,652 for interferon. In addition, the indirect cost of Peginterferon treatment strategy was NT$ 1,618, and NT$ 77 for interferon. The difference of the costs of these two strategies was almost two times, and there were significant drugs side effect that decrease the HRQoL. We therefore suggest that we should determine the genetic type of virus before the treatment, so that we can give the suitable drug treatment strategy according to the gene. We not only may let patients obtain more appropriate care, but also will let the Bureau of National Health Insurance reallocate limited resources to persons who need more and can protect patients from suffering side effects if the treatment is not successful.