使用Chlorheexidine及Povidone iodine預防癌症患者人工血管相關血流感染影響之成本效果

Abstract

研究背景與目的 腫瘤患者於檢查及治療期間多需依賴靜脈導管使用，其最常見合併症為相關血流感染，一但發生靜脈導管相關血流感染，可能影響患者整體生理心理狀態、照護品質並增加患者之併發症、致死率及醫療費用，故避免靜脈導管相關血流感染成為臨床腫瘤照護人員主要課題之一。因目前尚無針對人工血管相關血流感染使用氯已定(Chlorhexidine)及聚維酮碘(Povidone iodine)之成本效果分析，期待藉此研究增進腫瘤科患者照護品質，並提供醫院及相關感染控制政策決策者針對人工血管照護之政策建議。 研究方法 本研究針對固態腫瘤患者之人工血管入針處皮膚消毒消毒使用氯已定(Chlorhexidine)或聚維酮碘(Povidone iodine)進行前瞻性世代研究，於2009年10月至2012年2月蒐集醫療及感染相關費用，採醫院觀點以成本收費比分析成本並進行成本效果差異比及淨效益計算。 結果 研究結果顯示研究期間，患者平均醫療費用為新台幣360,675.21元。曾經有人工血管相關血流感染之患者於研究期間平均醫療花費為新台幣564,287.33元，顯著高於無感染者平均醫療花費新台幣331,112,99元。人工血管當次血流感染之平均花費為新台幣210,101.61元，影響人工血管當次血流感染醫療花費之因子為腫瘤型態、住院天數、加護病房使用與否及感染型態。 本研究以醫院觀點進行成本效果分析，結果顯示使用Chlorhexidine降低一名腫瘤患者罹患人工血管相關血流感染之成本效果差異比(ICER)為新台幣78,057.6元，達到之淨效益為每年節省新台幣1,230,452.47元成本支出。

建議 未來腫瘤處置若納入住院診斷關聯群支付制度後，使用Chlorhexidine消毒液可為醫院減少支出達到效益。若持續研究預防腫瘤科患者相關血流感染研究時，可考慮將「生活品質校正後生命年數」（Quality-adjusted life year, QALY）加入研究進行成本效用分析，以期持續改善腫瘤科患者之生活品質及降低血流相關感染。

Background and Purpose: Implantable port-catheter system (Port-A) is the most commonly used intravascular device on oncology patients. However, Port-A associated bloodstream infection (PABSI) is an important issue of caring oncology patient. How to prevent Port-A associated bloodstream infection (PABSI) is the challenge of oncologist. Antiseptic solution on port-A skin care is one method of preventing PABSI. The purpose of this study was to use cost effectiveness analysis to evaluate the number of infections and associated costs using Chlorhexidine and Povidone Iodine. Study Methods: A prospective study of evaluation port-A bloodstream infection between using Chlorhexidine and Povidone Iodine on port-A skin dressing were carried out from Oct. 2009 to Feb. 2012. The view point of this cost effectiveness analysis is based on the hospital. The cost analyzed included total medical charge and infection charge within study period and used cost to charge ratio to correct the charge data and to evaluate incremental cost effectiveness ratio and net benefit. Results The average total medical cost of the oncology patient during the study period was NTD 360,675.21. The average total medical cost of the oncology patient with PABSI during the study period was NTD 564,287.33, which is significantly higher than that of patients without PABSI at NTD 331,112,99. The average total medical cost during PABSI period was NTD 210,101.61. The factors associated with medical cost of PABSI were cancer type, total length of stay, use of intensive care unit and infection type. The incremental cost effectiveness ratio of preventing one patient with Port-A associated bloodstream infection by using Chlorhexidine on port-A skin dressing was NTD 78057.6. Net benefit of using Chlorhexidine to replace Povidone iodine can save the hospital NTD 1,230,452.47 annually. Recommendations The hospital can save the cost and get effectiveness by using Chlorhexidine on port-A skin care after oncology procedures were included the Diagnosis related groups (DRGs). In order to improve the life quality of oncology patient and decrease bloodstream infection, future reserachers may consider using quality-adjusted life year (QALY) to conduct cost utility analyses.