自費癌症藥物取得新適應症之處方決策評估 -以層級分析法分析醫師對肺癌藥物的評估

Abstract

近十年來，肺癌的發生率及死亡率在全球及台灣皆居高不下。根據世界衛生組織(WHO)的數據，肺癌是全球癌症死亡的主要原因。在台灣，肺癌死亡率在男女中均為第一位，尤其是在50至80歲的年齡層。吸菸、二手菸和空氣污染是主要危險因子。儘管男性吸菸率下降，女性肺腺癌的發生率卻逐年上升，對家庭和健保系統造成巨大壓力。

同時，過去十年中，肺癌治療新藥的發展如火如荼，包括化學治療、標靶藥物治療、免疫檢查點抑制劑治療及細胞治療等皆有良好的臨床試驗結果。然而，許多新藥在尚未納入台灣健保前，患者需自費購買。根據衛生福利部的資料，癌症治療費用高昂，肺癌的醫療支出尤為顯著。2023年，癌症健保支出達到1399億點，其中肺癌治療的醫療費用達243億點。癌症患者的醫療費用隨年齡增長而上升，對健保系統造成沉重負擔。因此，本研究旨在探討自費肺癌藥物對醫師處方決策的影響，分析影響醫師處方決策的因素，以提升病患和醫師對治療肺癌的共同目標，進而改善整體治療效果。

本研究主要在探討醫師在處方自費肺癌藥物時的考量因素及其影響。藉由探討台灣及全球肺癌趨勢、台灣健保制度下的癌症藥物自費市場、自費癌症藥物之決策點、以及醫師之癌症藥物處方因素，以具體分析影響醫師處方自費肺癌藥物的決策因素，建構影響構面及利用層級分析法得出影響權重。為更多了解醫師處方自費肺癌藥物的不同考量因素，本研究將針對第三方觀點、資訊傳遞管道、藥品特徵及藥廠資源構面，對於不同醫院屬性以及不同醫師特徵來探討決策的影響程度，歸納後得到以下結果： (1) 整體群體及各分群體對於四大考量構面呈現出相似的趨勢 (2) 不同醫師族群對於考量點不同，特別是在治療經驗有落差時 (3) 劃分出兩類群體(Group X、Group Y)，藥廠針對這兩類群體擬定不同的策略

總結來說，本研究探討針對不同醫師群體的差異化，擬定行銷策略，以提高醫師對自費肺癌藥物的處方信心，達到藥廠、醫師及患者三贏的局面。

Over the past decade, the incidence and mortality rates of lung cancer have remained high both globally and in Taiwan. According to data from the World Health Organization (WHO), lung cancer is the leading cause of cancer-related deaths worldwide. In Taiwan, lung cancer has the highest mortality rate among both men and women, particularly in the 50 to 80 age group. Smoking, second-hand smoke, and air pollution are major risk factors. Although the smoking rate among men has decreased, the incidence of lung adenocarcinoma in women has continued to rise, placing significant pressure on families and the healthcare system. Simultaneously, the development of new drugs for lung cancer treatment has been vigorous over the past decade, including chemotherapy, targeted therapy, immune checkpoint inhibitors, and cell therapy, all showing promising clinical trial results. However, many new drugs must be purchased out-of-pocket by patients before they are included in Taiwan's National Health Insurance (NHI). According to the Ministry of Health and Welfare, cancer treatment costs are substantial, with lung cancer medical expenses being particularly significant. In 2023, cancer-related NHI expenditures reached 139.9 billion points, with lung cancer treatment accounting for 24.3 billion points. As cancer patients' medical expenses increase with age, this places a heavy burden on the NHI system. Therefore, this study aims to investigate the impact of out-of-pocket lung cancer drugs on physicians' prescription decisions, analyzing the factors that influence these decisions to enhance the shared treatment goals of patients and physicians, ultimately improving overall treatment outcomes. This study primarily explores the considerations and influences on physicians when prescribing self-paid lung cancer medications. By examining lung cancer trends in Taiwan and globally, the out-of-pocket cancer drug market under Taiwan's National Health Insurance system, decision points for self-paid cancer medications, and the factors influencing physicians' prescription of cancer drugs, this study aims to concretely analyze the decision factors affecting physicians' prescription of self-paid lung cancer medications. The research constructs influencing dimensions and utilizes the Analytic Hierarchy Process (AHP) to determine the weight of these influences. To better understand the various considerations physicians have when prescribing self-paid lung cancer medications, this study investigates the impact of third-party perspectives, information dissemination channels, drug characteristics, and pharmaceutical company resources on decision-making. These factors are analyzed in relation to different hospital attributes and physician characteristics, leading to the following conclusions: (1) The overall group and each subgroup exhibit similar trends regarding the four main consideration dimensions. (2) Different physician groups prioritize different consideration points, especially when there is a discrepancy in treatment experience. (3) Two groups (Group X and Group Y) were identified, with different strategies proposed for each by pharmaceutical companies. In summary, this study explores differentiated marketing strategies for various physician groups to increase physicians' confidence in prescribing out-of-pocket lung cancer drugs, and achieve a win-win situation for pharmaceutical companies, physicians, and patients.