臺灣博碩士論文加值系統

研究背景與目的 巴金森氏症(Parkinson''s disease)是繼老年痴呆症(Dementia)之後臺灣地區第二常見之神經退化性疾病。臺灣相關統計顯示，2008年有85,510名巴金森氏症病人接受治療，過去研究發現篩檢可以多找出22.5%的早期個案，減少51%晚期個案發生以及25%的死亡率，如此將有效減輕對病人、家庭以及社會的經濟重擔。雖然巴金森氏症篩檢的早期偵測效益已被證實，然而其成本效益尚未被評估。因此，本研究目的旨在探討巴金森氏症篩檢的成本效益。
材料與方法 本研究以衛生主管機關觀點，使用2001年基隆市社區整合式篩檢中神經內科篩檢結果求得與巴金森氏症疾病相關參數，並以2001-2008年健保申報資料檔得到成本參數，據此建構馬可夫決策分析模式，模擬一個40歲以上社區民眾的世代，進行巴金森氏症篩檢之決定性與機率性成本效益分析。
研究結果 未折現下各篩檢策略相較無篩檢的增加成本效益比介於每多拯救一個人命年約需花費新台幣16,447與59,577之間；在3%折現率下，其值介於新台幣23,167至76,125之間。由成本效益可接受曲線顯示當願付額上限值介於2.1-8、8-11、11-25.5、大於25.5萬元等不同範圍時，分別以單次篩檢、三年一篩、二年一篩及每年一篩的篩檢策略具有成本效益的機會最高。
結論 實施巴金森氏症篩檢是具有成本效益的。

Background: Parkinson''s disease (PD) is the second most common neurodegenerative disease in Taiwan. A total of 85,510 patients suffered from PD have been under treated in 2008 in Taiwan. It has been showed that screening for early PD can lead to 51% reduction for late stage of PD, and 25% mortality reduction. Thus, early detection could relieve medical burden from PD for patients themselves, the family members, and even for society. However, the cost-effectiveness of PD screening was never addressed. The aim of this thesis was to evaluate the cost-effectiveness of PD screening program.
Materials and Methods: Parameters used in the Markov decision analytic model considering disease progress and the efficacy of PD screening were derived from Keelung Community–based survey for PD in 2001, which targeted at residents aged 40 years and above. Data on cost of PD treatment was derived from the national health insurance claimed data during the period of 2001 to 2008. Both deterministic and probabilistic cost-effectiveness analyses of PD screening program were conducted with computer simulation for a simulated hypothetical cohort of residents aged 40 years and above. The health policy maker’s view point was used for economic analysis.
Results: Without considering discount rate, compared with no screen strategy, the incremental cost-effectiveness ratios (ICER) of PD screening with one-shot or with different interscreening intervals ranged from NTD 16,447 to 59,577 per life-year gained. The ICERs ranged from NTD 23,167 to 76,125 per life year gained considering 3% discount rate. The best strategy is one-shot screen for ceiling ratio ranged from NTD 21,000 to 80,000. The second and third strategies were triennial screen and biennial screen for which the ceiling ratios changed from NTD 80,000 to 110,000, and NTD 10,000 to 255,000, respectively. If the ceiling ratio is larger than NTD 255,000, then annual screen became the most cost-effective strategy.
Conclusion: PD screening program is cost-effective.

口試委員會審定書 i
致謝 ii
摘要 iii
Abstract iv
第一章 前言 1
第一節 研究背景 1
第二節 研究動機與目的 5
第二章 文獻探討 6
第一節 巴金森氏症病理特性、臨床表徵及鑑別診斷 6
第二節 巴金森氏症之治療 8
第三節 巴金森氏症盛行率 10
第四節 巴金森氏症社區疾病篩檢實證研究 11
第五節 疾病成本的分類與範圍 12
第六節 巴金森氏症疾病成本實證研究 13
第七節 成本效益分析方法 15
第八節 馬可夫決策模式 17
第三章 材料與方法 21
第一節 研究族群 21
第二節 巴金森氏症篩檢馬可夫決策模式架構 21
第三節 疾病自然史 24
第四節 參數來源及設定 26
第五節 機率分布 29
第六節 模式假設 32
第七節 評估準則 34
第四章 研究結果 35
第一節 成本估算 35
第二節 模式驗證 35
第三節 決定性模式的成本效益分析-基準值估計 36
第四節 機率性成本效益分析 40
第五章 討論 49
第一節 主要結果 49
第二節 研究限制 51
第三節 篩檢計畫之其他考量因素 52
第四節 未來研究方向 53
參考文獻 55

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