臺灣博碩士論文加值系統

The persistent need to fight against and/or manage various diseases that affect the general human population around the world comes with a large increase in healthcare expenditure. To contain the ever-increasing healthcare costs while providing high-quality medical services, there is need to eliminate healthcare waste by regularly redistributing resources from low-value towards high-value healthcare technologies. This process of health technology management can be achieved by routinely reassessing the value of technologies in current use by means of an evidence-based approach called health technology reassessment. In spite of the fact that a framework to conduct health technology reassessment exists, limited practical experience has been reported. To this end, this dissertation contributes to the literature by adding to this knowledge gap, a practical health technology reassessment for hepatitis B virus screening tests for blood donors Taiwan. The results of this study report on the performance of the existing HBV screening strategy in Taiwan. Furthermore, the results suggest that value of the HBsAg testing is in doubt in a setting where NAT is in use. Nevertheless, HBsAg testing remains the preferred choice when the blood providers have extremely limited budgets and cannot afford to use NAT.

Abstract i
ABSTRACT ii
ACKNOWLEDGEMENTS iii
TABLE OF CONTENTS iv
LIST OF ABBREVIATIONS vi
LIST OF FIGURES vii
LIST OF TABLES viii
CHAPTER 1: INTRODUCTION 1
1.1. Background and motivation 1
1.2. Study aims and objectives 3
1.3. Dissertation structure 4
CHAPTER 2: REVIEW OF EXISTING LITERATURE 6
2.1. Healthcare provision in Taiwan 6
2.1.1. Health technology assessment organization 7
2.1.2. Taiwan Blood Services Foundation 8
2.2. Safety of the blood supply 9
2.2.1. The impact of hepatitis B virus on blood supply safety 9
2.2.2. Infectious pathogen testing 10
2.2.3. Serological blood tests 10
2.2.4. Nucleic acid testing (NAT) 11
2.2.5. Interpretation of HBV serological and viral DNA markers 12
2.2.6. Test sensitivity and specificity 13
2.2.7. Occult Hepatitis B Virus infection (OBI) 15
2.3. Healthcare technology lifecycle 15
2.4. Technology selection 16
CHAPTER 3: HEALTH ECONOMIC MODELING 18
3.1. Testing Algorithm 18
3.2. Blood screening strategies 19
3.3. Threat of infection 19
3.4. HBV transmission risk modeling 20
3.4.1. Residual risk estimation using the Weusten model 22
3.5. Disease modeling 26
3.5.1. Markov model for HBV prognosis 26
3.6. Data synthesis for the Markov model 30
3.6.1. Transition probability data 30
3.6.2. Cost data 31
3.6.3. Health utility data 32
3.7. Distributions for model parameters 32
3.7.1. Binomial and multinomial distributions for transition probabilities 32
3.7.2. Gamma distribution for cost data 37
3.7.3. Beta distribution for health state utilities 37
CHAPTER 4: HEALTHCARE ECONOMIC EVALUATION 41
4.1. Cost effectiveness analysis 41
4.2. Cost-effectiveness threshold 43
4.3. Software and computation 43
4.4. Residual risk and infectious window period days 44
4.5. Cost-effectiveness analysis summary 45
4.6. Net monetary benefit 45
4.7. Uncertainty in healthcare economic evaluation 48
4.7.1. Deterministic sensitivity analysis 48
4.7.2. Probabilistic sensitivity analyses 50
4.8. Discussion 51
CHAPTER 5: CONCLUSION, IMPLICATIONS, LIMITATIONS AND FUTURE WORK 54
5.1. Conclusion 54
5.2. Implications and future work 54
References 57
Appendix 69

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