臺灣博碩士論文加值系統

中文摘要
背景：水痘預防針已在許多國家開始施打，但是目前台灣尚未把水痘預防針列入常規接種計畫中。
目的：評估水痘預防針在台灣全面施打之經濟評估。
方法：使用決策分析方法及馬可夫數學模式以求出各年齡層之水痘流行病學數值,另外,自台灣4個不同地區取樣調查水痘病例之醫療資源使用情形及照護者生產力損失多寡, 並計算預防針接種政策執行時之各項成本, 進而推估其產生之效益、效果及效用。
結果：全面施行水痘預防針接種政策時多付出之針劑及醫療費用共約貳億捌仟萬元,但卻可減少柒億參仟萬元之工作生產力損失，為整個社會資源減少肆億伍仟萬圓之支出。但單從醫療費用支出者之層面而言，每減少一個水痘病例之發生約負擔1,417元，減少一個嚴重併發症約需250,000元，減少一死亡病例約需4仟5佰萬元，減少一終生失能則約需為玖仟貳佰萬元。
若從成本效用分析看來，醫療付費者每付出461元可得1個健康年(QALY)，從成本效益分析而言，在社會層面上每投資壹圓於水痘預防針接種政策上即可節省將近貳圓之支出，但是從付費者層面(只針對醫療費用之花費)而言，卻並不划算。
結論：從整體社會資源之經濟評估看來，只要疫苗成本低於2,270元即適於全面接種。

Abstract
Backgropund. ─Whether a routine varicella vaccination program is cost-effective has not been fully addressed in Taiwan.
Objective.─To perform an economic evaluation to determine whether it is worthwhile to initiate a routine varicella vaccination program for healthy children at age of 15 months old against varicella in Taiwan from health care payer’s perspective and the societal perspective.
Methods.─Decision analysis using a mathematical Markov model was conducted to compare the balance between costs and benefit/effectiveness/utility for a routine vaccination program against no vaccination. The vaccine efficacy was relied on published and/or unpublished data. Medical utilization rates and costs were collected from an empirical survey in 4 different districts in Taiwan.
Results.─From health care payer’s perspective, the discounted net cost for vaccination program is NT$ 281 millions. The discounted indirect cost saved by vaccination program is estimated at NT$ 733 millions. This yields NT$ 452 millions net saving due to vaccination program from the societal perspective.
The marginal cost-effectiveness ratios are calculated as NT$ 1,417, NT$ 249,556, NT$ 46 millions, and NT$ 92 millions for preventing an additional chickenpox case, major complication, death, and long-term disability, respectively, from health payer’s perspective. The marginal cost-utility ratio for the vaccinated group against the unvaccinated group is calculated as NT$ 461 per QALY gained from health care payer’s perspective. The vaccinated group dominates the unvaccinated group from the societal viewpoint.
From health care payer’s perspective, a varicella vaccination program can only save NT$ 0.34 in discounted costs for each dollar incurred in a vaccination program whereas save NT$ 2.06 from the societal viewpoint.
Conclusions The present study suggests that a routine varicella vaccination program is worthwhile from the societal perspective provided that the vaccine price not beyond NT$2,270

Contents
Abstract …………………………………………………...…………….iv
中文摘要…………………………………………………………………vii
I Introduction…………………………………………………………….1
II Brief Literature Review………………………………………………5
III Materials and Methods13
1. The Disease Natural History, Complications, and Medical Utilization of Varicella…………………………………………...13
2. Markov Decision Model…………………………………………14
3. Empirical Survey for direct costs, indirect costs and medical utilization…………………………………………………………20
4. Cost-effectiveness, cost-utility analysis cost-benefit analysis…………………………………………………………..24
5. The procedure for Markov decision analysis on cost-benefit analysis using tree-age is shown in Appendix A…………….25
IV Results………………………………………………………………..28
1. Empirical survey on the socio-economic consequences of varcella…………………………………………………………...28
2. Effectiveness and cost of vaccination…………………………31
3. Cost-effectiveness ratio, cost-utility ratio, and Benefit-Cost Ratio…………………………………………………………….32
4. Sensitivity analysis………………………………………………34
V Discussion…………………………………………………………….36
VI Reference ……………………………..…………………………….45
Table List
Table 1 Summary of varicella vaccine economic impact models……………..…………………………………………..48
Table 2 Baseline assumptions in varicella-related probabilities and varicella vaccine efficacy parameters……………………….49
Table 3 Assessment of utility in variable status……………………..50
Table 4 Demographics of children and associated events with chickenpox infection…………………………………………. 51
Table 5 Medical utility and school loss or work loss of families among cases with chickenpox infection………………….. …………………………………..52
Table 6 The “willingness to pay” among cases with chickenpox infection……………………………….……………………….53
Table 7 Estimation of health care utilization and productivity loss in varicella Infection………………………………………….54
Table 8 The effectiveness of varicella vaccination program against no vaccination by prevention of chickenpox case, long-term disabilitiy event and death……………….…………………………………………..55
Table 9 Direct and indirect costs in the vaccination and non-vaccination groups………………………………………56
Table 10 The costs, QALY and marginal C/E in vaccination and non-vaccination groups………………………………………57
Table 11 Sensitivity analyses for relevant parameters per life year gained…….……………………………………………………58
Table 12 Sensitivity analyses for relevant parameters per chickenpox prevented……...………………………………...59
Figure List
Fig. 1 The disease natural history, complications and medical utilizations of chickenpox infection………………………….60
Fig. 2 Markov decision analysis on cost-benefit analysis using tree-age. (effectiveness:life-year)…………………………………….61
Fig. 3 Markov decision analysis on cost-benefit analysis using tree-age. (effectiveness: cases of chickenpox)………………………63
Appendix
Appendix A :The procedure for Markov decision analysis on cost-benefit analysis using tree-age.…………………..65

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