臺灣博碩士論文加值系統

摘要
背景與目的：老人健康檢查已實施多年，然而實施至今，利用率卻只有25~40%，老人因接受健康檢查所產生的成本效果在國內很少有人探討，故本研究以高雄市某市立醫院的健檢資料，探討老人健康檢查參檢者心房顫動(AF)的盛行率與發生率，並以這些AF患者為基礎，進一步用成本效果分析法來評估老人健康檢查項目中，心電圖檢查與治療之成本與效果，期能提供相關主管機關制定老人衛生暨福利政策以及資源再分配之參考。
方法：本研究以AF患者誘發腦中風疾病為例，引用文獻和實際費用的數據，分別以盛行率和發生率推估模式來評估AF篩檢與治療的成本效果，並且各以三個MODEL來評估不同情況下，成本效果的變化。同時為了解所引用文獻與實際費用數據之影響，盛行率及發生率推估模式均以敏感度分析法來檢驗數據之影響。
結果：85-88年AF盛行率分別為1.43﹪、1.39﹪、1.55﹪、1.11%，85-88年AF發生率分別為0.49%、0.62%、0.33%，盛行率與發生率推估模式評估結果顯示，以MODEL1較保守的估計而言，接受健檢比未接受健檢的AF患者不但每人可節省8,169~54,059元，同時還可增加185天的壽命。以MODEL3較理想情況的估計而言，接受健檢比未接受健檢的AF患者不但每人可節省77,456~123,347元，同時還可增加482天的壽命。敏感度分析方面，不論在盛行率或發生率推估模式，每月居家照護月平均直接費用、腦中風患者需居家照護的比率、接受健檢服藥的遵醫囑率、折現率，對成本有中度的影響，而每年未接受治療中風的發生率對成本效果則是影響最大。
結論與建議：接受老人健檢者AF盛行率及發生率比國外一般老人族群低，而老人健檢計畫以AF的篩檢與治療深具成本效果。建議應將老人健檢計畫推廣至全國，並加強宣導與鼓勵以提昇參檢率。另外亦須加強健檢前後不同階段的衛教服務，以提升AF患者的就醫率與服藥的遵醫囑率，並長期追蹤管理病患的治療結果，降低腦中風的發生率，如此不但可以增加AF檢查與治療的成本效果，更可以提昇整體老人健康檢查計劃之成效。
關鍵詞：心房顫動(AF) 、成本效果、發生率、盛行率、腦中風

Abstract
Background and Purpose: Elderly Health Examination Program(EHEP) has been carried out for many years. However, the utilization were just about 25~40%.Cost-
Effectiveness Analysis of EHEP was seldom discussed in Taiwan. Therefore, the major purposes of this study are to understand the prevalence and incidence rates of atrial fibrillation(AF) of the elderly who attended health examination program; furthermore, Cost-Effectiveness Analysis(CEA) was used to evaluate the cost and effectiveness of EKG AF screening with the example of stoke patients. This study aims to provide resource relocation reference to related institution in charge of health and social welfare policy decision- making of elderly.
Method: Elderly who attended 1996 -1999 Health Examination Program in one of the municipal hospital, sponsored by Kaohsiung City government and Bureau of National Health Insurance, were included in the study. Three hypothetical models for each prevalence and incidence were developed to evaluate the cost effectiveness in different conditions. Sensitivity analysis was used to evaluate effect of each estimation indicators on the cost effectiveness.
Results: The results indicated that prevalence rate of atrial fibrillation in 1996-1999 were 1.43﹪, 1.39﹪, 1.55﹪, and 1.11%, and incidence rate were 0.49%, 0.62%, and 0.33%. Conservative estimation as shown in Model 1, both of prevalence and incidence inferential models indicated that, each atrial fibrillation patient who had attended health examination not only saved NT$ 8,169~54,059, but also increased the life of 185 days. In model 3, ideal estimation, each atrial fibrillation patient who had attended health examination not only saved NT$77,456~123,347, but also increased the life of 482 days. According to the results of sensitivity analysis, cost effectiveness was sensitive to following estimation indicators: stroke rate in untreated elderly, proportions of stroke patients in home care, monthly average direct cost of nursing home, discount rate , and to compliance of medication.
Conclusion and Suggestion: The prevalence and incidence rates of atrial fibrillation of the elderly who attended health examination program are lower than those of general elderly group of Westerners, and EHEP of AF screening with treatment is cost-effective for stroke prophylaxis. The implications of the results can be useful for health and social welfare policy relate to the elderly. This study suggests more promotion for the health examination program of the elderly is critical to maximizing its cost effectiveness. Scheduled education programs, before and after health examination, are also essential for atrial fibrillation patients who should seek for treatment and keep compliant for a lower incidence rate of stroke.
Key Word: atrial fibrillation, cost effectiveness, incidence, prevalence, stroke

目 錄
第一章 緒論
第一節 研究背景與動機 1
第二節 研究的重要性 3
第三節 研究目的 5
第四節 預期貢獻 6
第五節 名詞界定 7
第二章 文獻探討
第一節 AF盛行率 9
第二節 AF發生率 10第三節 AF治療費用與腦中風醫療費用 11
第四節 AF治療與未治療中風的發生率與死亡率 13
第五節 成本效果分析法 14
第六節 AF患者預防腦中風之成本效果分析 16
第三章 研究方法
第一節 研究架構 22
第二節 研究假設 28
第三節 研究對象與資料來源 28
第四節 研究變項定義 36
第五節 資料分析 38
第四章 研究結果
第一節 AF盛行率與發生率 40
第二節 盛行率推估模式之成本效果 44
第三節 發生率推估模式之成本效果 50
第五章 討論與建議
第一節 討論 58
第二節 建議 63
第三節 研究限制 64
參考文獻 65
圖 表 目 錄
表目錄
表2-1 AF盛行率與發生率之文獻摘要 19
表2-2 治療與未治療中風的發生率與死亡率之文獻摘要 20
表2-3 AF患者預防腦中風成本效果分析之文獻摘要 21
表3-1 AF患者平均每月門診醫療費用估算表 31
表3-2 腦中風患者平均每人之住院醫療費用 32
表3-3 死於腦中風者平均每人之醫療費用 33
表3-4 AF篩檢成本效果分析採用之數據 34
表3-5 治療與未治療中風的發生率與死亡率之試驗結果摘要 35
表4-1 85-88年度高雄市某市立醫院老人健檢參檢者分佈情形 41
表4-2 85-88年度高雄市某市立醫院老人健檢參檢者AF分佈情形 41
表4-3 85-88年參檢者之retention rate 43
表4-4 85-88年某市立醫院老人健檢參檢者AF新個案分佈情形 43
表4-5 盛行率推估模式之成本效果摘要 45
表4-6 盛行率推估模式MODEL1與MODEL3之成本效果比較 46
表4-7 盛行率推估模式的成本效果敏感度分析 48
表4-8 發生率推估模式之成本效果摘要 51
表4-9 盛行率推估模式MODEL1與MODEL3之成本效果比較 52
表4-10 發生率推估模式的成本效果敏感度分析 54
圖目錄
圖3-1 盛行率推估模式之費用評估架構圖 24
圖3-2 發生率推估模式之費用評估架構圖 25
圖3-3 盛行率推估模式之效果評估架構圖 26
圖3-4 發生率推估模式之效果評估架構圖 27

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