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研究生:林筱涵
研究生(外文):Hsiao-han Lin
論文名稱:台灣20-64歲癌症族群施打流感疫苗之成本效果分析
論文名稱(外文):Cost-Effectiveness analysis of Influenza Vaccination among Cancer Patients Aged 20 to 64 Years Old in Taiwan
指導教授:陳國東陳國東引用關係
指導教授(外文):Kow-tong Chen
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:59
中文關鍵詞:流感疫苗成本效果癌症
外文關鍵詞:cost-effectivenessinfluenza vaccinecancer patients
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背景:癌症病患是感染流感的高危險族,感染流感後會使病毒在他們身上繁殖時間較長,因此流感傳播期較長。此外,癌症病患感染流感會延遲危急生命的化學治療。近年來美國Advisory Committee on Immunization Practice(ACIP)已提倡針對高危險流感併發症族群施打流感疫苗,然而,到目前為止台灣尚未推動接種此項政策。因此本篇研究的目的為想評估台灣20~64歲癌症病患施打流感疫苗之成本效果。
材料與方法:使用決策分析模型,模擬34,112位20~64歲癌症病患,從醫療觀點與社會觀點評估流感疫苗政策之成本效果。癌症病患的資料來源為台灣91年癌症登記年報,醫療使用情形資料來源為全民健保資料庫,其餘參數資料來源包括國內、外學者的文獻資料。比較兩種方案: 20~64歲癌症病患執行流感疫苗政策與不執行流感疫苗政策。基準值病患假設為51歲(全民健保資料庫,年齡介於20~64歲且近五年被診斷為癌症之平均年齡)。
結果:由基準值,從醫療觀點看,執行疫苗計劃可節省約台幣1億7千萬元;從社會觀點看,執行疫苗計劃可節省約台幣7億元。由基準值,從醫療觀點看,相較於未執行疫苗計劃方案,每多預防一位癌症病患得流感可節省台幣66,482元;從社會觀點看,每多預防一位癌症病患得流感可節省台幣271,572元。最後敏感度分析得結果呈獻,即使基準值變動,從醫療觀點或社會觀點看,執行疫苗計劃仍為成本節省。
結論:無論從醫療觀點或社會觀點,在20~64歲癌症病患施打流感疫苗都是成本節省且符合成本效果,因此本研究結果建議政府單位應加強推動20~64歲癌症病患施打流感疫苗。
Background:Cancer patients have high risk of Influenza infections. Previous studies have shown an increased incidence and duration of Influenza infections among cancer patients. Furthermore, Influenza infections in cancer patients have often delayed life-saving therapy. As a result, the Advisory Committee on Immunization Practice (ACIP) currently recommends annual vaccination against influenza for all individuals at increased risk of influenza-related complications. However, the recommended vaccination schedule doesn’t include cancer patients in Taiwan. Therefore, the purpose of this study was to assess the cost-effectiveness of influenza vaccination of cancer patients in Taiwan.
Methods: We used a decision analysis model, from health care system and societal perspective, to estimate the cost-effectiveness of influenza vaccination on 34,112 cancer patients aged 20 to 64. A decision tree used estimates of disease burden, costs obtained from 2002 Taiwan's cancer annual report, resource utilization from National Health Research Institutes Database (NHRID) of 1998-2003, and supplemented with data from Taiwan and other countries’ published articles. The base-case patient was assumed to be a 51-year-old cancer patient (the mean age for NHRID, and 20-64 patients within 5 years of cancer diagnosis.)
Results:In base-case, from the health care system perspective, influenza vaccination resulted in savings of NT 17 million; from the societal perspective, influenza vaccination resulted in savings of NT 70 million. In base-case, compared with the no vaccination strategy, from the health care system and societal perspective, the incremental cost-effectiveness ratio was NT 66,482 and NT 271,572 per vaccinated cancer patient gained, respectively. Finally, even the base-case changed, from the health care system and societal perspective, the model was robust.
Conclusions:Both health care system and society indicate that the influenza vaccination would be cost-saving and cost-effective for cancer patients aged 20 to 64 years old in Taiwan. Implementing the influenza immunization programs is encouraged in this risk group.
摘要 III
ABSTRACT IV
致謝 VI
正文目錄 VII
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究目的 3
第二章 文獻回顧 4
第一節 流行性感冒 4
1.1流感病毒 4
1.2傳播方式 4
1.3潛伏期與可傳染期 5
1.4臨床症狀 5
1.5 流感的流行病學 5
1.6癌症族群與流感的流行病學 6
第二節 流感疫苗 7
2.1 流感疫苗株與病毒株 7
2.2流感疫苗的安全性 8
2.3癌症族群施打流感疫苗之效果分析 8
第三節 經濟評估 11
3.1 經濟評估 11
3.2 經濟評估的方法 12
3.3 差異成本效果比值(Incremental Cost-Effectiveness Ratio) 14
3.4 模式架構 15
3.5 敏感度分析 15
3.6 癌症族群施打流感疫苗之經濟評估研究 16
第三章 研究設計與方法 19
第一節 研究設計 19
1.1 研究對象 19
1.2 研究架構與比較方案 19
1.3 研究假設 20
1.4資料來源 20
第二節 資料處理與分析 24
2.1 分析軟體 24
2.2 基準值分析 24
2.3 敏感度分析 24
第四章 研究結果 26
第一節 基準值分析 26
1.1 估計台灣每年20~64歲癌症病人執行流感疫苗計劃減少之疾病負擔 26
1.2 估計台灣每年20~64歲癌症病人執行流感疫苗計劃減少之經濟負擔 26
1.3 成本效果比(CER)與差異成本效果比(ICER) 26
第二節 敏感度分析 27
2.1 單維敏感度分析 27
2.2 影響分析(Tornado analysis) 27
2.3 雙維敏感度分析 28
2.4 機率性敏感度分析 28
第五章 討論 29
第六章 結論與建議 34
第一節 結論 34
第二節 建議 34
參考文獻 35
















表目錄
表一 癌症病人感染流感之疾病負擔(基準值) 41
表二 癌症病人感染流感之疫苗效果(基準值) 42
表三 癌症病人感染流感之成本估計值(基準值,單位:新台幣) 43
表四 估計每年台灣20~64歲癌症病患執行流感疫苗計劃前後疾病負擔 (單位:人) 44
表五 估計每年台灣20~64歲癌症病患執行疫苗計劃前後經濟負擔(單位:新台幣) 45
表六 台灣20~64歲癌症病人之成本效果比(CER)與差異成本效果比(ICER) 46
表七 台灣每年20~64歲癌症病人執行流感疫苗計劃之單維敏感度分析 47
圖目錄
圖一: 研究模型(決策樹) 48
圖二: 台灣20~64歲癌症族群執行流感疫苗之經濟評估流程圖 49
圖三: 台灣20~64歲癌症病人之影響分析(醫療觀點)。 50
圖四: 台灣20~64歲癌症病人之影響分析(社會觀點)。 51
圖五: 台灣20~64歲癌症病人在疫苗效果與流感發生率之雙維敏感度分析(醫療觀點)。 52
圖六: 台灣20~64歲癌症病人在疫苗效果與流感發生率之雙維敏感度分析(社會觀點)。 52
圖七: 台灣20~64歲癌症病人之機率性敏感度分析(醫療觀點) 53
圖八: 台灣20~64歲癌症病人之機率性敏感度分析(社會觀點) 53
附錄(ICD-CODE第九版,部份) 54
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