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研究生:薛敬儒
研究生(外文):Ching-Yu Hsueh
論文名稱:對高風險嬰兒實施預防注射的藥物經濟學研究探討與分析
論文名稱(外文):Pharmacoeconomic Analysis for Drug Management Prevention Injection in High-Risk Infants
指導教授:吳建華吳建華引用關係
指導教授(外文):Chien-Hua Wu
學位類別:碩士
校院名稱:中原大學
系所名稱:應用數學研究所
學門:數學及統計學門
學類:數學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:37
中文關鍵詞:氣喘慢性肺病28週以下的早產兒先天性心臟病預防注射藥物經濟學分析呼吸道融合病毒
外文關鍵詞:High-Risk InfantsRespiratory Syncytial VirusPharmacoeconomic AnalysisChronic Heart Disease≦28 weeks premature infantsBronchopulmonary dysplasiaPalivizumabAsthmaChronic Lung Disease
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呼吸道融合病毒(Respiratory Syncytial Virus以下簡稱RSV)是引
起嬰幼兒的細支氣管炎及肺炎排名第一的病毒。因台灣位處於亞熱帶區域
,並沒有所謂的高峰期,幾乎整年都有病例產生。幾乎每一位嬰兒在兩歲
以前都會感染RSV病毒,RSV病毒對嬰兒及幼小兒童會造成特別嚴重的影響
。根據研究指出,有60~80%新生兒在出生第一年受到感染RSV病毒,幾乎
100%的兒童在第二年內感染病毒。而在受感染的的新生兒中有極高的可能
引發細支氣管炎或肺炎,及復原後的後遺症,哮喘及氣喘。這些新生兒將
較一般嬰兒需要更多的醫療照護及呼吸器治療。
研究目的是為了瞭解在台灣的高風險族群中及一般出生的新生兒因RSV病毒感染而住院的比率?以及針對中央健康局若將高危險族群幼兒列
入使用Palivizumab以預防呼吸道融合病毒感染的健保給付項目中,將對中
央健康局的全民健保成本所造成的衝擊評估及影響。
研究方法是建立一個成本效益評估模型後,比較實驗組及控制組所形
成的醫療費用。並計算出避免一個病人住院的成本(CHP)。
結果顯示在1,228個高風險新生兒的實驗模型中,避免一個高風險嬰兒
因感染RSV病毒而住院的費用(CHP)平均為台幣867,187元/每年。若以類別區分:第一類:≦28週的早產兒的(CHP)值平均為台幣816,991元/每年、第二類:一歲以下有慢性肺部疾病(BPD/CLD)的嬰兒(CHP)值平均為台幣1,714,226元/每年、第三類:一歲以下有先天性心臟病(CHD)的嬰兒的
(CHP)值平均為台幣626,330元/每年。
依據敏感性分析結果:CHP值最低為台幣474,483元/每年,最高為台幣1,803,183元/每年。若依類別區分:第一類:≦28週的早產兒的(CHP)值最低為台幣566,001元/每年,最高為台幣1,159,250元/每年、第二類:一歲以下有慢性肺部疾病(BPD/CLD)的嬰兒(CHP)值最低台幣為922,234
元/每年,最高為台幣4,011,003元/每年、第三類:一歲以下有先天性心臟病(CHD)的嬰兒的(CHP)值最低為台幣307,524元/每年,最高為台幣
1,555,027元/每年。
結論是在中華民國中,高風險嬰兒因感染RSV病毒而住院的比例達到
24.76%,遠高於一般出生嬰兒因感染RSV病毒而住院的比率千分之5.6。因
此如何減少高風險的嬰兒因感染RSV病毒而住院的問題應該被考慮。
Respiratory syncytial virus is cause the thin bronchitis
and pneumonia of baby's infant to rank the first of virus.Because Taiwan is located in a subtropical region, there is no peak,almost all cases arising throughout the year.Almost every baby will be
infected RSV before the age of two,RSV to infants and young children
can cause a particularly severe impact.According to research,60~ 80%
of newborns infected at birth and the first year of RSV virus,almost
100% of children infected virus in the second year.And in infected
newborns have very high may lead to bronchiolitis or pneumonia,and its long term sequelae after recovery,wheezing and asthma.These
newborn baby will need more than the average medical care and
treatment of breathing apparatus.
Comparison of the high-risk groups and Newborns born by the
general RSV infection and the rate of hospitalization? If the National Health Insurance for the high-risk groups included the use of child care Palivizumab to prevent respiratory syncytial virus infection in the National Health Insurance Project,the Central Health Council of thenational health insurance costs to assess the
impact and influence.
Assessment of the establishment of a cost-effective model,the
experimental group and control group formed by medical costs.And calculated to avoid Cost per Hospitalization Prevented(CHP) of a
patient.
The results showed that in 1,228 high-risk newborns in the
experimental model. The cost of hospitalization to prevented a high
risk infants RSV virus infection average need NT 867,187/ year.In
terms of categories:Category 1:≦28 weeks premature infant's CHP
average need NT 816,991/year.Category 2:Children’s under 1 years
of age with chronic lung disease/Bronchopulmonary dysplasia CHP average need NT 1,714,226/year.Category 3:Children’s under one year
of age with chronic heart disease CHP average need NT 626,330/year.
The cost of hospitalization to prevented a high-risk infants RSV virus infection minimum is NT474,483/year, maximum is NT 1,803,183
/year.In terms of categories:Category 1:The cost of hospitalization
to prevented RSV virus infection minimum is NT 566,001/year,maximum
is NT 1,159,250/year.Category 2:The cost of hospitalization to
prevented RSV virus infection minimum is NT 922,234/year,maximum is NT 4,011,003/year.Category 3:The cost of hospitalization to prevented RSV virus infection minimum is NT 307,524/year,maximum is
NT 1,555,027/year.
In the Republic of China,the high-risk infants infected with RSV
virus by the ratio of hospital is 24.76%,much higher than the general-born babies had been infected with RSV hospitalization rate of the virus is 5.6 per thousand.To reduce high-risk infants from
RSV infection in hospitalized should be considered.
目 錄
摘要.........................................................Ⅰ
ABSTRACT....................................................Ⅲ
誌謝.........................................................Ⅴ
目錄.........................................................Ⅵ
表目錄.......................................................Ⅶ
第一章 緒論...................................................1
1.1 呼吸道融合病毒的簡介.......................................1
1.2 呼吸道融合病毒感染的症狀表現................................2
1.3 呼吸道融合病毒的住院率.....................................3
1.4 呼吸道融合病毒的後遺症.....................................4
1.5 呼吸道融合病毒的預防方法...................................4
1.6 目的.....................................................6
第二章 文獻探討...............................................7
2.1 Palivizumab 的使用背景...................................7
2.2 使用Palivizumab的效果.....................................8
2.2.1 早產兒及慢性肺病(CLD)使用Palivizumab的效果...........8
2.2.2 先天性心臟病(CHD)使用Palivizumab的效果...............8
2.2.3 氣喘病患使用Palivizumab的效果........................10
2.3 Palivizumab的成本效益.....................................11
第三章 研究方法................................................14
3.1 研究對象..................................................14
3.2 對於高風險嬰兒實施Palivizumab預防注射的成本..................16
3.3 住院、門診成本.............................................17
3.4 氣喘(Asthma)的醫療成本....................................20
3.5 結果.......................................................22
第四章 結論....................................................24
4.1 問題討論...................................................24
4.2 結論......................................................25
References....................................................25

表 目 錄
表2-1:對高風險嬰兒使用Palivizumab的效果..........................9
表2-2:各個國家的研究結果........................................10
表2-3:由避免一個病人因RSV病毒感染而住院所需的成本(CHP)...........12
表2-4:每質量調整生命年的增量成本(ICER).........................13
表3-1:對於高風險嬰兒實施Palivizumab預防注射的成本................16
表3-2:估算台灣高危險族群感染呼吸道融合病毒之住院率.................17
表3-3:根據Impact-Study的研究推估使用Palivizumab的住院率..........18
表3-4:高風險族群因感染RSV病毒而住院的醫療費用.....................19
表3-5:高風險族群因感染RSV病毒所需的門診費用.......................20
表3-6:氣喘患者在未來的存活下的總醫療支出..........................21
表3-7:高風險族群因感染RSV病毒所需的健保醫療成本....................21
表3-8:在高風險族群所需的CHP值....................................22
表3-9:敏感性分析(一)...........................................23
表3-10:敏感性分析(二)..........................................23
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