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研究生:葉馨智
研究生(外文):Shing-Chih Yeh
論文名稱:以台灣全民健保資料庫分析紅斑狼瘡病人之存活與結果
論文名稱(外文):Survival and outcome analysis of patients with systemic lupus erythematosus in Taiwan
指導教授:藍祚運藍祚運引用關係唐高駿唐高駿引用關係
指導教授(外文):Tzuo-Yun LanGau-Jun Tang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:46
中文關鍵詞:紅斑狼瘡自體免疫風險共病症
外文關鍵詞:Systemic Lupus ErythematosusSLEautoimmuneriskco-morbidities
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  • 被引用被引用:2
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背景:紅斑狼瘡是一種慢性發炎的自體免疫疾病,由於侵犯身體任何組織器官,所以臨床表徵呈現多樣化。致病因子屬多因性包括環境、遺傳、免疫等。治療策略主要在調節免疫,避免組織器官的傷害,進而影響預後。
目的:本研究主要探討紅斑狼瘡病患人事件發生(死亡或洗腎)風險與對醫療費用及藥費影響。
方法:以台灣健保資料庫2000至2011年百萬人抽樣歸人檔,進行回溯性世代研究,從中選取2001至2006年符合診斷碼及用藥者追蹤5年,依用藥類別分輕症組穩定型、輕症組惡化型及重症組,經性別、年齡、共病症、就醫院所層級及分區別校正後,估計風險比與費用使用情形。
結果:符合條件者有617人,分別是輕症組穩定型292人、輕症組惡化型93人及重症組232人。輕症組惡化型事件發生(死亡或洗腎)風險是輕症組穩定型的1.3倍,重症組是3.4倍。醫療費用輕症組惡化型比輕症組穩定型增加69%,重症組增加116%;藥費則是輕症組惡化型比輕症組穩定型增加95%,重症組增加153% ( p<0.001 )。
結論:紅斑狼瘡疾病的進程越嚴重存活率越差,事件發生(死亡或洗腎)機率越高,花費也越多,而疾病嚴重程度及共病症為影響醫療費用及藥費的主要因素,因此,建議應加強篩選出尚未發現的族群,做到早發現早治療。

Background: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterized by chronic inflammation of various body tissues/organs. The clinical presentation of the disease varies greatly as it can affect any body parts. Precipitating factors for the disease include genetics, the environment, and patients' own immune systems. The primary treatment strategy is to adjust patient's autoimmune response in order to reduce tissue/organ damages which subsequently improves prognosis.
Goal: The current study was to examine the association between the severity of SLE and the risk of incidents (death or the end stage renal failure) in SLE patients and how they affect medical expenses related to medical treatments and medications.
Method: This retrospective cohort study includes data from the National Health Research Databases in Taiwan dated from 2000 to 2011. The data is further analyzed by selecting qualified sample patients based on the criteria of a confirmed SLE diagnosis and that they had been receiving drug treatments for 5 years after the date of diagnosis. The sample patient data is categorized into the mild symptom-stable group, mild symptom-progressing group, and the severe symptom group based on the type of medication received. An estimation of risk ratio and possible medical expenses is projected after controlling for gender, age, co-morbidity, and the size and location of the hospital visited.
Result: The total number of qualified sample patients is 617 among which 292 are in the mild symptom-stable group, 93 are in the mild symptom-progressing group, and 232 are in the severe symptom group. The risk of health incidents (death or the end stage renal failure) in the mild symptom-progressing group and the severe symptom group when comparing with the mild symptom-stable group are 1.3 times and 3.4 times higher respectively. The medical treatment expenses of the mild symptom-progressing group and the severe symptom group comparing to the mild symptom-stable group are increased by 69% and 116% respectively whereas the medication expenses are increased by 95% and 153% (p<0.001).
Conclusion: The severity of the disease progression predicts lower survival rate, higher health incidents (death or ESRD) which result in higher overall medical expenses. The severity of the disease and co-morbidities are the major factors affecting the expenses related to medical treatments and medications; thus emphasis on early screening identifying high risk group and offering active treatments is highly recommended.

致謝 I
中文摘要 II
Abstract III
表目錄 VI
圖目錄 VII
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的與問題 3
第三節 研究重要性與貢獻 3
第二章 文獻探討 4
第一節 紅斑狼瘡之概述 4
第二節 紅斑狼瘡死亡率 9
第三節 紅斑狼瘡醫療花費 9
第三章 研究設計與方法 10
第一節 研究流程 10
第二節 研究架構 13
第三節 研究假設 15
第四節 研究對象與資料來源 15
第五節 研究工具 16
第六節 研究變項操作型定義及測量 16
第七節 分析方法 18
第四章 研究結果 23
第一節 紅斑狼瘡病患描述性分析 23
第二節 紅斑狼瘡病患存活分析 32
第三節 紅斑狼瘡病患預後分析 34
第四節 紅斑狼瘡病患費用分析 38
第五章 討論 42
第一節 研究結果討論 42
第二節 研究驗證 43
第三節 研究限制 43
第六章 結論與建議 44
參考文獻 45

表目錄
表 1 99 年-102 年全民健康保險重大傷病醫療費用點數表 ..................... 3
表 2 紅斑狼瘡臨床特徵表 .......................................................................... 5
表 3 紅斑狼瘡診斷標準 .............................................................................. 6
表 4 定義為洗腎代碼一覽表 17
表 5 紅斑狼瘡患者使用藥物一覽表 19
表 6 依WHO/ATC/DDD 系統整理類固醇之定義每日劑量 21
表 7 Deyo's 共病症表 22
表 8 紅斑狼瘡病患基本特質與結果 25
表 9 輕症紅斑狼瘡病患事件發生(死亡或洗腎)之基本特質 26
表 10 輕、重症紅斑狼瘡病患事件發生(死亡或洗腎)之基本特質 27
表 11 紅斑狼瘡病患事件發生(死亡或洗腎)之基本特質 28
表 12 觀察期間紅斑狼瘡病患醫療費用(元)使用情形 30
表 13 觀察期間紅斑狼瘡病患藥費(元)使用情形 31
表 14 輕症紅斑狼瘡病患事件發生(死亡或洗腎)之相對風險分析 35
表 15 輕、重症紅斑狼瘡病患事件發生(死亡或洗腎)之相對風險分析 36
表 16 紅斑狼瘡病患事件發生(死亡或洗腎)之相對風險分析 37
表 17 輕症紅斑狼瘡病患的醫療費用和藥費分析 39
表 18 輕、重組紅斑狼瘡病患的醫療費用和藥費分析 40
表 19 紅斑狼瘡病患的醫療費用和藥費分析 41

圖目錄
圖 1 95-102 年重大傷病卡有效領卡數 3
圖 2 研究流程(資料處理) 11
圖 3 研究流程(分組) 12
圖 4 研究架構一:紅斑狼瘡病患預後分析 13
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