論文名稱：台灣戒菸門診服務計畫之投資報酬率分析
研究所名稱：臺北醫學大學醫務管理系碩士班
研究生姓名：林琨棟
指導教授：湯澡薰 臺北醫學大學醫務管理學系暨研究所 教授
研究目的
本研究擬針對2003年1月至2012年12月期間，實施之「門診戒菸治療服務」，藉由計算此計畫的直接成本，與加入計畫而戒菸成功者之效益，從政府的觀點，推估此計畫的投資報酬率，藉由量化的財務數字，幫助政策決策者了解，是否值得繼續投資此項政策。
研究方法
成本部分使用國健署公布之政府預算書中，戒菸門診計畫相關之預算費用。效益部分，分為因戒菸而節省的醫療成本，及因戒菸避免的死亡成本。效益計算上，使用2003-2012年之健保資料庫抽樣檔，搭配政府官方統計資料(如吸菸盛行率、每月薪資…等)，及各種流行病學的文獻數據。最後，結合推算的成本與效益，轉換為淨利益及投資報酬率。成本和效益以通貨膨脹及折現率調整，並進行敏感度分析，以了解各參數的不確定性及結果的穩定性。
結果
此門診計畫於2003-2012年之每年預算成本，介於0.97億至2.06億元間。每年因戒菸而造成的醫療成本節省，介於4065萬及2.56億元，而因戒菸而避免的死亡成本，則為11.9億及59.4億元。整體而言，每投資一塊錢，可回收11.3到52.5元。
結論
結果顯示，從政府的觀點來看，此十年間國健署對此計畫的投資，是具成本效益的，而全面性地推廣門診戒菸治療，可以造成大量的成本節省，值得政府未來繼續投資。

Title of thesis: The Return on Investment of Smoking Cessation Outpatient Clinic Program in Taiwan
Author: Kuen-Dong Lin
Thesis advised by: Chao-Hsuin Tang, Ph.D
Objectives: This study aims to evaluate the smoking cessation outpatient clinic program in Taiwan during 2003-2012 by return on investment analysis from the government’s perspective.
Methods: Administrative data from Health Promotion Administration, Ministry of Health and Welfare was used to estimate annual budget costs of the program from 2003 to 2012. The benefit data were collected from Nation Health Insurance Research database released from the National Health Research Institute, Adult Smoking Behavior Surveys released by Health Promotion Administration, and several epidemiology related literatures, to estimate the medical costs and mortality costs averted by smoking cessation. Estimated costs and benefits were combined together to calculate the net benefit and return on investment to assess whether the outpatient program is worth investing. All costs and benefit were inflation and discount adjusted. Sensitivity analysis were performed to account for the uncertainty of parameters.
Results: Administrative data showed that, program costs including pharmacotherapy, counseling, tracking, physician training courses and promotion costs, ranged about 97-206million NT dollars per year. Medical costs savings were about 40.7 to 256 million NT dollars per year. Mortality costs averted were estimated to be about 1.19 to 5.94 billion NT dollars per year. Every 1$ dollar in program costs was associated with about $11.3 to $52.5 NT dollars in costs savings annually during 2003-2012.
Conclusions: These results suggest that an investment in the smoking cessation outpatient clinic program was cost-beneficial from government’s perspective. A comprehensive tobacco cessation clinic program may result in substantial costs savings.

中文摘要 I
Abstract III
目 錄 V
表 目 錄 VII
圖 目 錄 XXIII
第一章 緒論 1
第一節 研究動機與背景 1
第二節 研究目的及研究問題 3
第二章 文獻探討 4
第一節 菸害相關流行病學概況 4
第二節 尼古丁成癮及戒菸治療 19
第三節 戒菸門診服務 23
第四節 經濟評估種類 26
第五節 菸害相關之成本及效益 31
第六節 研究現況探討 34
第三章 研究材料與方法 36
第一節 研究架構 36
第二節 研究設計 38
第三節 研究對象及操作型定義 43
第四節 統計分析 54
第四章 研究結果 56
第一節 描述性統計分析 56
第二節 成本分析 57
第三節 戒菸後醫療成本節省分析 58
第四節 死亡成本節省分析 71
第五節 淨利益及投資報酬率分析 75
第六節 敏感度分析 76
第五章 討論 339
第一節 研究資料完整性討論 339
第二節 研究結果討論 342
第三節 敏感度分析討論 345
第四節 研究限制 346
第六章 結論與建議 347
第一節 結論 347
第二節 建議 348
附錄 355

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