跳到主要內容

臺灣博碩士論文加值系統

(44.192.38.248) 您好!臺灣時間:2022/11/27 01:33
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:張仁洋
研究生(外文):Jen-Yang Chang
論文名稱:探討台灣類風濕性關節炎病患之罹病成本
論文名稱(外文):The Cost of illness of Rheumatoid Arthritis in Taiwan
指導教授:郎慧珠郎慧珠引用關係
指導教授(外文):Hui-Chu Lang
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:2015
畢業學年度:103
語文別:中文
論文頁數:92
中文關鍵詞:類風濕性關節炎罹病成本
外文關鍵詞:Rheumatoid ArthritisCost of illness
相關次數:
  • 被引用被引用:0
  • 點閱點閱:210
  • 評分評分:
  • 下載下載:27
  • 收藏至我的研究室書目清單書目收藏:0
研究背景與目的:
類風濕性關節炎(Rheumatoid Arthritis,RA)是一種自體免疫失調疾病,常見於女性且通常於中年時期發病,疾病發作時全身關節都可能被侵犯,又以手部關節最常見,所以一旦得到了此疾病,病患的日常生活將大大受到影響。一般而言治療類風濕性關節藥物主要有非類固醇消炎止痛藥物(NSAIDs)、疾病修飾抗風濕病藥物(DMARDs)、類固醇製劑 (Corticosteroids)與生物製劑(Biologics)。其中由於生物製劑對於類風濕性關節炎良好的療效,使得該類藥物用於治療病患的機會大增。類風濕性關節炎的盛行率依地區不同而有差異,在歐洲地區各國約,0.4%-3%,北美地區是0.5-1.6%之間(Kvien,2004),台灣則是0.12%左右。本研究希望藉由探討類風濕性關節炎之相關費用,從直接成本,如罹患類風濕性關節炎的病人一年內利用多少資源?以及因疾病造成的生產力損失等間接成本。

研究方法:
本研究使用全民健保資料庫承保抽樣歸人檔2010 年資料,以及行政院國家科學委員會補助專題研究計畫"類風濕性關節炎病人治療療效與生活品質探討 "(郎慧珠等,2011)所建立之問卷訪談資料,以類風濕性關節炎病患為分析單位,探討病患整年度之罹病成本,並從病患特質以及求醫行為來分析對其之的影響。透過全民健保資料庫之承保抽樣歸人檔資料計算直接醫療成本、健保支出,推算總醫療花費,透過問卷資料計算直接非醫療成本及間接成本。

研究結果:
類風濕性關節炎病患於一年內的直接成本為211,725元,其中大部分都是直接醫療成本,為189,593元,藥費占整個直接成本的56%。病患的求醫行為是影響直接成本的主要因素。間接成本為315,112元。將類風濕性關節炎病患的直接成本與間接成本相加後所得出的罹病總成本是一年526,837元,其中直接成本佔40%,間接成本佔60%,間接成本高於直接成本。

結論:
526,837元的罹病成本對於一位病患或其家庭而言都是個不小的數字,不過並不是只有病患及其家庭在負擔的,故有關當局應該除了加強臨床上對於患者的病情進行治療與控制,使其能夠恢復或保持其工作狀態與生產力之外,於已經失能的病患更要提供足夠且足以維生的相關福利政策,以及建立起具有足夠支持性及同理心的社會環境。

Background and Objective:
Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated. The aim of this study was to estimate the economic cost of RA patients and their family in Taiwan.

Methods:
We estimated cost of RA from the societal perspective. Data Sourced both from the Taiwan’s National Health Insurance Research Database (NHIRD) in 2010 and a face-to-face interview survey to the patients with RA. We identified all patients by both the primary diagnosis code ICD-9-CM 714.0 and the catastrophic illness certificate from NHI claim data. In addition, Patients were recruited from rheumatology outpatient clinics at two medical centers and one regional hospital from March 2010 to June 2011. Direct medical costs, direct nonmedical costs, and productivity loss due to job loss and sick leave of patients with RA were estimated.

Results: 
The mean annual per patient total medical costs were NT$189,593. Drug expense, in outpatient and inpatient, represented more than half of the medical costs. The cost of patients who accepted biologics therapies was significantly higher than the patients who didn’t accept. The mean annual direct nonmedical costs were NT$22,132 per patient. Annual productivity loss due to job loss was NT$263,301 and sick leave were around NT$45,231 per patient.

Conclusion:
In this study, the indirect cost of RA is higher than the direct cost of RA in Taiwan. This result may represent that the government should make efforts not only to improve the treatment and care of RA patients but also to create a supportive and well social welfare environment for RA patients and their family.

目錄

誌謝 I
中文摘要 II
Abstract III
表目錄 V
圖目錄 VI
第一章、 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 研究重要性 5
第二章、 文獻回顧 6
第一節 類風濕性關節炎 6
第二節 疾病成本 10
第三節 類風濕性關節炎罹病成本實證研究 13
第三章、 研究方法 18
第一節 研究設計 18
第二節 研究架構 20
第三節 資料來源及研究對象 23
第四節 成本之組成以及計算公式 27
第五節 研究變項及變項之操作型定義 31
第六節 研究工具與資料分析 34
第四章、 研究結果 35
第一節 全民健康保險資料庫結果 35
第二節 問卷資料結果 60
第三節 疾病成本分析 68
第五章、 討論 74
第一節 人口學特質 74
第二節 罹病成本 76
第三節 研究限制 81
第六章、 結論與建議 83
第一節 結論 83
第二節 建議 85
附錄、 92



表目錄
表2-1 1987年類風濕性關節炎診斷標準………………………….………… 13
表2-2 2010年類風濕性關節炎診斷標準…………………………………… 14
表2-3 類風濕性關節炎罹病成本相關研究………………………………….. 22
表2-4 類風濕性關節炎罹病成本相關研究(續)……………………………… 23
表3-1 民國一百年各性別、年齡層之勞動力參與率、就業率、平均薪資…. 32
表3-2 健保資料庫變項及操作型定義………………………………………. 37
表3-3 問卷資料變項及操作型定義…………………………………………. 39
表4-1-1 門診病患人口學特質………………………………………………. 42
表4-1-2 人口學特質與門診費用之檢定…………………………………….. 44
表4-1-3 人口學特質與門診醫療利用之檢定………………………………... 46
表4-1-4 住院病患人口學特質………………………………………………. 48
表4-1-5 人口學特質與住院費用之檢定…………………………………….. 50
表4-1-6 人口學特質與住院醫療利用之檢定………………………………... 52
表4-1-7 人口學特質與總醫療費用之檢定…………………………………... 54
表4-1-8 人口學特質與各醫療費用之檢定………………………………….. 55
表4-1-9 門診病患薪資損失之檢定…………………………………………. 57
表4-1-10 病患總薪資損失之檢定…………………………………………... ..59
表4-1-11 門診費用回歸分析……………………………………………….... 61
表4-1-12 住院費用回歸分析……………………………………………….... 63
表4-1-13 醫療總費用回歸分析…………………………………………….... 65
表4-2-1 問卷病患人口學特質……………………………………………….. 67
表4-2-2 人口學特質與間接成本之檢定……………………………………... 70
表4-2-3 間接成本回歸分析………………………………………………...... 73
表4-3-1 直接成本總表……………………………………………………...... 75
表4-3-2 間接成本…………………………………………………………… 77
表4-3-3 類風濕性關節炎病患之罹病成本…………………………………... 79







圖目錄
圖3-1 研究流程圖…………………………………………………………... 25
圖3-2 健保資料庫(直接醫療成本)之研究架構……………………………… 27
圖3-3 問卷資料(間接成本)之研究架構……………………………………... 28
圖3-4 篩選流程圖…………………………………………………………... 30
圖4-1 直接成本之組成與比例………………………………………………. 74
圖4-2 類風濕性關節炎間接成本……………………………………………. 76
圖4-3 疾病總成本之組成與比例……………………………………………. 78
圖4-4 疾病總成本之組成與比例……………………………………………. 78

參考文獻
中文資料
吳思熹(2002),類風濕性關節炎病患罹病成本之探討,國立台北護理學院護
理研究所碩士論文。
詹于瑩(2002),透析病患的疾病成本:以全國健保資料庫為例,陽明大學醫
務管理研究所碩士論文。
林育慈(2006),糖尿病疾病成本分析—以願付價值法為例,銘傳大學經濟學
研究所碩士論文。
呂芷茵(2011),台灣泛自閉症障礙者之疾病成本分析,陽明大學醫務管理研
究所碩士論文。

英文資料
Acton, J. P.. (1975) Measuring the Social Impact of Heart and Circulatory Disease
Programs: Preliminary Framework and Estimates. Rand Corporation Report
Álvarez-Hernández E et al.(2012) Catastrophic health expenses and impoverishment
of households of patients with rheumatoid arthritis. Reumatol Clin.
8(4):168-73.
Anis AH, Guh DP, Lacaille D, Marra CA, Rashidi AA, Li X, Esdaile JM. (2005).
When patients have to pay a share of drug costs: effects on frequency of
physician visits, hospital admissions and filling of prescriptions. CMAJ.
173(11):1335-40.

Boonen A, Severens JL.(2011) The burden of illness of rheumatoid arthritis. Clin
Rheumatol. 30 Suppl 1:S3-8.
Catay E, Del Cid CC, Narváez L, Velozo EJ, Rosa JE, Catoggio LJ, Soriano
ER.(2012) Cost of rheumatoid arthritis in a selected population from
Argentina in the prebiologic therapy era. Clinicoecon Outcomes Res.
4:219-25.
Chen HH, Huang N, Chen YM, Chen TJ, Chou P, Lee YL, Chou YJ, Lan JL, Lai KL,
Lin CH, Chen DY.(2013) Association between a history of periodontitis and
the risk of rheumatoid arthritis: a nationwide, population-based, case-control
study. Ann Rheum Dis. 72(7):1206-11.
Cooper NJ.(2000) Economic burden of rheumatoid arthritis: a systematic review.
Rheumatology (Oxford). 39(1):28-33.
David L Scott, Frederick Wolfe, Tom W J Huizinga (2010) Rheumatoid arthritis.
Lancet. 376: 1094–1108.
de Azevedo AB1, Ferraz MB, Ciconelli RM.(2008) Indirect costs of rheumatoid
arthritis in Brazil. Value Health. 11(5):869-77.
D P Rice. (1967). Estimating the cost of illness. Am J Public Health Nations
Health 57(3): 424–440.
D P Rice, and B S Cooper.(1967) The economic value of human life. Am J Public
Health Nations Health. 57(11): 1954–1966.
Filipovic I, Walker D, Forster F, Curry AS.(2011) Quantifying the economic burden of
productivity loss in rheumatoid arthritis. Rheumatology (Oxford).
50(6):1083-90.
Flurey CA, Morris M, Richards P, Hughes R, Hewlett S.(2014) It's like a juggling act:
rheumatoid arthritis patient perspectives on daily life and flare while on
current treatment regimes. Rheumatology (Oxford). 53(4):696-703.
Furneri G, Mantovani LG, Belisari A, Mosca M, Cristiani M, Bellelli S, Cortesi PA,
Turchetti G.(2012) Systematic literature review on economic implications
and pharmacoeconomic issues of rheumatoid arthritis. Clin Exp Rheumatol.
30(4 Suppl 73):S72-84.
Gabriel SE, Michaud K. (2009). Epidemiological studies in incidence, prevalence,
mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther ;
11(3),p.229
Gibofsky A.(2012) Overview of epidemiology, pathophysiology, and diagnosis of
rheumatoid arthritis. Am J Manag Care. 18(13 Suppl):S295-302.
Hernández Alava M, Wailoo A, Wolfe F, Michaud K.(2013) The relationship between
EQ-5D, HAQ and pain in patients with rheumatoid arthritis. Rheumatology
(Oxford). 52(5):944-50.
Huscher D, Merkesdal S, Thiele K, Zeidler H, Schneider M, Zink A; German
Collaborative Arthritis Centres.(2006) Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany. Ann Rheum Dis. 65(9):1175-83.
Huscher D, Mittendorf T, von Hinüber U, et al.(2013). Evolution of cost structures in
rheumatoid arthritis over the past decade. Ann Rheum Dis ;74(4), pp.738–
745.
Jacobs P, Bissonnette R, Guenther LC.(2011) Socioeconomic burden of
immune-mediated inflammatory diseases--focusing on work productivity and
disability. J Rheumatol Suppl. 88:55-61.
J L Hu¨lsemann, T Mittendorf, S Merkesdal, S Zeh, S Handelmann, J- M von der
Schulenburg, H Zeidler, J Ruof. (2005) Direct costs related to rheumatoid
arthritis: the patient perspective. Ann Rheum Dis 64:1456-1461.
Kaleb Michaud, Jodi Messer, Hyon K. Choi, and Frederick Wolfe. (2003). Direct
medical costs and their predictors in patients with rheumatoid arthritis: a
three-year study of 7,527 patients. Arthritis Rheum. 48(10):2750-62.
Kalkan A, Hallert E, Bernfort L, Husberg M, Carlsson P.(2014) Costs of rheumatoid
arthritis during the period 1990-2010: a register-based cost-of-illness study in
Sweden. Rheumatology (Oxford). 53(1):153-60.
Karaca-Mandic P, Joyce GF, Goldman DP, Laouri M.(2010) Cost sharing, family
health care burden, and the use of specialty drugs for rheumatoid arthritis.
Health Serv Res. 45(5 Pt 1):1227-50.
Kirchhoff T, Ruof J, Mittendorf T, Rihl M, Bernateck M, Mau W, Zeidler H, Schmidt
RE, Merkesdal S. (2011). Cost of illness in rheumatoid arthritis in Germany
in 1997-98 and 2002: cost drivers and cost savings. Rheumatology (Oxford).
50(4):756-61.


Kuo CF, Luo SF, See LC, Chou IJ, Chang HC, Yu KH. (2013) Rheumatoid arthritis prevalence, incidence, and mortality rates: a nationwide population study in Taiwan. Rheumatol Int; 33(2):355-60.
Kvamme MK, Lie E, Kvien TK, Kristiansen IS. (2012). Two-year direct and indirect costs for patients with inflammatory rheumatic joint diseases: data from real-life follow-up of patients in the NOR-DMARD registry. Rheumatology (Oxford). 51(9):1618-27.
Kvien TK.(2004) Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics. 22(2 Suppl 1):1-12.
Lai NS, Tsai TY, Li CY, Koo M, Yu CL, Lu MC.(2014) Increased frequency and costs of ambulatory medical care utilization prior to the diagnosis of rheumatoid arthritis: a national population-based study. Arthritis Care Res (Hoboken). 66(3):371-8.
Lapsley HM, March LM, Tribe KL, Cross MJ, Courtenay BG, Brooks PM; Arthritis Cost and Outcome Project Group.(2002) Living with rheumatoid arthritis: expenditures, health status, and social impact on patients. Ann Rheum Dis. 61(9):818-21.
Leardini G1, Salaffi F, Montanelli R, Gerzeli S, Canesi B.(2002) A multicenter cost-of-illness study on rheumatoid arthritis in Italy. Clin Exp Rheumatol. 20(4):505-15.
Lee TJ, Park BH, Son HK, Song R, Shin KC, Lee EB, Song YW.(2012) Cost of illness and quality of life of patients with rheumatoid arthritis in South Korea. Value Health. 15(1 Suppl):S43-9.
Loreto Carmona, MD, PhD , Marita Cross, PhD , Ben Williams , Marissa Lassere, MD, PhD , Lyn March, MD, PhD .(2010). Rheumatoid arthritis. Best Practice &; Research Clinical Rheumatology 24: 733–745
Lundkvist J, Kastäng F, Kobelt G.(2008) The burden of rheumatoid arthritis and access to treatment: health burden and costs. Eur J Health Econ. 8 Suppl 2:S49-60.
McIntosh E.(1996) The cost of rheumatoid arthritis. Br J Rheumatol. 35(8):781-90.



Merkesdal S, Ruof J, Schöffski O, Bernitt K, Zeidler H, Mau W.(2001) Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Arthritis Rheum. 44(3):528-34.
Merkesdal S, Ruof J, Huelsemann JL, Mittendorf T, Handelmann S, Mau W, Zeidler H.(2005) Indirect cost assessment in patients with rheumatoid arthritis (RA): comparison of data from the health economic patient questionnaire HEQ-RA and insurance claims data. Arthritis Rheum. 53(2):234-40.
Miranda LC, Santos H, Ferreira J, Coelho P, Silva C, Saraiva-Ribeiro J; FRAIL Study Group.(2012) Finding Rheumatoid Arthritis Impact on Life (FRAIL Study): economic burden. Acta Reumatol Port. 37(2):134-42.
Nguyen Xuan Thanh, Arto Ohinmaa, Cheryl Barnabe, Joanne Homik, Susan G. Barr, Liam Martin, Walter P. Maksymowych.(2013) Self-Reported Productivity Losses of People with Rheumatoid Arthritis in Alberta, Canada. The Open Pharmacoeconomics &; Health Economics Journal. 5: 11-14.
Nicholson S, Pauly MV, Polsky D, Sharda C, Szrek H, Berger ML.(2006) Measuring the effects of work loss on productivity with team production. Health Econ. 15(2):111-23.
Põlluste K, Kallikorm R, Meiesaar K, Lember M. (2012). Use of general practice and rheumatology outpatient services in rheumatoid arthritis. Fam Pract. 29(4):433-40.
Pugner KM, Scott DI, Holmes JW, Hieke K.(2000) The costs of rheumatoid arthritis: an international long-term view. Semin Arthritis Rheum. 29(5):305-20.
Rat AC, Boissier MC.(2004) Rheumatoid arthritis: direct and indirect costs. Joint Bone Spine. 71(6):518-24.
Rikke Søgaard, Jan Sørensen, Louise Linde, and Merete L Hetland.(2010) The significance of presenteeism for the value of lost production: the case of rheumatoid arthritis. ClinicoEconomics and Outcomes Research. 2: 105–112.
Ruof J, Hülsemann JL, Mittendorf T, Handelmann S, von der Schulenburg JM, Zeidler H, Merkesdal S.(2003) Costs of rheumatoid arthritis in Germany: a micro-costing approach based on healthcare payer's data sources. Ann Rheum Dis. 62(6):544-9.

Schelling, T. C.,(1968), "The Life You Save May Be Your Own," , Problems in Public Expenditure Analysis.
S M M Verstappen, H Verkleij, JWJ Bijlsma, E Buskens , A A Kruize, A H M Heurkens, M J van der Veen, J W G Jacobs, on behalf of the Utrecht Rheumatoid Arthritis Cohort Study group (SRU).(2004). Determinants of direct costs in Dutch rheumatoid arthritis patients. Ann Rheum Dis;63(7), pp.817–824.
Sokka T et al. (2009). Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database. Ann Rheum Dis. 68(11):1666-72.
Turchetti G, Bellelli S, Mosca M.(2014) The social cost of rheumatoid arthritis in Italy: the results of an estimation exercise. Reumatismo. 65(6):271-7.
van Jaarsveld CH, Jacobs JW, Schrijvers AJ, Heurkens AH, Haanen HC, Bijlsma JW. (1998) Direct cost of rheumatoid arthritis during the first six years: a cost-of-illness study. Br J Rheumatol. 37(8):837-47.
Wayne Burton, Alan Morrison, Ross Maclean and Eric Ruderman. (2006) Systematic review of studies of productivity loss due to rheumatoid arthritis. Occupational Medicine. 56:18–27.
Wei Zhang and Aslam H. Anis. (2009) Health insurance and out-of-pocket expenses Arthritis Care &; Research 61(11):1467-1469.
Wolfe F, Michaud K. (2009). Out-of-pocket expenses and their burden in patients with rheumatoid arthritis. Arthritis Rheum. 61(11):1563-70.
Xu C et al.(2014) Societal costs of rheumatoid arthritis in China: a hospital-based cross-sectional study. Arthritis Care Res (Hoboken). 66(4):523-31.
Yu KH, See LC, Kuo CF, Chou IJ, Chou MJ.(2013) Prevalence and incidence in patients with autoimmune rheumatic diseases: a nationwide population-based study in Taiwan. Arthritis Care Res (Hoboken). 65(2):244-50.
Zhang W, Anis AH.(2011) The economic burden of rheumatoid arthritis: beyond health care costs. Clin Rheumatol. 30 Suppl 1:S25-32.
Zhu TY, Tam LS, Li EK.(2011) Societal costs of rheumatoid arthritis in Hong Kong: a prevalence-based cost-of-illness study. Rheumatology (Oxford). 50(7):1293-301.

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top