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研究生:林羿秀
研究生(外文):Yi-Hsiu Lin
論文名稱:比較骨質疏鬆症女性病患服用Bisphosphonate或Raloxifene藥物之不良反應與醫療資源利用情形
論文名稱(外文):Comparison of Adverse Drug Reaction and Healthcare Utilizations between Bisphosphonate and Raloxifene on Osteoporosis Women
指導教授:李英俊李英俊引用關係
指導教授(外文):Ying-Chun Li
學位類別:碩士
校院名稱:國立中山大學
系所名稱:企業管理學系醫務管理碩士班
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:2017
畢業學年度:105
語文別:中文
論文頁數:127
中文關鍵詞:Bisphosphonate藥物治療骨質疏鬆症醫療資源利用不良反應Raloxifene
外文關鍵詞:osteoporosisdrug treatmentBisphosphonateRaloxifeneadverse drug reactionhealthcare utilization
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研究目的:
本研究的目的在探討服藥與否及服用Bisphosphonate與Raloxifene類藥物的骨質疏鬆病患,其在不良反應與醫療資源利用的情形。

研究方法:
本研究是使用國家衛生研究院全民健康保險資料庫2007年至2012年之資料的回顧性研究。個案組為有接受藥物治療(Bisphosphonate和Raloxifene)之骨質疏鬆症的病患,對照組為未接受藥物治療的骨質疏鬆症病患。此外使用傾向分數配對法(PSM)來控制樣本選擇偏差。研究分析以描述性分析、邏輯斯迴歸和線性迴歸來進行數據分析,探討病人基本資料與其不良反應和醫療資源利用情形。

研究結果:
共有2946例患者納入我們的分析。個案組(N = 1022)和對照組(N = 1924)依年齡和Charlson合併指數(CCI)配對。使用藥物治療與否與骨折和中風的風險增加有顯著相關(p <0.05)。不同的服藥者也與骨折風險增加顯著相關(p <0.05)。個案組的醫療資源利用情形皆高於對照組。而除了住院部分外,服用Bisphosphonate之病患其醫療資源利用情形上也高於服用Raloxifene之病患。

研究結論:
本研究結果顯示服用Raloxifene藥物之病患產生骨折、冠心病、中風及死亡的風險都較服用Bisphosphonate藥物之病患低,而服用Bisphosphonate藥物之病患產生心房顫動或撲動及靜脈血栓栓塞的風險則較服用Raloxifene藥物之病患低;然而,上述皆無達顯著性相關。使用藥物治療需謹慎,也須注意病患服藥後有無產生不良反應。
Objectives:
The purpose of this study is to explore the issue of drug treatment and to compare adverse drug reaction and healthcare utilizations between Bisphosphonate and Raloxifene on Osteoporosis women.

Method:
This study is a retrospective study using the National Health Insurance Database. The study periods were from 2007 to 2012. Patients who received drug treatment (Bisphosphonate and Raloxifene) for osteoporosis were in the case group, and those who did not receive treatment were in the control group. We used the Propensity Score Matching Method (PSM) to control the sample selection bias. The data analysis was carried out in descriptive analyses, multivariate logistic regressions, and multiple linear regressions to examine patients’ basic information, adverse drug reaction and healthcare utilizations.

Results:
A total of 2946 patients were included in our analysis. The case group (N=1022) and control group (N=1924) were matched 1:2 in terms of age and the Charlson Comorbidity Index (CCI). Drug treatment was associated with a significant increased risk of fractures and CVA (p<0.05). Different drug users were also linked with a significant increased risk of fractures. The healthcare utilization was higher in the case group than in the control group. In addition to hospitalization, the healthcare utilization was also higher in Bisphosphonate group than in Raloxifene group.

Conclusion:
Patients receiving treatment with Raloxifene may have a lower risk of fractures, CHD, CVA and mortality than those treated with Bisphosphonate, while patients receiving treatment with Bisphosphonate may have a lower risk of AF and VTE. However, statistical significance was not reached. Medication should be administered with caution and the importance of adverse reactions to different drug users cannot be overemphasized.
論文審定書 i
致謝 ii
中文摘要 iii
Abstract iv
目錄 v
圖次 vi
表次 vii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 骨質疏鬆症定義與測量 4
第二節 骨質疏鬆症治療藥品 8
第三節 骨質疏鬆症治療與不良反應之探討 11
第四節 骨質疏鬆症治療與醫療資源利用之探討 18
第五節 文獻小結 19
第三章 研究方法 20
第一節 研究設計與架構 20
第二節 研究問題與假設 22
第三節 研究樣本及資料來源 23
第四節 研究變項操作型定義 29
第五節 研究分析工具及方法 31
第四章 研究分析與結果 32
第一節 描述性統計分析 32
第二節 推論性統計分析 50
第五章 研究討論 100
第一節 研究假設驗證 100
第二節 研究結果討論 103
第六章 結論與建議 106
第一節 研究結論 106
第二節 研究限制 107
第三節 研究建議 109
第四節 研究貢獻 110
參考文獻 111
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