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研究生:余珊嫺
研究生(外文):YU, SHAN-SIAN
論文名稱:住院戒菸尼古丁替代療法與Varenicline藥物治療之成本效果分析:以南部某醫學中心為例
論文名稱(外文):Cost-Effectiveness Analysis of Nicotine Replacement Therapy and Varenicline in Inpatients Receiving Medication-Based Smoking Cessation Therapy:An Example of One Southern Medical Center
指導教授:張永源張永源引用關係李易蓁李易蓁引用關係
指導教授(外文):CHANG, YONG-YUANLEE, I-CHEN
口試委員:薛光傑許弘毅
口試委員(外文):HSUEH, KUANG-CHIEHSHI, HON-YI
口試日期:2021-05-27
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫務管理暨醫療資訊學系碩士在職專班
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:2021
畢業學年度:109
語文別:中文
論文頁數:90
中文關鍵詞:住院戒菸治療成本效果分析尼古丁替代療法
外文關鍵詞:inpatient smoking cessation treatmentVareniclineNicotine Replacement Therapycost–effectiveness analysis
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研究目的:
本研究目的主要比較住院吸菸個案使用尼古丁替代療法(NRT) 與戒必適(Varenicline)之成本效果差異。
研究方法:
自某醫學中心自建資料庫取得2016年1月至2020年6月住院期間有吸菸且有戒菸治療之初診個案,開立藥物條件為20(足)歲以上之健保對象及尼古丁成癮度量表(Fagerström Test for Nicotine Dependence;FTND)達4分(含)以上或平均1天吸10支菸(含)以上者並進行戒菸衛教,分為尼古丁替代療法(NRT)與Varenicline藥物治療兩組,採複線性暨二項對數迴歸分析後,並經過消費者物價指數(Consumer Price Index;CPI)校正後進行成本效果分析之比較。
研究結果:
在年齡(P=.018)、菸齡( P=.006)兩組有顯著性差異,兩者住院期間初診戒菸治療費用(t=-.653, P=.514)、回診戒菸治療費用(t=.955, P=.340)、總醫療費用(t=.755, P=.451)無顯著性差異,Varenicline 在3個月及6個月時間點戒菸成功率分別是NRT的1.68倍 (aOR=1.68, P=.024)及1.63倍 (aOR=1.63, P=.031),Varenicline藥物治療平均每多一次的初診與回診合併總療程費用會比尼古丁替代療法(NRT)組多出2760元。
結論與建議:
Varenicline藥物治療在3個月及6個月時間點戒菸成功率上比尼古丁替代療法(NRT)更優勢,Varenicline藥物治療平均每多一次的初診與回診合併總療程費用會比尼古丁替代療法(NRT)組高,進行住院戒菸之Varenicline藥物治療的增量成果效果比(ICER)優於尼古丁替代療法(NRT)為部分成立,但吸菸個案戒菸後,因為生活上的改變或壓力等吸菸誘因,仍有再度復吸之可能,建議除了追蹤三個月、六個月戒菸率,仍需要追蹤一年、三年、五年、七年等長期追蹤戒菸情況。

Research purposes
This study aimed to compare the differences in cost-effectiveness
between nicotine replacement therapy and varenicline in inpatients receiving medication-based smoking cessation therapy.
Research method
From a self-built database of a medical center, data of inpatient who were smokers and attended smoking cessation treatment from January 2016 to June 2020 for the first time were obtained. The conditions for prescribing medication were patients being 20 years or older and covered by Taiwan’s national health insurance, and their Fagerstrom Fagerstrom Test for Nicotine Dependence (FTND)score reaching 4 or above or that they smoked over 10 cigarettes a day. To the patients, smoking cessation-related health education was provided. The patients were divided into two groups, namely the nicotine replacement therapy (NRT) group and varenicline medicine treatment group. Multiple linear and binomial logarithmic regression analysis was adopted. After Consumer Price Index (CPI) calibration, a cost–effectiveness analysis was conducted, and the results were compared.
Research results
Statistically significant differences were observed in patients’ age (p = .018) and smoking duration (p = .006), but not in their expenses for their first treatment for smoking cessation treatment during their hospital stay (t = −.653, p = .514), their expenses for returning to the clinic for smoking cessation treatment (t = .955, P = .340), and their total medical expenses (t=.755, P=.451). At 3 months and 6 months, the success rates of quitting smoking using varenicline were 1.68 times (aOR = 1.68, p = .024) and 1.63 times (aOR = 1.63, p = .031) that of using NRT. Compared with the NRT group, the total treatment expenses of combined first visit and returned visits of the varenicline medicine treatment group was NT$2,760 more with each increased number of times of seeking treatment.
Conclusion and suggestions
At 3 months and 6 months, varenicline medicine treatment exhibited higher success rate than NRT did in smoking cessation treatment. The total treatment expenses of combined first visit and returned visits of the varenicline medicine treatment group was higher than the NRT group. The hypothesis that conducting inpatient varenicline medicine treatment had a superior incremental cost effectiveness ratio than the NRT treatment was partially valid. However, after cases quit smoking, due to smoking triggers such as changes in life or stress, they may begin smoking again. It is advised that in addition to tracking to 3-month and 6-month smoking cessation rates, long-term tracking such as 1-year, 3-year, 5-year, and 7-years tracking may be performed.

致謝 I
摘要 II
Abstract IV
目錄 VI
表目錄 IX
圖目錄 XI
第一章 緒論 1
第一節 研究背景 1
第二節 研究重要性 4
第三節 研究目的 6
第四節 名詞解釋 7
第二章 文獻探討 9
第一節 吸菸盛行率與危害之文獻探討 9
第二節 住院期間戒菸介入之文獻探討 17
第三節 戒菸治療方式之文獻探討 22
第四節 尼古丁替代療法 (Nicotine Replacement Therapy, NRT)及Varenicline藥物治療成本效果分析之文獻探討 30
第三章 研究材料與方法 38
第一節 研究方法與設計 38
第二節 研究概念架構 39
第三節 研究假說 40
第四節 研究樣本與資料來源 41
第五節 研究變項 44
第六節 統計分析 53
第四章 研究結果 56
第一節 研究樣本之人口學特徵及吸菸背景差異之比較 57
第二節 研究樣本控制兩組顯著性差異特徵後之成本分析比較結果 59
第三節 研究樣本控制兩組顯著性差異特徵後之效果分析比較結果 61
第四節 研究樣本兩組之增量成本效果比(ICER)統計分析結果 63
第五章 討論 65
第一節 兩組之人口學特徵及吸菸背景特徵差異之討論 66
第二節 兩組戒菸成本差異比較之討論 68
第三節 兩組戒菸效果差異比較之討論 69
第四節 兩組戒菸成本效果差異之討論 70
第五節 研究限制及未來研究方向 71
第六章 結論與建議 73
第一節 結論 73
第二節 建議 74
參考文獻 75
英文參考文獻 75
中文參考文獻 78
英文參考文獻
1.World Health Organization. (2020). Tobacco. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/tobacco
3.Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., . . . Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine, 368(4), 341-350.
4.Hsueh, K.-C., Chen, C.-Y., Yang, Y.-H., & Huang, C.-L. (2010). Smoking cessation program in outpatient clinics of Family Medicine Department in Taiwan: a longitudinal evaluation. Evaluation & the health professions, 33(1), 12-25.
5.Stead, L. F., Perera, R., Bullen, C., Mant, D., Hartmann-Boyce, J., Cahill, K., & Lancaster, T. (2012). Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev, 11, Cd000146. doi:10.1002/14651858.CD000146.pub4
6.Cahill, K., Stevens, S., Perera, R., & Lancaster, T. (2013). Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev(5), Cd009329. doi:10.1002/14651858.CD009329.pub2
7.Bentz, C. J. (2007). An intensive smoking cessation intervention reduced hospital admissions and mortality in high risk smokers with CVD. Evidence-based medicine, 12(4), 113-113.
9.Wilkins, K., Shields, M., & Rotermann, M. (2009). Smokers' use of acute care hospitals--a prospective study. Health Rep, 20(4), 75-83.
11.American Heart Association. (2015). How Smoking and Nicotine Damage Your Body. American Heart Association. Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/how-smoking-and-nicotine-damage-your-body
12.Yang, M., Fann, C., Wen, C., & Cheng, T. (2005). Smoking attributable medical expenditures, years of potential life lost, and the cost of premature death in Taiwan. Tob Control, 14(suppl 1), i62-i70.
13.Goodchild, M., Nargis, N., & Tursan d'Espaignet, E. (2018). Global economic cost of smoking-attributable diseases. Tob Control, 27(1), 58-64. doi:10.1136/tobaccocontrol-2016-053305
14.Stanaway, J. D., Afshin, A., Gakidou, E., Lim, S. S., Abate, D., Abate, K. H., . . . Abd-Allah, F. (2018). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1923-1994.
18.Mokdad, A. H., Ballestros, K., Echko, M., Glenn, S., Olsen, H. E., Mullany, E., . . . Murray, C. J. L. (2018). The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. Jama, 319(14), 1444-1472. doi:10.1001/jama.2018.0158
19.Chen, Z., Peto, R., Zhou, M., Iona, A., Smith, M., Yang, L., . . . Li, L. (2015). Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet, 386(10002), 1447-1456. doi:10.1016/s0140-6736(15)00340-2
20.Rawshani, A., Rawshani, A., Franzén, S., Sattar, N., Eliasson, B., Svensson, A. M., . . . Gudbjörnsdottir, S. (2018). Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med, 379(7), 633-644. doi:10.1056/NEJMoa1800256
21.Centers for Disease Control and Prevention. (2015). Division for heart disease and stroke prevention, heart disease risk factors. Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheet /fs_heart_disease.htm
22.Falkstedt, D., Wolff, V., Allebeck, P., Hemmingsson, T., & Danielsson, A. K. (2017). Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45 000 Swedish Men. Stroke, 48(2), 265-270. doi:10.1161/strokeaha.116.015565
23.Centers for Disease, C., Prevention, National Center for Chronic Disease, P., Health, P., Office on, S., & Health. (2010). Publications and Reports of the Surgeon General. In How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US).
24.American Cancer Society.(2021). The Tobaccoatlas. Available: https://zh.tobaccoatlas.org/topic/%e5%81%a5%e5%ba%b7%e5%bd%b1%e5%93%8d/
26.de Azevedo, R. C., Mauro, M. L., Lima, D. D., Gaspar, K. C., da Silva, V. F., & Botega, N. J. (2010). General hospital admission as an opportunity for smoking-cessation strategies: a clinical trial in Brazil. Gen Hosp Psychiatry, 32(6), 599-606. doi:10.1016/j.genhosppsych.2010.09.013
29.Rigotti, N. A., Clair, C., Munafò, M. R., & Stead, L. F. (2012). Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev, 5(5), Cd001837. doi:10.1002/14651858.CD001837.pub3
30.Stead, L. F., Buitrago, D., Preciado, N., Sanchez, G., Hartmann-Boyce, J., & Lancaster, T. (2013). Physician advice for smoking cessation. Cochrane Database Syst Rev, 2013(5), Cd000165. doi:10.1002/14651858.CD000165.pub4
32.Tashkin, D. P. (2015). Smoking Cessation in Chronic Obstructive Pulmonary Disease. Semin Respir Crit Care Med, 36(4), 491-507. doi:10.1055/s-0035-1555610
33.Abdul-Kader, J., Airagnes, G., D'Almeida, S., Limosin, F., & Le Faou, A. L. (2018). [Interventions for smoking cessation in 2018]. Rev Pneumol Clin, 74(3), 160-169. doi:10.1016/j.pneumo.2018.03.004
35.Elrashidi, M. Y., & Ebbert, J. O. (2014). Emerging drugs for the treatment of tobacco dependence: 2014 update. Expert Opin Emerg Drugs, 19(2), 243-260. doi:10.1517/14728214.2014.899580
36.Heydari, G. (2017). Is Cost of Medication for Quit Smoking Important for Smokers, Experience of Using Champix in Iranian Smoking Cessation Program 2016. Int J Prev Med, 8, 63. doi:10.4103/ijpvm.IJPVM_375_16
37.Madae'en, S., Obeidat, N., & Adeinat, M. (2020). Using cost-effectiveness analysis to support policy change: varenicline and nicotine replacement therapy for smoking cessation in Jordan. J Pharm Policy Pract, 13, 65. doi:10.1186/s40545-020-00270-y
38.Lee, D., Lee, Y. R., & Oh, I. H. (2019). Cost-effectiveness of smoking cessation programs for hospitalized patients: a systematic review. Eur J Health Econ, 20(9), 1409-1424. doi:10.1007/s10198-019-01105-7
39.Aumann, I., Rozanski, K., Damm, K., & Graf von der Schulenburg, J. M. (2016). [Cost-Effectiveness of Pharmacological Smoking Cessation Therapies - A Systematic Literature Review]. Gesundheitswesen, 78(10), 660-671. doi:10.1055/s-0035-1548852
40.Chang, P. Y., Lo, P. C., Chang, H. C., Hsueh, K. C., & Tsai, Y. W. (2016). Comparative Effectiveness of Smoking Cessation Medications: A National Prospective Cohort From Taiwan. PLoS One, 11(11), e0166992. doi:10.1371/journal.pone.0166992
43.Chang, P.-Y., Shiu, M.-N., Yuan, Y.-T., Chang, H.-C., Su, P.-Y., & Lan, T.-H. (2017). Comparative Effectiveness of Varenicline and Nicotine Replacement Therapy for Smoking Cessation in Older and Younger Smokers: A Prospective Cohort in Taiwan. Nicotine & Tobacco Research, 21(2), 149-155. doi:10.1093/ntr/ntx275



中文參考文獻
2.衛生福利部國民健康署(2019)。臺灣菸害防制年報(第一版)。臺北市:衛生福利部國民健康署。
8.林琨棟(2015)。台灣戒菸門診服務計畫之投資報酬率分析。臺北醫學大學醫務管理學研究所。
10.劉瑞瑤、陳曾基、黃信彰 (2017)。 門診戒菸成功之影響因子探討[Predicting Factors of Smoking Cessation in Outpatient Smoking Cessation Clinic]。台灣家庭醫學雜誌, 27(3),頁 146-153。 doi: 10.3966/168232812017092703002
15.邱南英、張庭綱、薛光傑、吳憲林(2015)。二代戒菸治療醫師諮商技巧手冊(第三版)。臺北市:衛生福利部國民健康署。
16.衛生福利部國民健康署、台灣家庭醫學醫學會、台灣內科醫學會、台灣精神醫學會(2017)。二代戒菸治療教育課程基本教材(第三版)。臺北市:衛生福利部國民健康署。
17.衛生福利部國民健康署委託戒菸治療與管理窗口(2019)。 醫事機構戒菸服務補助計畫作業須知。取自 https://ttc.hpa.gov.tw/Web/Download.aspx
25.衛生福利部國民健康署(2012)。臨床戒菸服務指引(第一版)。臺北市:衛生福利部國民健康署。
27.林芸安、蔡仲弘 (2011)。 台灣中老年男性戒菸因素之探討[Predictors of Smoking Cessation among Older Male Smokers in Taiwan]。台灣公共衛生雜誌, 30(1),頁 36-44。 doi: 10.6288/tjph2011-30-01-05
28.衛生福利部國民健康署(2019, May 8)。 國人吸菸行為調查結果。取自 https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1718&pid=9913
31.蔡晏平、柯文欽、李碧霞、苗迺芳 (2018)。 冠狀動脈心臟病住院病人戒菸行為相關因素之研究[Factors Associated with Smoking Cessation Among Hospitalized Patients with Coronary Artery Disease]。新臺北護理期刊, 20(1),頁 27-39。 doi: 10.6540/ntjn.2018.1.003
34.吳映萱、黃柏誠 (2019)。 成人戒菸藥物治療。家庭醫學與基層醫療, 34(10),頁 292-297。
41.行政院主計總處(2021)。 物價指數統計表。 主計總處統計專區。取自 https://www.stat.gov.tw/ct.asp?xItem=35375&CtNode=487&mp=4
42.薛光傑、杜明勳、葛魯蘋、周明岳、陳麗玲(2006)。某醫學中心戒菸門診成效。台灣家醫誌,16(1),頁1-12。

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