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研究生:邱欣玲
研究生(外文):Shin-Lin Chiu
論文名稱:青光眼在台灣之研究(一)隅角閉鎖型青光眼與隅角開放型青光眼盛行率及發生率: 2001-2010之變化(二)全民健康覆蓋下青光眼藥物花費趨勢
論文名稱(外文):Glaucoma Researches in Taiwan1.The Prevalence and Incidence of Diagnosed Angle Closure Glaucoma and Open Angle Glaucoma: Changes from 2001 to 20102.Trends in Glaucoma Medication Expenditures under Universal Health Coverage
指導教授:藍守仁藍守仁引用關係
指導教授(外文):Shou-Jen Lan
口試委員:林隆堯彭慶添余黃平謝嫣娉藍守仁
口試委員(外文):Long-Yau LinChing-Tien PengHuang-Ping YuYen-Ping HsiehShou-Jen Lan
口試日期:2015-07-07
學位類別:博士
校院名稱:亞洲大學
系所名稱:健康產業管理學系健康管理組
學門:商業及管理學門
學類:醫管學類
論文出版年:2015
畢業學年度:103
語文別:英文
論文頁數:79
中文關鍵詞:全民健康覆蓋青光眼藥物花費縱向研究治療擴張隅角開放型青光眼盛行率隅角閉鎖型青光眼盛行率
外文關鍵詞:universal health coverageglaucoma medication expenditurelongitudinal studytreatment expansionprevalence of diagnosed open angle glaucomaprevalence of diagnosed angle closure glaucoma
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研究目的:在台灣醫療照護是眾所周知的低花費,高效率,高品質,良好的醫療可近性,和高公平性。本研究目的是分析2001年至2010年間隅角開放型青光眼及隅角閉鎖型青光眼的盛行率以及1997年至2010年間,台灣在全民健康覆蓋下青光眼藥物花費的趨勢。
研究方法:本研究根據縱向健康保險數據庫,為全國性人群為基礎的回顧性縱向研究。診斷中有隅角開放型青光眼及隅角閉鎖型青光眼都被列入研究群組,並且根據患者的性別及年齡分組來比較組間的差異。另外,凡使用青光眼藥物的患者都被涵蓋在本研究內,並按照性別,年齡,收入和職業來分組。本研究使用2011年通脹指數來調整研究設計和通貨膨脹之後,分析了使用青光眼藥物的患者的資料。
結果結果:在2001至2010年間,隅角開放型青光眼及隅角閉鎖型青光眼盛行率都有增加的趨勢。在2005年之前,隅角閉鎖型青光眼的盛行率大於隅角開放型青光眼,然而從2005年之後,隅角開放型青光眼的盛行率大於隅角閉鎖型青光眼。隅角開放型青光眼的發生率上升不明顯,但隅角閉鎖型青光眼發生率則顯著下降。老年人口有較高的青光眼發生率。女性有較高的隅角閉鎖型青光眼發生率。青光眼藥物年度花費從1997年的0.21百萬美元增加到2010年的0.63百萬美元。根據廣義估計回歸模型顯示,青光眼藥物花費每年增加。此外,患者在40歲以上,男性患者,最高收入分組佔有最多青光眼藥物花費,而藍領階級的青光眼藥物花費較其他職業別來的低。若以青光眼藥物類別來說,前列腺素衍生物(prostaglandin analogs),甲型促進劑(α-agonists),和複方藥物支出顯著增加,但乙型阻滯劑(ß-blockers)和膽鹼促進劑(cholinergic agonists)則支出顯著下降。在1999年和2000年,青光眼小樑切除手術的數字有兩個轉折點,此時剛好是前列腺素衍生物在台灣上市及全民健康保險開始給付的年份。
結論:台灣女性有較高風險發生隅角閉鎖型青光眼。隅角閉鎖型青光眼及隅角開放型青光眼在2005年間盛行率的轉變跟台灣近視高盛行率及白內障手術被廣泛接受有關。此外,在1997-2010年間,台灣青光眼藥物的花費上升。花費增加的因素包括青光眼患者人數增多,更頻繁地使用的前列腺素衍生物,良好的醫療可及性,以及可能是更積極的治療這種疾病。 前列腺素衍生物的具有青光眼小樑切除手術治療擴張的效果。本研究結果也顯示,社會經濟地位不同在這樣的全民醫療保險覆蓋體系下,青光眼照護及青光眼藥物花費變化仍存在差距。

Purpose: Medical care in Taiwan is well known for its low imbursement, high efficiency, high quality, excellent medical accessibility, and high equity. We investigate the trends in prevalence of diagnosed open angle glaucoma (OAG) and angle-closure glaucoma (ACG) during the period 2001-2010 and the trends in glaucoma medication expenditures under universal health insurance coverage from 1997 to 2010 in Taiwan.
Methods: A nationwide population-based retrospective longitudinal study based on records from the Longitudinal Health Insurance Database 2000. The study population comprised all patients with a diagnosis of OAG and ACG. Patients were stratified by gender and age; differences in prevalence and incidence were compared between the stratified groups. Besides, patients who had taken anti-glaucomatous agents were enrolled and stratified by gender, age, income and occupation. After adjusting for survey design and inflation using the 2011 inflation index, we analyzed the data of patients using glaucoma medication.
Results: Throughout the study period, the prevalence of diagnosed OAG and ACG increased. Before 2005, the prevalence of ACG was higher than that of OAG; however, from 2005 to 2010, the prevalence of OAG was higher than ACG. The incidence of diagnosed OAG increased insignificantly, but ACG decreased significantly. Elder people had higher prevalence and incidence of OAG and ACG. Female had higher prevalence and incidence rate of ACG during the study period. Annual medication expenditures increased from $0.21 million in 1997 to $0.63 million in 2010. Generalized estimating regression models showed that the expenditures for glaucoma medication during the study period increased year by year. In addition, patients older than 40 years, male patients and patients in the highest income bracket incurred higher medical expenditures, while blue collar workers had lower medical expenditures than the other working classes. Expenditures significantly increased for prostaglandin analogs (PGAs), α-agonists, and fixed combination drugs, but significantly decreased on ß-blockers and cholinergic agonists. The number of trabeculectomy shows two break points in 1999 and 2000 when PGAs were listed and reimbursed.
Conclusions: Women in Taiwan are at a higher risk of ACG. The reason for the change of prevalence between OAG and ACG after 2005 may be related to the increased high prevalence of myopia or to the rising number of cataract surgeries performed in Taiwan, or both. The cost of glaucoma drugs rose in Taiwan during the period 1997-2010. Factors responsible for such an increase include higher numbers of glaucoma patients, more frequent use of prostaglandin analogs, improved medical accessibility, and possibly more aggressive treatments for this disease. PGAs may have the effect of treatment expansion for trabeculectomy. These results also suggest socioeconomic disparities in glaucoma care, as well as understanding of the changes in the expenditure of glaucoma medications under such universal health insurance coverage system.

Table of Contents

Chapter 1 INTRODUCTION 1
Section 1 Background 1
Section 2 Research motive 2
Chapter 2 LITERATURE REVIEW 4
Section 1 Literature review on prevalence of glaucoma 4
Section 2 Literature review on glaucoma treatment 6
Section 3 Literature review on economic impact of glaucoma 6
Chapter 3 METHODOLOGY 8
Section 1 Database 8
Section 2 Study sample 8
Section 3 Statistical analyses 9
Chapter 4 RESULTS 11
Section 1 Prevalence of glaucoma 11
A. Total number in database 11
B. Prevalence of diagnosed open angle glaucoma and diagnosed angle closure glaucoma 11
C. Incidence rate of diagnosed open angle glaucoma and diagnosed angle closure glaucoma 14
Section 2 Cost analyses on glaucoma medication expenditure 22
A. The number of database 22
B. Overall costs on glaucoma medication expenditure 22
C. Mean expenditure per capita and the demographic factor for expenditure 29
D. The changes of expenditure between different glaucoma medications) 32
E. The change of trabeculectomy number during the study period 32
Chapter 5 DISSCUSSION 34
Section 1 Gender difference in the types of glaucoma and literature review 34
Section 2 Age difference in the types of glaucoma and literature review 34
Section 3 Reasons of reversion of prevalence between diagnosed open angle glaucoma and angle closure glaucoma and literature review 35
Section 4 Trends in overall glaucoma medication cost and literature review 36
Section 5 Discuss about who spend more money and literature review 37
Section 6 Changes of expenditure between different glaucoma medications and literature review 39
Section 7 Effect of new drug on trabeculectomy and literature review 40
Section 8 Research limitations 41
Chapter 6 CONCLUSIONS AND RECOMMENDATIONS 42
Section 1 Conclusions 42
Section 2 Recommendations 43
BIBLIOGRAPHIES 44
APPENDIX 53
Appendix 1 Acronym table 53
Appendix 2 Table of glaucoma medication Codes in Taiwan National Health Insurance program 54
Appendix 3 Demograhy on analysis of glaucoma medication expenditure 75
Appendix 4 Changes of glaucoma medication cost 77
Appendix 5 Changes of glaucoma medication cost (adjusted by CPI) 78
Appendix 6 Trends in glaucoma medication cost (adjusted by CPI) 79

List of Tables

Table 1. Trends in prevalence of diagnosed open angle glaucoma (OAG) and angle-closure glaucoma (ACG) in Taiwan (1/1,000), 2001-2010 12
Table 2. Trends in crude and age-standardized incidence rate of diagnosed open angle glaucoma (OAG) in Taiwan (1/100,000), 2001-2010 15
Table 3. Trends in crude and age-standardized incidence rate of diagnosed angle-closure glaucoma (ACG) in Taiwan (1/100,000), 2001-2010 16
Table 4. Total and mean glaucoma medication expenditure (USD, adjusted for inflation to the 2011 Consumer Price Index of Taiwan), LHID2000 1997-2010 23
Table 5. The results of generalized estimating equations regression model (USD/year) 31


List of Figures

Figure 1. Trends in the prevalence of diagnosed open angle glaucoma (OAG) and angle closure glaucoma (ACG) in Taiwan, 2001-2010 13
Figure 2. Trends in age-standardized incidence rate of diagnosed open angle glaucoma (OAG) and angle-closure glaucoma (ACG), 2001-2010 17
Figure 3. Age-standardized incidence rate of diagnosed open angle glaucoma by gender group, 2001-2010 18
Figure 4. Age-standardized incidence rate of diagnosed angle closure glaucoma by gender group, 2001-2010 19
Figure 5. Age-standardized incidence rate of diagnosed open angle glaucoma by age group, 2001-2010 20
Figure 6. Age-standardized incidence rate of diagnosed angle closure glaucoma by age group, 2001-2010 21
Figure 7. Annual glaucoma medication expenditures, by gender 25
Figure 8. Annual expenditure of glaucoma medication, by age group 26
Figure 9. Annual expenditure of glaucoma medication, by insured salary 27
Figure 10. Annual expenditure of glaucoma medication, by occupation type 28
Figure 11. Mean expenditure per person for glaucoma medication, by gender 30
Figure 12. Plot of total expenditure of glaucoma medication, by medication class 33


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