| 摘要: | 成本控制是醫療照護系統之主要議題,特別是在全民健保制度實施之際,醫療照護需求大幅增加,如何在有限的成本下,提供有效的醫療服務是目前重要課題之一,益更凸顯評估貨幣性成本價值的成本效益分析在臨床上的重要性。 鑒於血液透析是慢性尿毒症病人治療的主流,且健保每月支出血液透析費用約八億元,故本研究針對慢性尿毒症病人進行血液透析療法之成本效益評估,本研究以奇美醫院規則性血液透析達半年之165名慢性尿毒症病人為對象,採多元迴歸模式分析,發現出院狀況,總住院日,糖尿病有無及年齡等項目與治療後的日常生活活動功能改善有顯著相關;總住院日及首次血清白蛋白濃度兩項因素與成本有顯著相關;另就成本效益分析發現,非糖尿病腎病變之尿毒症患者其成本效益高於糖尿病腎病變之尿毒症患者;非糖尿病腎病變之尿毒症患者,若首次血清白蛋白濃度較低,首次血球容積百分比較小者,其成本效益表現較佳;糖尿病腎病變之尿毒症患者需住院日長之治療,而非糖尿病腎病變之尿毒症患者僅需短住院日之治療。此結果希望有助於醫療機構、政府控制成本又要兼顧效益之策略考量依據。
Cost containment is the key issue in healthcare systems and a key concept that government and medical providers must grasp in this time of shrinking budgets and growing demand for health care. As healthcare budgets come under increasing scrutiny, cost-cutting solution is a faith. Medical care must be made cost-effective, more value must be obtained for the money spent. Cost-effectiveness analysis (CEA) is emerging as an economic approach for determining the relative value of health care programs, technologic innovations, and clinical decisions. Given the high expenditure of hemodialysis in Taiwan, we made this investigation to assess the cost-effectiveness of hemodialysis for chronic uremic patients in Chi-Mei Foundation Hospital. After assembling patient characteristics, outcomes, and cost for 165 patients. We identify that discharge status, length of stay, history of diabetics, and age are significant predictors of activity of daily living (ADL). Length of stay, albumin of hemodialysis at first time are significant predictors of direct medical cost. In summary, patients with diabetic uremia have lower cost-effectiveness ratio. Patients with nondiabetic uremia with the characteristics of less albumin and less hematocrit of hemodialysis at first time have higher cost-effectiveness ratio. Patients with diabetic uremia have longer length of stay than ones with nondiabetic uremia. The results will be valuable for government and medical care providers allocating resources. |
