比較良性攝護腺肥大患者二種治療方式之成本分析

A Comparative Study of the Cost Analysis on Two Types of Therapy for BPH Patients

背景及目的：攝護腺肥大患者接受手術治療或口服藥物治療各有其優缺點， 目前國內並未見相關的論述，以比較二種不同治療方式，所投注成本與達成 效果之經濟效益，故引發本研究動機。本研究目的在於運用「成本分析」之 經濟評估技術'藉由總成本當做經濟結果（Economic outcome） 拈標做評估， 治療達到目標率（治療後'國際攝護腺症狀評分表' [IPSS]分數比治療前減 少30%）當做臨床治療結果（Clinical outcome） 拈標，比較攝護腺肥大患者接 受口服藥物治療及手術治療二種不同治療方式，在成本上之差異性。 方法：採類實驗設計法的二組前後測設計，引用成本分析（C的t Analysis） 、 醫院作業成本報表及病患因排尿問題所花費用（六個月）之間卷表，為研究 工其。研究期間自民國90 年11 月至91 年4 月，採立意取樣法，研究樣本是臺北 市某醫學中心，在門診期間被醫師診斷為中度阻塞症狀之攝護腺肥大患者， 一組為未接受手術而使用同一種藥物治療，另一組為願意接受手術。在治療 前向患者說明研究的目的並取得患者同意後，前測二組各收案100 人，共收案 200人。每個月病患自填一張「病患因排尿問題所花費用之間卷表」，至下一 個月返診取藥時再交回門診護理站；連續收集治療後六個月之資料，回收率 100% 0 分析採描述性統計、卡方檢定、獨立樣本t檢定法。 結果與結論：接受手術治療六個月後之醫療保險金額、自付金額及總成本顯 著高於口服藥物治療，二組治療達到目標率無顯著差異。在因應健保總額支 付制度之實行下，健康管理條必然趨勢。建議醫療提供者對於攝護腺肥大之治療應從臨床治療結果及經濟結果等整體性做評估，在治療決策時，若病患 符合本研究收案條件者，應優先選擇成本最低者；即優先考慮使用口服藥物 治療，以達到醫療資源合理有效的分配。根據本研究結果，期望能提供醫療 人員做決策時之參考。

Background and aim: There are advantages and disadvantages for BPH patients to receive surgical therapy or oral medication therapy. Currently, there is not any relevant literature research reports of the comparison between these two therapy methods within the country, so it is the motivation behind the research. The purpose of this study is using economic assessment method of cost analysis, and through therapy success rate ( 'International Prostate Symptom Score' IPSS after therapy is 30% less than before therapy) as a clinical outcome indicator and total cost as an economic outcome indicator to compare the cost difference between oral medicine and surgery in treating benign enlarged-prostate patient. Method: This study was a quasi-experimental design to explore the effects on cost analysis between the two different treatments. The reliability and validitytested instruments were used in this study as followings: the patient's questionnaire about urination problem (six months) and cost reports for hospital procedures. From November of 2001 to April of 2002, a total of 200 subjects who were diagnosed with mid-level clog enlarged prostate were drawn from outpatient clinic in a Taipei medical center. There were two groups in this study; 100 patients were received oral medicine treatment, and another 100 were treated by surgery. Two study group patients were fully informed of the research goal and consented. Two groups had 100 patient cases respectively with a total of 200 patient cases. Patients were to fill out one 'Questionnaire of patient expenses due to urination problem' each month and returned it to consultation's nursing station the next month during follow-up consultation visit with consecutive collection of six-month data after therapy with a response rate of 100%. The descriptive statistics, 2 test, independent sample t-test were used in this study.