運用資料包絡法探討接受不同乳房手術病患之滿意度分析

To Analysis of satisfaction of patients who received different kinds of Breast Cancer surgery by Data Envelopment Analysis

乳癌目前為女性十大癌症排名第一位，發生率逐年上升。而乳癌的治療目前仍以外科手術為主，並配合放射線治療、化學治療及荷爾蒙藥物治療，使得醫療費用高於其他癌症的治療，隨著全民健康保險給付日益縮減，病患醫療費用負擔增加，究竟乳癌三種手術方式在臨床效益、病患復發及費用的差異性如何？本研究目的在於探討病患對於「復發時間」、「醫療費用」及三種乳癌手術之病患滿意度。本研究之研究對象為南部某醫學中心於5年內共1059位此段時間施行過乳癌手術之病患，分析乳癌病人的不同治療方式及醫療資源耗用；主要研究依變項包含：復發情形、醫療費用及手術滿意度，藉此比較三種治療方式之臨床效益。研究資料回收以SPSS軟體作為分析工具，進行單因子變異數分析及CCR模式滿意度效率評估。研究結果發現：（1）三種手術方式復發時間無差異。（2）在復發前醫療費用有差異，發現乳房切除手術（重建），其醫療費用較其他兩種手術費用高，在有復發病患醫療費用比較，發現其三種手術醫療費用無差異。（3）三種手術在病患滿意度無差異。結論與建議：在本研究結果中發現乳房重建手術不僅在復發、醫療費用及滿意度的表現，都可取代乳房保留手術，晚期病患無法實行乳房保留手術，只有乳房重建手術可以取代成為治療標準，由於目前乳房重建的費用每家醫院不同，是否符合病患的需求仍值得探究，希望本研究結果能做為本院醫師選擇手術方式的參考方向，並提供乳癌團體參考，極力向政府機關及保險單位爭取乳房重建手術納入全民健保，不應該將其視為美容整型手術，減輕病患負擔提高生活品質。

In Taiwan, the incidence of breast cancer is increasing in recent years. Breast cancer became the leading cancer in female. In addition to operation, current major treatments of breast including chemotherapy, radiotherapy, hormonal therapy and target therapy. Although these treatments can improve breast cancer survival, they make the cost of breast cancer treatments larger than other cancers. In Taiwan, all these treatments are reimbursed by our National Health Insurance programs. But the reconstruction of breast after total mastectomy is not reimbursed. There are three major operation methods for breast cancer, including breast conserving surgery (BCS), modified radical mastectomy (MRM) and Modified radical mastectomy with breast reconstruction (MRM+TRAM). We will compare these three methods in breast cancer satisfaction.
One thousand and fifty nine patients treated in Kaohsiung medical university 5years were enrolled in this study. From the cancer registry data, the recurrence, medical expense and patients' satisfaction was analyzed. The statistical methods including one way ANOVA and CCR model for patients' satisfaction scale.
Our study showed(1). there is no statistical significant in three groups in time to recurrence (2). The medical expense was significantly higher in MRM+TRAM group without recurrence, but there is no difference in those with disease recurrence.(3).There is no difference in patients' satisfaction in three groups. We conclude that for those patient who doesn't accept MRM without reconstruction for her breast, MRM with TRAM is a good alternative to BCS in consideration of disease control, cost effectiveness and patients' satisfaction. Conclusions and Recommendations: This study show breast reconstruction surgery is not only in the performance of relapse, medical expenses and satisfaction, It also can replace breast-conserving surgery. In patients with advanced breast conserving surgery can not be implemented in the results of this study, only the breast reconstruction surgery has become the standard of care which may be substituted. Because the current cost of breast reconstruction is different in every hospital, meets the needs of patients are still worth exploring. I hope the results of this study can give surgeon a reference of surgical approach, and provide a reference for breast cancer group. We tried to government agencies and Insurance unit for breast reconstruction surgery included universal health insurance. It should not be considered as cosmetic plastic surgery, and reduce the burden on patients to improve quality of life.