| 中文摘要 |
本研究藉由全民健保的申報資料，進行第二型糖尿病病患合併使用新型抗血糖藥物thiazolidinediones（TZDs）類藥物rosiglitazone及pioglitazone的經濟效益（cost-effectiveness）評估。本研究的資料來源是為期五年（2001-2005）的全國性世代追蹤資料，針對24,654名第二型糖尿病病患，比較其中合併使用TZDs類藥物（rosigli-tazone或pioglitazone）組與合併使用傳統抗血糖藥物組兩組於臨床效益（延遲仰賴胰島素控制血糖的時間）及醫療費用的差別。研究結果發現，合併使用TZDs類藥物組的病患比起合併使用傳統抗血糖藥物組於血糖控制方面的臨床療效較佳（151 days (0.41 years) vs. 101 days (0.28 years)），然而合併使用TZDs類藥物組的病患，其醫療費用也較傳統抗血糖藥物組為高，藉由合併使用TZDs類藥物，每位民眾每多獲得一年良好的血糖控制，全民健保的支出約在九萬五千元新台幣，而目前健保給付的兩個TZDs類藥物rosiglitazone (95,874 NT dollars per year) 及pioglitazone (95,485 NT dollars per year)的經濟效益估算是近似的。本研究結果將可作為衛生政策決策過程的重要參考。" |
| 英文摘要 |
The cost-effectiveness of adding the two health insurance covered thiazolidinediones (TZDs)- rosiglitazone or pioglitazone, to metformin in treating type 2 diabetes mellitus was assessed from a Taiwanese National Health Insurance (NHI) perspective. This analysis was based on patient-level data extracted from Taiwan’s NHI databases. Type 2 diabetic patients who received consecu-tive metformin treatments between 2001 and 2005 were identified. Clinical effectiveness, a proxy of glycemic control (time to insulin dependence), and direct medical cost were also estimated. Incremental cost-effectiveness ratio (ICER) was calculated and expressed as cost per delayed year to insulin dependence. Compared to add-on non-TZDs, add-on rosiglitazone and pioglitazone were associated with delays of additional 151 days (0.41 years) and 101 days (0.28 years) in insulin dependence, respectively. Total mean medical costs were higher in add-on TZDs users compared to add-on non-TZDs users. The additional total medical costs of add-on rosiglitazone or pioglitazone were comparable, with ICERs of 95,874 and 95,485 New Taiwan (NT) dollars per year delay in insulin dependence, respectively. Add-on TZDs improves glycemic control but also increases direct medical cost. In terms of the incremental medical costs associated with these clinical benefits, add-on rosiglitazone or pioglitazone are similar in Taiwan. |
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