淋巴癌病患之醫療資源利用與療效之探討

A Study on Relationships Between Utilization of Medical Resources and Clinical Outcomes in Lymphoma Patients

目的：探討淋巴癌病患在不同人口學特性、疾病特徵、治療方式的情況下，其醫療資源利用與存活率之相關情形。方法：研究設計採回溯性研究，資料來源為：一為病歷回顧，收集2006年至2013年間淋巴癌病患人口學特性、疾病特性，醫療處置等相關資料。二為病理報告檔，三為資訊室申報健保署之住院醫療費用明細及門診醫療費用明細。資料使用SPSS第20.0版分析，以描述性統計分析各個變項，單因子變異數分析、線性迴歸分析醫療資源利用情形。以Kaplan-Meier存活分析其存活率。結果：本研究總共納入448位淋巴癌病患進行分析，平均發病年齡為57±16歲，組織型態以B cell Lymphoma為主，佔83.5％。53.3％病患接受以標靶藥物（Rituximab）為主的治療。每人平均住院天數為27±29天、門診次數為57±44次、總醫療費用為457,460±454,116元。病人職業、與家人同住、白蛋白值、B型肝炎帶原者、使用標靶藥物、有接受化學治療者醫療資源利用較高。其五年的整體存活率可達60％，女性存活率明顯比男性高，LDH與β2-microglobulin對淋巴癌病患存活有影響。結論：人口學與疾病特性、治療方式是影響醫療資源利用的因子。淋巴癌治療原則是根據疾病特性、健康狀態做考量隨者標靶藥物的介入可改善其存活率。此研究為單一醫學中心之收案，未來可與癌症資料庫做結合來互相印證其醫療資源利用情形。

Purposes: To explore the correlation between utilization of medical resources and survival rate in lymphoma patients with different demographic characteristics, disease characteristics, and treatment approaches. Methods: This was a retrospective study. The data sources on lymphoma patients from 2006 to 2013 were as follows: 1. A review of medical records by collecting the demographic characteristics, disease characteristics, medical treatment, and other relevant data; 2. Pathology reports; 3. Details of hospitalization expenses and outpatient medical expenses submitted to the National Health Insurance Administration by the information office. The data were analyzed with SPSS Version 20.0. Descriptive statistics were applied for the analysis of each variable. One-way ANOVA and linear regression analysis were conducted for medical resource utilization. Kaplan-Meier survival rate was adopted to analyze the survival rate. Results: In this study, a total of 448 lymphoma patients were included in the analysis. The average age at disease onset was 57±16 years. B cell lymphoma was the predominant tissue type, accounting for 83.5%. Among the patients, 53.3% received a targeted drug (rituximab). The average length of hospital stay per patient was 27±29 days, the number of outpatient visits was 57±44, and the total medical expenses were NTD 457,460±454,116. Patient's job, patient's who lived with family, patient's albumin level, Hepatitis B carriers, patients who used a targeted drug, and those who received chemotherapy had a higher utilization rate of medical resources. The five-year overall survival rate was up to 60%, and the survival rate in females was significantly higher than that in males. LDH and β2-microglobulin affected the survival of lymphoma patients. Conclusions: Demographic and disease characteristics as well as treatment approaches are the factors that influence the utilization of medical resources. The principle of lymphoma treatment is to consider the disease characteristics and health status, and intervention by targeted drugs can improve the survival rate. This study enrolled cases in a single medical center, which can be combined with cancer databases in the future to mutually confirm the utilization of medical resources.