| Summary: | 碩士 === 國立中山大學 === 醫務管理研究所 === 94 === Background:
Hepatocellular carcinoma (HCC) is the leading cause of cancer in Taiwan, which consumes high medical expense among the total healthcare expenditure and becomes the significant burden to the finance of National Health Insurance (NHI). However, population-based statistics about the cost with the survival rate is rare.
Objective:
Through analyzing the data from the Bureau of National Health Insurance and hospital clinical files, we estimated the medical expenditure for treating HCC patients and the factors associated with treatment outcome.
Methods:
The National Health Insurance data from 1996 to 2002 with ICD-9 code 155 were used, which include age, gender, visiting time, and medical cost for inpatient or outpatient visits. The population-based data were analyzed to estimate 1-5 year survival probability and medical cost of HCC patients.
In hospital-based data, 189 patients from 1991 to 2004 were recorded by clinical chart and 62 of them diagnosed during 2002 and 2004 were further selected to match the claim data. These informations were used for computing survival or recurrence probability, related factors, and medical cost.
Results:
For all incident cases in 1997, the average 5-year cumulated cost was NT$ 219,398, while the cumulated cost for those patients survived more than five years was NT$ 491,288. The survival probability was 30.8% for more than one year, 20.9% for more than two years, 15.2% for more than three years, 11.3% for more than four years, and 9.7% for more than five years in 1997 respectively. Female and those age >45-65 years old seemed to have better survival outcomes than male and those age ≦45 years old or >65 years old , the averaged medical cost per treated case surviving more than five years were T$2,457,214 for male and NT$ 1,987,874 for female.
Hospital clinical data indicated that TNM stages, therapy choice, liver cirrhosis, and ascites are risk factors for surviving. Although pre-TACE treatment has higher expenditure, its five-year survival probability is better than other treatments in this research.
Conclusions:
This paper presents medical cost with survival probability and its associated factors for HCC patients and further estimates the medical cost per life saved for treating HCC patients. Our findings can offer the policy-maker, provider, and patient to evaluate the intervention or prevention program in the future.
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