Target Therapy, Medical Resource Utilization and Cost Effectiveness Analysis of Non-Small Cell Lung Cancer in Taiwan

• Main Authors: Li-Kuei Wang, 王麗桂
• Other Authors: Zhao- Song Chang
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/25329764623498516915

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 98 === The National Health Insurance (NHI) has included drugs used for target therapy to treat Non-Small Cell Lung Cancer (NSCLC) such as Gefitinib (Iressa) and Erlotinib (Tarceva) in the reimbursement list since 2004. However, research evaluating what should be included in the reimbursement is still relatively poor. The current studies to this aspect primarily use the itemized charges and individual hospitals in the NHI database for the analysis, yet they frequently fail to reflect the average cost characteristics of target therapy for cancer treatment, which therefore arouse the need for further investigation. The present study adopts the cross-sectional design of retrospective studies, which encompass The data is from Taiwan Cancer Database(TCDB) from 2004 to 2006, National Health Insurance Research Database(NHIRD) from 2004 to 2009, and Taiwan’s Death Registries from 2004 to 2009. Kaplan-Meier analysis was used to construct survival curves with Cox proportional hazard model to evaluate target survival day with the spent cost, and measure the direct effectiveness of the invested medical cost. The samples included in the current research are 17,451 NSCLC patients, of which 11,064 (63%) are male and 6,387(37%) are female. The most common ages range from 40 to 69, which take 8,598 (49%) out of the total. 3,713(21%) are diagnosed stage III, with 9,648 (55%) are stage IV. Overall, more than 70% of the selected samples are at final stages, of which the male (49%) are apparently more than the female (29%). There are 2,996 patients participating in target therapy, with total hospitalization of 27 days, total clinical visit and emergency cost of $NT 1,583,551, and total drug expense of $NT 1,443,192, including those for target therapy of $NT 420,307. When the total survival days are compared, target survival days are 825 days, whereas those with conventional therapies are 464 days and those with non-aggressive therapies are 220 days. Prognosis with target therapy is 92%, compared to that of conventional therapies 46% and non-aggressive therapies 18%, respectively. The multiple linear progression analysis indicates that, with the impact factors of treating mode, age, stage, and Charlson Comorbidity Index (CCI), the gross explanation power of total clinical visit and emergency cost reaches 49.4% after calibrated. From the functional analysis of Cox proportional hazard model that includes data collected until December 31st, 2009, it shows that each increment of CCI results in 11% increase of death risk. The death risk of the female is 0.68 of that of the male. In terms of treating modes, the death risk of conventional therapies is 223% and that of non-aggressive ones is 522% higher than that of target therapy, respectively. In the hazard functions of stage, the death risk of patients at late stages is 7.5 folds of that at early stages, which is also proportional to the ages. Finally, the difference of cost effectiveness between target therapy and conventional therapies is $NT 2,799 each day. In conclusion, the present study shows that the major impact factors of the cost of medical care for NSCLC patients are stage, age, treating mode, and CCI. The analysis of cost effectiveness indicates that each survival year to be extended requires significantly more cost of medical care. The difference of this matter also matches the outcome of different treating modes that has been observed in clinical medicine. It then postulates that the relationship between clinical medicine and medical economics can be effectively validated when medical cost effectiveness is estimated under the viewpoint of medical economics.