| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所 === 98 === Purpose： Chronic Myeloid Leukemia (CML) accounts for 15 to 20% of adult leukemia. The incident rate of CML among every hundred thousand people is 1 to 1.5. Imatinib, one of the curing methods of CML, has a relatively high cost-effective. However, not every country would include imatinib into its health care supply due to different considerations. In Taiwan, the institute of National Health Insurance included imatinib as the ambit of patients having CML in primary stage in 2004. Based on this situation and the yearly soaring expenditure on anti-cancer drugs under the system of National Health Insurance, I want to discuss the treatment patterns of CML and the utilization of healthcare resource for CML. This paper may offer some new ideas to clinical medical institutions, hospital managers and policy makers of public health.
Methods：This study is a longitudinal study that analyzes secondary data (from National Health Insurance Research Database), taken from 1998 to 2007 newly diagnosed patients with CML. I want to discuss the annual change of treatment patterns of CML. In addition, according to treatment patterns of CML, I would also discuss the annual change of the healthcare resource utilization.
Results：The treatment patterns of CML showed annual change after the introduction of the target therapy. Starting from 2002, the use of the target therapy was increasing compared with other CML treatments. This resulted from patients’ age, the severity of CML disease and the complications during the treatment patterns of CML. The total medical cost had been increasing from 232.17 (thousand NT dollars) in 2002 to 413.40 (thousand NT dollars) in 2007. When we took a closer look at the outpatient cost, inpatient cost and drug cost, we could find that the proportion of drug cost was increasing from 53.85% (2002) to 76.57% (2007). As far as inpatient cost was concerned, it decreased from 33.08% in 2002 down to 15.22% in 2007. The ratio of outpatient cost had little change, with the trend of decrease from 13.08% in 2002 to 8.21% in 2007. The average length of stay decreased from 2003. The average length of stay was from 34.06 days in 2003 down to 28.09 days in 2007. The average outpatient visits was between 35.50 to 33.26 times from 2000-2007. The impact factors of total medical costs were the age of patients, CML severity, complications and treatment patterns of CML.
Conclusion：This study analyzed 1998-2007 newly diagnosed with CML. Due to the new-introduced medicine, the treatment patterns of CML has changed. In the past, the new cases used stem cell transplantation and other CML treatments for the first treatment. In 2001, target therapy (imatinib) was on the market. Since then, the use of the target therapy was increasing. The ratio of using stem cell transplantation apparently decreased year by year. The overall hospitalization rate, inpatient cost and the average length of stay are going down. Patients getting treatment become younger. The severity of CML disease has been decreased. All of these show that the quality of medical care is improved and the concept of early treatment is practiced. Thus, we can expect a future that people can live longer and the total mortality can be reduced more efficiently.
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