| Summary: | 碩士 === 高雄醫學大學 === 臨床藥學研究所 === 99 === BACKGROUND: Colorectal Cancer (CRC) is the third leading cause of cancer death in Taiwan. Surgery and auxiliary chemotherapy are common treatment strategies for this disease. Target therapies which have shown benefits in clinical trials have arrived on the market. Treatment innovations bring about the cost increases in medicine which includes medical equipments, drugs, and health care. This study aims to analyze prescription pattern and medical utility of colorectal cancer patients using National Health Insurance (NHI) database in Taiwan.
METHODS: Cross-sectional studies were conducted from 2000 to 2008, using a nation- representative, million-sampled, longitudinal NHI dataset (LHID2005) published by National Health Research Institute. Individual medical data of colorectal cancer (ICD-9-CM153,154) patients were extracted from 2000 to 2008. First, demographics, co-morbidities, treatment patterns, and first time usage ratio of prescription pattern of chemotherapy were analyzed. Lastly, the total medical utilization was evaluated using descriptive statistics which incorporates total medical cost, total pharmaceutical cost, chemotherapy drug cost, hospital visits, and hospital days. Wald chi-square tests were conducted to examine the differences between ratio of prescription and age or Charlson index score. Analysis of Variance was conducted to examine the difference between the average hospital stays and hospital visits within the first three years after new diagnosis. The Kaplan–Meier method was used to calculate survival curve.
RESULTS: During the 9-year study period, 2855 patients were newly diagnosed with CRC, among which 56% were male, 44% were female and the ratio of male to female was 1.29. The average age of the study group was 66.39±13.33 years old. The average Charlson index score was 0.93±1.23, in which gastric ulcer, diabetes mellitus and chronic pulmonary diseases had higher ratio. In term of treatment pattern, 86.9% of study group go through surgical treatment, and 56.7 % had surgery plus adjuvant chemotherapy. 5-FUI/LV and UFT prescriptions were the most common for first time use of chemotherapy. More than half of the patients would switch to another chemotherapy. There were more than 60% of patients who completed the 6-month treatment schedule. Analyzing chemotherapy prescription with age, patients whose age falls within 50-79 years old were the majority. During the 9-year study period, 58 CRC patients utilized target-therapy which the male to female ratio was 1.64. The average age of these people was 59.64±11.62 years old. The most common first time target therapy use was 5-FU/LV/IRI/CET (31.03%). During the study period, using target-therapy group has higher average of survival time (24.77±9.38 months) than other group. Total medical cost per person and total drug cost per person were much higher in first-year than consecutive years. The proportion of chemotherapy drug cost as compared with total drug cost for the first three years were 40.6%, 50.4%, and 45.8%, respectively.
CONCLUSION: This study found that the newly diagnosed patients of CRC in Taiwan between 2000 and 2008, the mainstream treatment plan consists of surgery or surgery with auxiliary chemotherapy. The choice of first time chemotherapy prescription was affected by the patients’ age, and co-morbidities. The first time chemotherapy treatment pattern utilizes Cape, UFT, 5-FU, 5-FU/LV, UFT/LV, 5-FU/LV/OX, and 5-FU/LV/IRI as major treatment choices. A completed treatment schedule is within a 6-month period. In term of medical utilization and cost, the first year after diagnosis has the highest cost and utilization.
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