Evaluation on Medical Utilization, Clinical Effectiveness and Feasibility in Quality of Life Meaures on Patients with Chronic Hepatitis B in Taiwan

• Main Authors: Yun-Ting Lin, 林芸亭
• Other Authors: Yaw-Bin Huang
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/44805201586651109915

碩士 === 高雄醫學大學 === 臨床藥學研究所 === 99 === Background: With the high prevalence of chronic hepatitis B (CHB) in Taiwan, the infection control, long-term treatment and complications management have been one of the most important tasks to healthcare authority. However, there is still lacking of outcomes data to justify the cost-effectiveness of treatment and the impact of treatment on quality of life in Taiwan. This study aims to explore the medical utilization of CHB patients, outcomes which associated with completeness of CHB treatments, factors contributing to CHB patients'' quality of life (QoL), and the feasibility of QoL measurement tools for CHB patients in Taiwan. Methods: Firstly, a cross-sectional study was conducted from 2000 to 2008 using a nationwide sampled, longitudinal claim-based database (LHID2005) constituting of a million beneficiaries randomly sampled in 2005. CHB patients were included and followed the claim data which was associated with medical utilization and medical cost. All of results were reported by descriptive statistics method and analyzed by linear regression. Secondly, a retrospective cohort study was conducted from October 2003 to December 2008 using LHID2005. Adult CHB patients who received interferon or antivirus (lamivudine, adefovir) treatment were included, and those with underline diseases which may influence the judgment on treatment outcomes (relapse of CHB) were excluded. The relapse features among different therapeutic agents were evaluated and stratified by the completeness of treatment course. All of results were reported by descriptive statistics method and analyzed by log-rank test. Finally, consecutive adult CHB patients who visited liver clinics were invited for interviews. Time-trade off (TTO), EuroQol group 5-dimension (EQ-5D) questionnaire and 100-mm visual analogue scale (EQ-5D VAS) were used to measure participations’ utility. Multivariate analysis was used to evaluate the association between utility values and patients’ demography characteristics and Charlson comorbidity index. Results: During the study period, monthly number of outpatient visits, therapeutic prescriptions and medical costs significantly increased. Furthermore, the monthly number of prescription (P=0.0017, β=13.90) and drug cost (P=0.0024, β=57670.80) of entecavir also significantly increased. Of the 238 included patients (mean age=39.10±12.77 years, 73.5% male) had completed their first CHB treatment courses. There were five patients took another drug treatments after the completeness of the first treatment course. Overall, the recurrent rate of hepatitis B amongst those completed treatment course was less than 10%; and there was no significant difference in the recurrent rates between different agents. A total of 120 participants (mean age=48.02±11.04 years, 85% male) were recruited into QoL measurement study. The mean utility for EQ-5D index, EQ-5D VAS, and TTO were 0.89±0.14, 0.83±0.87 and 0.65±0.29, respectively. The former two utilities were significantly associated with employment status whilst TTO was significantly associated with marriage status. Some of participants felt financial burden of long-term drug therapy and worried about complications of CHB. Conclusion: This study revealed that implementation of the reimbursement scheme for hepatitis B medical treatments significantly increased the medical utilization. There was no significant difference of relapse rates between different therapeutic agents. EQ-5D questionnaire and EQ-5D VAS were feasible QOL measurements for Taiwanese CHB patients.