| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 99 === Research Purpose
Cerebral infarction ranks third for the cause of death among people within the nation; this research is focused on a systematic study of initial cerebral infarction and comparing the cost benefit analysis of different medical treatments.
I. Discussion of the relation between the characteristics of cerebral infarction patients and the different medical treatments they receive.
II. Discussion of the relation between different medical treatments and the clinical nature of cerebral infarction patients.
III. Comparison of the difference between direct and indirect costs of cerebral infarction patients under different medical treatments.
IV. Comparison of the difference between direct and indirect benefits for cerebral infarction patients under different medical treatments.
V. Comparison of the difference between cost benefits for cerebral infarction patients under different medical treatments.
VI. Comparison of the difference between cost utilities for cerebral infarction patients under different medical treatments.
Research Method
The sample hospital used within this research is a medical center in the south that adopts the two years retrospective longitudinal approach, spanning from Jan. 2009 to Dec. 2010; used for the sampling of initial cerebral infarction patients under medical treatments such as the anti-platelet and the tissue plasminogen activator. Among a total of 1,601 cases collected, 1,554 of the cases were patients who received anti-platelets and 47 cases were patients who received the tissue plasminogen activator treatment. This research analyzes whether variables such as different medical treatments, population characteristics and clinical nature…etc. affects the allocation of medical funds; evaluates economic calculations of the cost utility ratio by using the quality-adjusted life years (QALYs) from the European quality of life research method (Post et al., 2001); conducts univariate sensitivity analysis on cost benefit aspects and also uses the “Inpatient medical expenditures detail files (DD)” and “Medications main file (DRUG)” from the National Health Insurance Research Database (NHIRD) from Jan. 2007 to Dec. 2008 for the data comparison of the sample hospital and the nationwide database, which covers 2,599 cases of anti-platelets treatment and 19 cases of tissue plasminogen activator treatment.
Research Result
Research results shows that the population attributes within the cases of the sample hospital is the same as the data from NHIRD; therefore the cases from the sample hospital is qualified to be used as the parent group for the discussion of medical resources exhaustion under anti-platelets treatment and tissue plasminogen activator treatment. The research results yield that the average age of patients who received anti-platelets treatment is 69.31±12.03 years old, while those who received tissue plasminogen activator treatment averages around 66.36±12.35 years old; the choice between these two treatments varies significantly according to gender and risk factors such as heart disease and cigarette consumption (P value＜0.05).
Regarding cost benefit analysis, the sum of direct costs, indirect costs and opportunity costs adds up to the total medical cost, respectively: anti-platelets treatment 736,309 NTD, and tissue plasminogen activator treatment 1,039,246 NTD.
As to the cost benefit aspect, anti-platelets treatment and tissue plasminogen activator treatment can provide respectively 6.49 QALY and 7.33 QALY. Besides taking into consideration the medical expenses, the cost benefit evaluation from sociology and the patient’s point of view shows that in comparison with the hospitalization days (8.06 ± 7.89 days) and the frequency of the use of outpatient services (3.41 ± 5.18 times) for anti-platelets treatment, the hospitalization days (13.43 ± 11.04 days) and the frequency of the use of outpatient services (6.21 ± 10.83 times) for tissue plasminogen activator treatment is apparently higher. It can be inferred that tissue plasminogen activator treatment has a higher increase of cost benefit ratio than the anti-platelets treatment; resulting in an additional expense of 360,639 NTD per each increasing year of survival under QALY. After conducting univariate sensitivity analysis, it is revealed that gender and the severity of the disease are important factors that influence cost benefits.
Conclusion and Proposition
This research reveals that the factors influencing the cost benefits of medical treatments for cerebral infarction patients are gender, and risk factors such as high blood pressure and cigarette consumption (in accordance with references); the cost benefit research shows that in the current stage, using the tissue plasminogen activator treatment results in a higher cost per each increasing year of survival under QALY.
1. Male, with risk factors such as heart disease and cigarette consumption are patient characteristics that affect the use of different medical treatments.
2. Severe illness is a clinical factor that affects the use of different medical treatments.
3. Direct costs, direct benefits and cost benefits differ between different medical treatments.
How to increase life quality and decrease physiological disorder of initial cerebral infarction patients after medical treatment is an important and meaningful issue. This research reveals that with the implementing of perspective long-term research on the evaluation of health economics and life quality, extending the cost benefit observation period of initial cerebral infarction therapy can provide further long-term cost benefits.
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