| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 103 === Background and Objectives
Few long-term and/or short-term cost-benefit researches had been done regarding the influenza vaccinations effect on End-stage Renal Disease (ESRD). In our database, we have enough evidences showing the tendency of triggering serious complications from influenza. Therefore, we decided to conduct a thorough study on senior ESRD pa-tients older than 65-year-old and analyze its both long-term and short-term cost-benefit structure that respects to influenza vaccinations。
Methods
This study was designed to utilize retrospective approach which targeted those pa-tients who held critical illness card, ICD-9-CM code 585.xx, from National Health Insur-ance Bureau and had chronic kidney failure disease, were over sixty-five, and were diag-nosed with ESRD from January first of 2005 to December 31th of 2010. We divided those patients into two groups: one took influenza vaccinations and one without. Moreover, we picked primary or secondary diagnosis of ICD-9-CM influenza, pneumonia 480-487, acute nasopharyngitis 460-466, chronic obstructive pulmonary disease 490-496, and respiratory system disease 500-518. Medical cost was calculated based on averaged charged fees for outpatient and hospitalization visits and stays. Cost-Benefit analysis was based on independent samplings and multiple linear regression analysis method。
Results
In total, there were initially 11,609 elderly and ESRDs recruided in the study. After normalizing, there were 6,560 cases were selected. We divided those patients into two groups: one took influenza vaccinations and one without. Based on inoculation medical expenses records, 2,931 patients had vaccinations and 3,629 patients did not. By using propensity score matching (PSM), we selected 2,775 patients in each group。
This study was taking from perspective of the health insurance payers. Direct in-volved cost included both medical and non-medical. Medical cost was calculated based on declared points and averaged charged fees for outpatient and hospitalization visits and stays. From this cost-benefit study, we found that the vaccination group was more cost-benafit than the control group (non-vaccine.) For the vaccination group, each patient could save NT$121.1 within 3-month period and NT$265 per year compared to the con-trol group. Long-term cost-benefit was also better than the short-term’s. Additionally, we found that over 75-year-old patients were more cost-effective than the 65-74 year-old elderly. Overall medical cost could save up to NT$294.3 per person。
Finally, we conducted sensitivity analysis and found the most sensitive issue for short-term (3-month) timeframe was Charlson Comorbidity Index (CCI). For the long-term (1-year) timeframe, hospitalization was the main concern。
Conclusions and Suggestions
This study showed the overall medical expenses were lower when compared the vaccination group against the no-vaccination group for both timeframes: short-term (3-month) and long-term (1-year). The results showed that if 80% of ESRD patients had influenza vaccinations, we estimated that we could have saved seven hundred and sixty million dollars. Moreover, these estimates had not yet included unquantifiable benefits such as life cost, life quality, etc. Therefore, we believe the results shown here were conservative and maybe under estimated. We also found that this study could also apply to other diseases such as flu, pneumonia and respiratory inflammation. For those age ≧75-year-old vs. 65-74 year-old, illness severity ≧1 point vs. 0 point, facility type (hospital vs. clinic), diabetes (yes vs. no), former groups’ incremental cost- effectiveness ratio (ICER) were all better than the latters’. We believe that if we can raise the vaccina-tion coverage rate, we should be able to further reduce our overall medical expenses。
We suggest future research can base on the current effort and grow the database with more suitable cases and expand our findings. From doing so, we should be able to have better control of those severe diseases. Another idea is to analyze cost-benefit from potential years of life lost (PYLL) point of view。
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