| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 104 === Background
Colorectal Cancer (CRC) is the most common cancer in the world; in recent years, it is also the first incidence rates of cancer and the third main cause of cancer death in Taiwan. According to the 2012 statistics database of Taiwan Health Promotion Administration (HPA) shows the incidence rates among CRC is 45.1 per 100,000 people and the global cancer statistics report shows that Taiwan’s incidence rate of CRC was highest than other countries by World Health Organization (WHO) in 2012. With the increase of cancer patients, the treatment method and medical resource utilization have gradually taken seriously. Therefore, the purposes of study are to assess and discuss in medical resource utilization, survival and cost-effectiveness analysis in different staging CRC patients.
Methods
The research contained prospective and retrospective design, the prospective study was conducted to investigate health-related quality of life (HRQoL) questionnaires during 2010 to 2015 and the retrospective study was conducted to collect the data from medical record. The patients of study were the newly diagnosed CRC and underwent surgery between January 2005 to December 2015 at one medical center in Southern Taiwan. Data sources included three parks: 1st was HRQoL questionnaires, 2nd was medical record and 3rd was database (including inpatient costs, outpatient costs and death file). We used General Estimating Equations (GEE) to control time by STATA 11.0 statistical software.
Results
For treatment stage costs, the result shows that Terminal Stage cost more dollars than other treatment stages in all staging CRC patients, and Terminal Stage cost was also significantly higher than Initial Treatment Stage among the staging IV CRC patients (NTD$201,800). Otherwise, the result shows that staging IV CRC patients cost more money than other patients in all treatment stage costs, Initial Treatment Stage costs and Continuous Care Stage costs were all higher than staging I CRC patients (NTD$161,714；NTD$431,768). The study found that postoperative 1-5 years costs decline by years in all staging CRC patients, especially in staging IV CRC patients, 5 year costs less than 1 year (NTD$667,103).
Survival analysis shows that staging IV CRC patients’ hazard ratio significantly higher than staging I CRC patients (HR 3.73) and mortality ratio higher than staging I CRC patients (69.2% versus 91.9%). And the result of the cost-effectiveness analysis (CEA) in different staging CRC patients shows that early staging CRC patients had better outcome but cost less than other staging CRC patients. Especially, staging I CRC patients significantly cost less than staging IV CRC patients (NTD$1,925,571).
Conclusions
The study shows that staging IV CRC patients cost more money in all treatment stage and also had worse cost-effectiveness. The result shows that late staging CRC patients cost more money but got lower treatment effect than early staging CRC patients, according to our results, suggesting clinic physician and ministry of health and welfare administration to continuing for popularizing cancer screening and stress on early diagnosis and therapy.
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