良性前列腺肥大病患之藥物經濟學研究
A Study of Medicine Survey on Benign Prostatic Hyperplasia in
Taiwan
中文摘要
良性前列腺肥大(BPH)是全球老年男性最常見的慢性疾病，並且是老年男性下泌尿道症候群 (Lower Urinary Tract Symptoms, LUTS)的主要病因，嚴重影響患者本身的生活品質。因此 BPH 的臨床治療選擇被廣泛的討論，而各種治療模式之長期成本效益在歐美地區並已成為老人 醫學的研究重點。 本研究利用健保局全民健保資料庫承保抽樣歸人檔 1997~2004 年四組(R01、R02、R03、R04) 共 19,510 人(108,630 人次、114,953 筆處方)之就醫資料，以回溯性研究法(retrospective study)，分析 BPH 病患用藥與治療趨勢及直接醫療成本，並初步探討不同治療模式之治療成功 率以及成本效益，以提供醫療照護決策者與衛生主管機關參考選擇最符合效益的治療模式。 研究結果發現自 1997 年到 2004 年，台灣 50 歲以下男性罹患 BPH 之比率約為 1.4%，而 70 歲以上男性罹患 BPH 之比率則達 44.6%。病患有 AUR、UTI、尿失禁等併發症之比率平均為 14.6%，其中以 UTI 最多(10.3%)。BPH 病患的治療模式以單獨使用α1-adrenergic blocker 治療者居多(56%)，且有逐年上升的趨勢(R2=0.97, p<0.001)。 回溯比較 BPH 不同治療模式 1997~2004 年的直接醫療成本發現，以手術治療者第一年的直接 醫療成本新台幣 52,270 元最高，觀察治療者 10,173 元最低；然而之後每年的直接醫療成本 則以 5α-reductase inhibitor 單獨治療者 12,117 元最高，手術治療者 2,586 元最低。 分析各種治療模式之成本效益，與α1-adrenergic blocker 單獨治療模式相比，以手術治療較 具經濟效益，每增加 1%治療成功率只須多花費 9,744 元。與觀察治療模式相比，手術治療模 式每增加 1%治療成功率須多花費 518,413 元，而與 5α-reductase inhibitor 單獨治療者或 合併藥物治療者相較，手術治療之成本較低且成功率較高。 根據本研究結果，對於輕度 BPH 病患之治療，未來應朝向以早期給與α1-adrenergic blocker 治療，可以改善病患下泌尿道症候群現象；而對於中重度之 BPH 病患，則建議改以手術治療， 比α1-adrenergic blocker 單獨治療、5α-reductase inhibitor 單獨治療或合併藥物治療更 具成本效益。不過所謂最好的治療模式端視病人以及社會對醫療花費及治療結果的認同與期待， 因此，BPH 的治療成本效益未來仍需更多的分析資料佐證。
英文摘要
Benign prostate hyperplasia (BPH) is one of the most common chronic diseases in aging male around the globe, and the main cause of lower urinary tract symptoms (LUTS), which seriously compromising the patients’ quality of life. Thus the clinical treatment options of BPH have been discussed broadly, and the long-term
cost-effectiveness analysis of variable treatment models has become the main interest topics of geriatrics in North America and Europe.
This study accessed the National Health Insurance database, utilizing data from all 4 groups of Random-Sampled Individual Insure Files (R01, R02, R03 and R04) from year 1997 to 2004, a total of 19,510 men, 108,630 records, and 114,953 prescriptions. A retrospective study has been performed, the trend of therapy and direct medical costs of BPH medications was analyzed; also the success rate between different therapeutic models and their cost-effectiveness were discussed, to provide healthcare decision-maker and healthcare authority a reference for choosing the most
cost-effective therapeutic model.
The study reveals that, from 1997 to 2004, the prevalence of Taiwanese male less than 50 years old with BPH is about 1.4%, and increased to 44.6% for male over 70 years old. An average of 14.6% patients has comobidities like AUR, UTI or incontinence, and UTI is most commonly seen (10.3%). The most common therapy for BPH patient is single-agent α1-adrenergic blocker (56%), increasing yearly (R2=0.97, p<0.001).
Looking back at the average direct medical cost of different therapies from 1997 to 2004, we found out that the direct medical cost of surgery (NTD 52,270) was much higher in the first-year than others, the lowest cost is that of watchful waiting (NTD 10,173); however, single-agent 5α-reductase inhibitor treatment has the highest direct medical cost (NTD 12,117) in subsequent years, while surgery cost the least (NTD 2,586).
In the cost-effectiveness analysis of various therapies, surgery is more cost-effective compared with α1-adrenergic blocker single therapy, each 1 % incremental treatment success rate cost only an extra of NTD 9,744. Although 5α-reductase inhibitor single therapy and 5α-reductase inhibitor combined with α1-adrenergic blocker both have higher successful treatment rates than α1-adrenergic blocker alone or watchful waiting, but it’s less economic than surgery.
According to the results of this study, the future treatment of mild BPH patients should be early introduction of α1-adrenergic blocker, which would be helpful for control LUTS. The recommended treatment for moderate to severe BPH patients is surgery, which is more cost-effective than α1-adrenergic blocker single therapy, 5α-reductase inhibitor single therapy, or a combination of α1-adrenergic blocker and 5α-reductase inhibitor. However, the ‘best’ treatment depends on the value that an individual and society place on costs and consequences. Therefore, more information about patient preferences and risk evaluation is needed to inform treatment
