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預防保健的成本效益評估:以乳癌篩檢為例

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Academic year: 2021

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預防保健的成本效益評估:以乳癌篩檢為例

文羽苹;許玫玲

Abstract

目標:以乳房X光攝影為例,討論成本效益分析在全民健保預防保健政策評估的應用及限制。方 法:採用衛生署癌症資料,藍忠孚與梁玲郁的「失能調整人年」DALY數據與健保支付標準,利 用Maciosek等作者提出篩檢預期效益的計算方式,估計不同假設下乳房X光攝影篩檢乳癌的成 本與效益。結果:成本效益分析顯示,二階段策略能降低篩檢成本,使篩檢符合成本效益的要求, 高單價、低篩檢敏感度、偽陽性等因素可能使全面性乳房X光攝影乳癌篩檢有效益不敷成本之 虞。結論:成本效益的分析可作為預防保健決策的一環,其重點在利用明確的方法與資訊,使各 種意見可以得到充分討論。雖然在目前假設下全面篩檢不符成本效益,分析顯示,若能提高篩檢 敏感度或降低篩檢單價,預防篩檢之預期效益將可以提高。我們建議健保相關政策亦可以利用成 本效益分析,作為決策的重要工具。

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