2004年至2010年台湾慢性阻塞性肺疾病的医疗资源利用趋势及药物治疗管理
Trends in health care resource utilization and pharmacological management of COPD in Taiwan from 2004 to 2010.
作者信息
Tsai Ying-Huang, Yang Tsung-Ming, Lin Chieh-Mo, Huang Shu-Yi, Wen Yu-Wen
机构信息
Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi.
Graduate Institute of Clinical Medical Sciences, College of Medicine.
出版信息
Int J Chron Obstruct Pulmon Dis. 2017 Sep 28;12:2787-2793. doi: 10.2147/COPD.S147968. eCollection 2017.
RATIONALE
COPD has attracted widespread attention worldwide. The prevalence of COPD in Taiwan has been reported, but little is known about trends in health care resource utilization and pharmacologic management in COPD treatment.
OBJECTIVE
The objective of this article was to study trends in health care resource utilization, pharmacologic management, and medical costs of COPD treatment in Taiwan.
MATERIALS AND METHODS
Reimbursement claims in the Taiwan National Health Insurance System from 2004 to 2010 were collected. The disease burden of COPD, including health care resource utilization and medical costs, was evaluated.
RESULTS
The pharmacy cost of COPD increased from 2004 to 2010 due to the increased utilization of long-acting muscarinic antagonist (LAMA) and fixed-dose combination of long-acting β2-agonist and inhaled corticosteroid (LABA/ICS), whereas the cost of all other COPD-related medications decreased. The average outpatient department (OPD) cost per patient increased 29.3% from 1,070 USD in 2004 to 1,383 USD in 2010. The highest average total medical cost per patient was 3,434 USD in 2005, and it decreased 12.4% to 3,008 USD in 2010. There was no significant difference in the average number of OPD visits and emergency department visits per patient. The highest average number of hospital admissions was 0.81 in 2005, and it decreased to 0.65 in 2010. The average number of intensive care unit (ICU) admissions decreased from 0.52 in 2005 to 0.31 in 2010.
CONCLUSION
From 2004 to 2010, the average total medical cost per patient of COPD was slightly decreased because of the decreased average number of hospital admissions and ICU admissions. The costs of both LAMA and LABA/ICS increased, while the cost for all other COPD-related medications decreased. These findings suggest that the increased utilization of LAMA and LABA/ICS may have contributed to the decreased average number of hospital admissions and ICU admissions in COPD patients from 2004 to 2010.
原理
慢性阻塞性肺疾病（COPD）已在全球引起广泛关注。台湾地区COPD的患病率已有报道，但对于COPD治疗中医疗资源利用趋势和药物治疗情况知之甚少。
目的
本文旨在研究台湾地区COPD治疗的医疗资源利用趋势、药物治疗情况及医疗费用。
材料与方法
收集了2004年至2010年台湾全民健康保险系统的报销申请。评估了COPD的疾病负担，包括医疗资源利用和医疗费用。
结果
2004年至2010年，由于长效毒蕈碱拮抗剂（LAMA）和长效β2受体激动剂与吸入性糖皮质激素固定剂量组合（LABA/ICS）的使用增加，COPD的药房费用有所增加，而所有其他与COPD相关药物的费用则下降。每位患者的平均门诊费用从2004年的1070美元增加到2010年的1383美元，增长了29.3%。每位患者的最高平均总医疗费用在2005年为3434美元，到2010年下降了12.4%，降至3008美元。每位患者的平均门诊就诊次数和急诊就诊次数无显著差异。最高平均住院次数在2005年为0.81次，到2010年降至0.65次。重症监护病房（ICU）的平均住院次数从2005年的0.52次降至2010年的0.31次。
结论
2004年至2010年，由于平均住院次数和ICU住院次数减少，每位COPD患者的平均总医疗费用略有下降。LAMA和LABA/ICS的费用均有所增加，而所有其他与COPD相关药物的费用则下降。这些发现表明，2004年至2010年LAMA和LABA/ICS使用的增加可能导致了COPD患者平均住院次数和ICU住院次数的减少。
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