頁籤選單縮合
題名 | H1N1 2009流感大流行期間使用快速篩檢與否之成本分析=Cost Analysis of the Use of Rapid Influenza Diagnostic Test during H1N1 2009 Influenza Pandemic |
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作 者 | 郭宗文; 莊人祥; | 書刊名 | 疫情報導 |
卷期 | 25:11 2009.11[民98.11] |
頁次 | 頁705-714+左762-772 |
分類號 | 415.239 |
關鍵詞 | H1N1 2009流感; 流感快速篩檢; 克流感; 成本分析; H1N1 2009 influenza; Rapid influenza diagnostic test; Tamiflu; Cost analysis; |
語文 | 中文(Chinese);英文(English) |
中文摘要 | 本文目的為分析H1N1 2009流感陽性率變化對是否使用流感快速篩檢作為給予克流感依據所產生之影響。我們使用決策樹電腦模擬模型比較兩種克流感使用策略在醫療成本上之差異。模擬中使用之數據來自國內外研究文獻及疾病管制局和署立醫院之統計資料。我們並執行一維及二維敏感性分析評估各項變數在可信範圍內變動對模擬結果所產生之影響。 依臺灣地區H1N1 2009流感佔所有類流感病患之35%計算,根據快篩結果給予克流感之成本,將較不經快篩直接給予類流感病人克流感為低。一維敏感性分析結果顯示,當H1N1 2009流感陽性率高於54%,或當流感併發重症病患住院之平均醫療費用超過218,000元時,直接給予克流感在醫療成本上較為有利。二維敏感性分析顯示,當併發重症病患平均住院費用高於120,000元,或併發重症住院之機率高於1.3%時,不經快篩直接給予類流感病人克流感之策略較為經濟所需達到之H1N1 2009流感之陽性率將低於54%。 本分析結果建議,抗病毒藥物使用規定應隨疫情變化而調整。當H1N1 2009流感陽性率持續上升,應適時將抗病毒藥物使用規定改為直接投藥予臨床上有類流感症狀病人。此外,對併發重症住院機率較高之高危險群病患,若有類流感症狀,亦可考慮直接給予克流感,以增進醫療資源之有效運用,及降低併發重症之機會。 |
英文摘要 | In order to evaluate the effect of changes in the proportion of H1N1 2009 influenza among influenza-like illness (ILI) to the direct medical cost associated with different strategies of administering Tamiflu to patients with ILI, a decision tree was constructed to compare the direct cost of two strategies of administering Tamiflu. Baseline parameter values used in the analysis were obtained from literature review and data from Centers for Disease Control and Department of Health, Taiwan. One- and two-way sensitivity analyses were performed to test the effect of changes in parameter values on the outcome of the two strategies. Administering Tamiflu to patients with ILI according to results of rapid influenza diagnostic test is more economical than to all patients with ILI without performing rapid test based on the current proportion of H1N1 2009 influenza among ILI of 35% in Taiwan. Administering Tamiflu to all patients with ILI is more cost-effective when the fraction of H1N1 2009 influenza among ILI exceeds 54%, or when the average cost of hospitalization due to complications from H1N1 2009 influenza exceeds $218,000. The benefit of administering Tamiflu to all patients with ILI is more evident when the average cost of hospitalization or the probability of hospitalization due to complications is high. Guidelines for Tamiflu administration should be modified based on the course of H1N1 2009 influenza pandemic. As the proportion of H1N1 2009 influenza among ILI continues to rise, it may be more appropriate to administer Tamiflu to patients with ILI regardless of rapid test results when necessary. To patients with suspected influenza illness who are at increased risk for complications, empirical Tamiflu treatment should be given as early as possible to reduce the risk of developing severe disease. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。