| 摘要: | 【研究目的】 本研究的目的在於評估健保門診患者的高血壓盛行率與描述高血壓自知率、治療率及控制率的改變趨勢，並推估利用健保門診篩檢高血壓的成本效果，以及比較"病例發現"方式與"大眾篩檢"方式，何者有較低的邊際成本。 【研究方法】 本研究以中部某醫學中心的門診20歲以上病患為對象，進行個別訪談與血壓測量，共有1,068位男性與705位女性病患接受檢查。以使用決策樹的決策分析法，來推估利用健保門診篩檢高血壓的成本效果，並以一次敏感性分析評估引用數據對成本效果的影響。 【研究結果】 以≧160/95 mm Hg為標準，高血壓的盛行率為38%，男性為43.1%，女性為30.2%。與過去的研究比較，高血壓的自知率與治療率明顯增加至84.2%與68.5% (p<0.001)。卻只有17.6%的高血壓患者，其血壓控制在140/90 mm Hg以下，此與過去的研究並無顯著改變(p>0.05)。利用健保門診篩檢高血壓，其品質調整生命年的成本，在男性為100,302元，女性為119,325元。在敏感性分析方面，高血壓治療對腦中風發生率的影響與高血壓治療的年度成本對成本效果有高度敏感性。 【結論】 高血壓的低控制率亟需進一步改善，而利用健保門診篩檢高血壓是具有良好成本效果的。此外，也比一般大眾篩檢有較低的成本。我們建議門診患者於每次就醫時，應常規測量其血壓，並且儘可能選擇低成本的抗高血壓藥物。; Purpose: The purpose of this study was to assess the prevalence of hypertension in outpatient services and to describe the trend in changes of awareness, treatment, and control of hypertension. In addition, it was to estimate the cost-effectiveness of hypertension screening in outpatient services, and to compare which is less expensive between case-finding and mass screening. Methods: The study was conducted in the outpatient department of a medical center in Central Taiwan, and included an in-person interview and blood pressure measurement. There were 1,068 men and 705 women, aged 20 or older, examined. Decision analysis using decision tree was adopted for estimating the cost-effectiveness of hypertension screening in outpatient service, and one-way sensitivity analysis was used. Results: The prevalence of hypertension at≧160/95 mm Hg was 38%, which was 43.1% in men and 30.2% in women. Compared with the findings of the previous studies, hypertension awareness and treatment increased significantly to as high as 84.2% and 68.5% respectively (p<0.001), but only 17.6% were controlled below 140/90 mm Hg, which did not changed significantly (p>0.05). The cost per quality-adjusted life years was estimated as NT$ 100,302 for men and NT$ 119,325 for women. Cost-effectiveness was highly sensitive to the effect of hypertension treatment on the stroke rate and the annual cost of hypertension therapy. Conclusion: Low rate of hypertension control calls for further improvement. Hypertension screening in outpatient services was cost-effective, and the cost of screening was less expensive than that of mass screening. We recommend screening routinely for all adults in outpatient services and using low-cost antihypertensives as possible. |
