視訊輔助胸腔鏡手術(VATS)應用於第一次原發性自發性氣胸之成本效果分析; The Cost-effectiveness Analysis of Video-assisted Thoracoscopic Surgery (VATS) on First Primary Spontaneous Pneumothorax

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Title:	視訊輔助胸腔鏡手術(VATS)應用於第一次原發性自發性氣胸之成本效果分析;The Cost-effectiveness Analysis of Video-assisted Thoracoscopic Surgery (VATS) on First Primary Spontaneous Pneumothorax
Authors:	周文鈺
Contributors:	中國醫藥學院醫務管理研究所
Keywords:	原發性自發性氣胸;視訊輔助胸腔鏡手術;胸管引流;醫療經濟評估;成本效果分析;敏感度分析;primary spontaneous pneumothorax;video-assisted thoracoscopic surgery;VATS;chest tube placement;chest intubation;cost-effectiveness analysis;sensitivity analysis
Date:	1992
Issue Date:	2009-12-23
Abstract:	「原發性自發性氣胸」，乃在無任何意外性或醫源性外傷，且無明顯病理原因下，空氣進入肋膜腔中，導致肺受到壓迫所產生之結果。常發生於健康人身上，尤其常見於年輕瘦高之男性。其導致之最主要問題，在於復發率不低，且會隨復發次數增加而提昇。目前氣胸之治療方式甚多，並無一定的治療準則。其中胸管引流為最普遍且行之有年的治療方式；而視訊輔助胸腔鏡手術，乃近年來逐漸被應用之新技術，且已被證實為有效的治療方式，然因其施行成本甚高，故介入時間應於第一次或復發時，臨床上引起了各種不同的看法。本研究將比較首次發病之原發性自發性氣胸患者，合併施行胸管引流及視訊輔助胸腔鏡手術，相較於僅單純施行胸管引流之成本差異及效果差異。並進一步評估患者日後復發，以胸管引流治療，所需再花費之成本，與患者於首次發病時，即以合併視訊輔助胸腔鏡手術治療，所需多花費之成本比較，做為判定視訊輔助胸腔鏡手術應用於首次發病之原發性自發性氣胸患者，是否具成本效果之依據。最後，由於某些成本項目之取得，存在不確定性，故將再對不確定之成本項目，進行敏感度分析。本研究之主要結果發現，合併施行胸管引流及視訊輔助胸腔鏡手術，相較於僅施行胸管引流者，於手術過程中，需多耗費約12,188.03元，扣除2.24天術後胸管引流天數，及2.83天術後住院日數之縮減，可節省約3,899.08元後，最終增加之總成本為約8,288.95元。而在效果部份，合併施行視訊輔助胸腔鏡手術，可減少日後1.39%之復發率。故每減少1%之復發率，約需多花費5,954.96元。此外，患者日後復發時，假設僅以胸管引流治療，所需再花費之成本，轉換現值為139.37元，低於合併施行胸管引流及視訊輔助胸腔鏡手術治療，需增加之總成本(8,288.95元)。故首次發病之原發性自發性氣胸患者，以合併視訊輔助胸腔鏡手術治療，相較於僅以胸管引流方式治療，就本研究之評估結果，較不具成本效果。最後，於敏感度分析之結果，大致而言，即使將不確定之成本降至最低，合併施行胸管引流及視訊輔助胸腔鏡手術，所需多增加耗費之成本，仍比日後氣胸復發，僅以胸管引流治療之成本，高出許多。唯每日生產力損失之成本，若由528元提高至3,319元時，則於首次發病時，選擇合併施行視訊輔助胸腔鏡手術，將較具成本效果。; Primary spontaneous pneumothorax is the due to lung compression in the result of air into the pleural space without any accidental or iatrogenic trauma and overt underlying lung disease. It often occurs in healthy persons, especially on young, thin and tall men. The major problem of treatment is high recurrent rate. Without universal guideline, several treatment modalities are currently available for patients with pneumothorax. During past two decades, chest tube placement is the most accepted approach in curing pneumothorax. Recently, video-assisted thoracoscopic surgery (VATS) has become a new technique for treating patients with pneumothorax. Previous studies have provided that VATS is an effective treated approach. However, there are no data on the cost-effectiveness of using VATS to treat patients with pneumothorax. An economic study was conducted alongside a retrospective design at two sites in Taiwan to establish the costs and effectiveness of two different modalities for treating patients with first primary spontaneous pneumothorax. Cost-effectiveness was estimated as the cost per recurrent rate saved. The main results of this study are that total incremental costs of combine chest tube placement with video-assisted thoracoscopic surgery over chest tube placement alone are about 8,288.95 NT dollars. On the other hand, our results found that there is no statistically significant difference in recurrent rate for the different modalities. The estimated effectiveness is 5,954.96 NT dollars per 1% recurrent rate saved. Comparing to the costs of treatment by chest intubation alone, combining chest tube placement with VATS is not cost-effective without taking mortality and the quality of life into account.
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