精神分裂症患者發生併發症及醫療耗用趨勢分析

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Title:	精神分裂症患者發生併發症及醫療耗用趨勢分析 Cohort study on Complication Hazard and Medical Cost in Patients with Schizophrenia in Taiwan
Authors:	魏婉菁;Wan-Ching Wei
Contributors:	公共衛生學院環境醫學研究所碩士班
Keywords:	精神分裂症;成本;併發症;醫療耗用;隨機參數模型;Schizophrenia;cost;complications;medical consumption;random parameter model
Date:	2010
Issue Date:	2010-09-29 12:03:31 (UTC+8)
Abstract:	背景：研究發現，精神分裂症患者因為藥品和其他機制，發生併發症的風險較高，但無論是併發症的發生或日漸增加的社會負擔和醫療費用，在台灣目前仍沒有加以研究的空間；健康保險資料可用於相關研究。目的：本研究的目的在於探討精神分裂症患者發展成為糖尿病、高血壓及高血脂的風險；同時也分析相關因子與醫療耗用變化的情形可供探討國內公共衛生對於精神醫療問題相關政策之用。方法：首先，估計精神分裂每年的盛行率與發病率，選取1997-2007年間ICD-9 為295，A211並大於15歲之精神分裂症患者。對照世代則選取健保資料庫中1997-2000年間沒有任何心理精神疾病之個案，兩組世代追蹤到2007年底，調查其併發症，以糖尿病，高血壓和高血脂為主的發生。接著，再進一步分析兩組世代發生合併症後的醫療耗用情形。結果：精神分裂症發生率從1997年的11.3每萬人，下降到2007年的4.59每萬人，盛行率從28.4每萬人增加到 45.3每萬人。精神分裂症病患（N=3289)比起對照世代（N= 13156）年齡較大，收入較少，生活在城市化程度較低的地區或東部地區。精神分裂症患者有較高的糖尿病發生率（15.3 對 7.52每千人年），高血壓發生率（28.5對17.7每千人年）和高脂血症（17.0對10.9每千人年）。多變量 Cox比例風險回歸分析顯示，精神分裂症患者發生糖尿病的危害比為 5.68（95％CI：4.96-6.52），高血壓為4.86（95％CI：4.42-5.53），高脂血症為2.55（95％CI：2.27-2.87）。隨機參數模型估計顯示，精神分裂症患者在罹患併發症後之耗費，僅較一般族群多了0.013個健保點。結論：精神分裂症患者有較高的風險發生併發症，以糖尿病最高，其次為高血壓和高脂血症，同時在年輕的精神分裂症患者尤其明顯；而這些併發症並不如預期對總體健保醫療耗用造成大幅影響。 Background: Studies have found that patients with schizophrenia are at an increased risk of complications because of medication and other mechanisms. It has not been well studied in Taiwan whether the complications increase social burden and medication cost . Schizophrenia is considered one of catastrophic diseases in the National Health Insurance system with the data available for research and public use. Objective: This thesis study investigated whether patients with schizophre -nia were at an increased risk to develop diabetes mellitus, hypertension and hyperlipidemia. We also investigated factors associated with the cost variations for caring these patients. Methods: We first estimated the annual incidence and prevalence of schizo- phrenia (ICD-9 295, A211) in 1997-2007 for population >15 years of age. A cohort of patients with schizophrenia and a comparison cohort without the disease identified from the National Health Insurance claims data of 1997-2000 were established. Both cohorts were followed up until the end of 2007 to investigate the complications,including diabetes, hypertension and hyperlipide- mia.The pattern of costs for caring these schizophrenia cases with complication was assessed. Results: The incidence of schizophrenia estimated from the claims data decreased annually from 11.3 per 10,000 in 1997 to 4.59 per 10,000 in 2007 and the prevalence increased from 28.4 per 10,000 in 1997 to 45.3 per 10,000 in 2007. The schizophrenia cohort (N =3289) were older, had less income, and were more likely living in less urbanized areas or the east part of Taiwan or off islands, compared with the comparison cohort (N=13,156). The schizophrenia patients had higher incidence rates of diabetes mellitus (15.3 vs. 7.52 per 1,000 person-years), hypertension (28.5 vs. 17.7 per 1,000 person-years) and hyperlipi- demia (17.0 vs. 10.9 per 1,000 person-years). The multivariate Cox proportional hazards regression analysis showed that the hazard ratios of complications were 5.68 (95% confidence interval (CI): 4.96-6.52) for diabetes, 4.86 (95% CI: 4.42 -5.53) for hypertension, and 2.55 (95% CI: 2.27-2.87) for hyperlipidemia. The random parameter model for the cost estimates showed that the care for the complications caused additional cost of only 0.013 NHI points. Conclusion: Patients with schizophrenia are at an elevated risk of developing complications, the highest for diabetes, and followed by for hypertension and hyperlipidemia. These complications do not involve much additional cost for the patient care.
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