癌症與急性冠心症之三年內直接與間接成本

第 4 章研究結果

第四節癌症與急性冠心症之三年內直接與間接成本

4-4-1. 癌症與急性冠心症之直接與間接成本

Table 4-4 呈現各個癌症和急性冠心症在診斷後三年內之直接醫療成本

(direct medical cost)，以及罹病(morbidity)與死亡(mortality)相關之間接成本 (indirect cost)。直接與間接成本總和最高者為食道癌(2,453,246 元)，其次為白血病(1,745,292 元)及口腔癌(1,695,017 元)，最低者則為前列腺癌(431,489)、女性乳癌(589,511 元)及大腸直腸癌(708,107)。急性冠心症之直接與間接成本總和僅 435,609 元，較多數癌症的花費更低。

直接醫療成本之中位數最高者為食道癌(534,457 元)、口腔癌(525,738 元)及非何杰金氏淋巴瘤(420,084 元)，最低者則為肝癌(213,447)、前列腺癌(251,901) 及大腸直腸癌(292,404 元)。與罹病相關間接成本之中位數最高者為食道癌 (27,971 元)及乳癌(16,179 元)，最低者則為前列腺癌(2,271 元)及白血病(2,812 元)。與死亡相關間接成本之中位數最高者為食道癌(761,363 元)，最低者則為女性乳癌、大腸直腸癌、口腔癌、前列腺癌及非何杰金氏淋巴瘤，由於此五者在診斷後三年內的死亡率不及50%，故中位數值皆為 0。而在急性冠心症，各項直接醫療成本與罹病相關間接成本之中位數皆明顯比所有癌症低，死亡相關間接成本除略高於前列腺癌，相比於其他癌症也較低。Figure 4-3 將 Table 4-4 各項花費之平均值以圖示呈現百分比分布，其中以食道癌及肝癌之間接成本占比最高，占七成以上，而女性乳癌及前列腺癌則有七成以上為直接醫療成本。

Table 4-5 呈現診斷後三年內之直接醫療成本中所有藥品、抗癌藥品的花費

及其占比。三年內直接醫療成本與藥品花費的趨勢大致與章節

4-3-1 及 4-3-2 所

述之趨勢接近。

Figure 4-4 將 Table 4-4 及 Table 4-5 各項花費之平均值，繪製成長條圖所 示。直接與間接成本總和及間接成本最高者為食道癌，直接醫療成本、所有藥品花費及抗癌藥品花費最高者則為白血病。

doi:10.6342/NTU201901297

Table 4-5. Direct and indirect costs of first three years after diagnosis of cancers or ACS, per patient (in TWD)

Cancers Direct medical costs Indirect costs: Morbidity Indirect costs: Mortality Mean of total cost Mean (SD) Median (Q1-Q3) Mean (SD) Median (Q1-Q3) Mean (SD) Median (Q1-Q3)

Lung cancer 552,287

(550,240) Female breast cancer 418,379

(467,657) Colorectal cancer 359,933

(394,202)

Liver cancer 322,779

(429,972)

Oral cancer 589,332

(459,155)

Leukemia 853,920

(1,259,013) Prostate cancer 335,095

(288,343) Gastric cancer 356,505

(395,095) Esophageal cancer 594,493

(440,412) NHL, Non-Hodgkin lymphoma; ACS, acute coronary syndrome; SD, standard deviation

doi:10.6342/NTU201901297

Table 4-6. Direct medical costs with specified drug costs of first three years after diagnosis of cancers or ACS, per patient (in TWD)

Cancers Direct medical cost (A) Sum of all medication costs (B) Ratio of

mean (B/A)

Sum of anti-cancer drug cost (C) Ratio of mean (C/A) Mean (SD) Median (Q1-Q3) Mean (SD) Median (Q1-Q3) Mean (SD) Median (Q1-Q3)

Lung cancer 552,287

(550,240)

Female breast cancer 418,379 (467,657) Colorectal cancer 359,933

(394,202)

Liver cancer 322,779 (429,972)

Oral cancer 589,332

(459,155)

Leukemia 853,920

(1,259,013)

Prostate cancer 335,095 (288,343)

Gastric cancer 356,505 (395,095)

Esophageal cancer 594,493 (440,412)

NHL, Non-Hodgkin lymphoma; ACS, acute coronary syndrome

doi:10.6342/NTU201901297

Figure 4-3. Percentage distribution of direct and indirect mean costs

Figure 4-4. Bar chart of direct and indirect mean costs (in TWD)

NHL, Non-Hodgkin lymphoma; ACS, acute coronary syndrome 43%

71%

51%

26%

35%

49%

78%

51%

35%

24%

42%

57%

29%

49%

74%

65%

51%

22%

49%

65%

76%

58%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% Direct medical cost Indirect cost

0 500 1000 1500 2000

千 2500 Indirect: Mortality cost Indirect: Morbidity cost

Direct: Non-medication medical cost Direct: Non-anticancer drug medication cost Direct: Anticancer drug cost

doi:10.6342/NTU201901297

4-4-2. 依診斷年分進行次群組分析之結果

Table 4-6 及 Table 4-7 呈現次群組分析(subgroup analysis)分析之結果，依初 診斷的年份分為前期(2007 年至 2010 年)新發個案與後期(2011 年至 2014 年)新發個案兩組。對大部分的癌症和急性冠心症，不論是直接醫療成本或是單就藥品花費，在後期新發個案皆較前期者為高，尤其以前列腺癌及非何杰金氏淋巴瘤之抗癌藥品費用增加最多，中位數分別由7,993 元增加為 28,788 元、由 18,372 元增加為 49,533 元。

與罹病相關之間接成本在兩次群組的變化則不一致，在女性乳癌、大腸直腸癌、肝癌、口腔癌、白血病、食道癌及急性冠心症，後期的間接成本較前期低，其餘癌症包括肺癌、前列腺癌、非何杰金氏淋巴瘤及胃癌則相反，然而不論增加或減少，兩次群組之絕對值差異皆在1,000 元以內。

與死亡相關之間接成本在所有癌症及急性冠心症，後期新發個案皆較前期者為低。除了乳癌及前列腺癌，大部分癌症之直接與間接成本的總和，後期新發個案的成本皆較前期者更低。

依據 Table 4-6 及 Table 4-7 之各項成本平均值以長條圖所示為 Figure 4-5，

同時呈現平均死亡年齡，在前列腺癌及急性冠心症，因其死亡年齡較高，與死亡相關的間接成本則明顯較其他癌症低。

doi:10.6342/NTU201901297

Table 4-7. Direct and indirect costs in different year of diagnosis, grouped by 4-year intervals (in TWD)

Cancers Year of

diagnosis N Direct medical cost Indirect cost: Morbidity Indirect cost: Mortality Mean of total cost Mean (SD) Median (Q1-Q3) Mean (SD) Median (Q1-Q3) Mean (SD) Median (Q1-Q3)

Lung cancer 2007~2010 40,533 536,377 (553,902) 2011~2014 47,035 565,997

(546,699)

2007~2010 38,691 393,334 (431,657) 2011~2014 49,725 437,867

(492,982)

2007~2010 48,551 375,015 (367,587) 2011~2014 64,435 348,570

(412,763)

2007~2010 44,965 284,288 (354,281) 2011~2014 46,022 360,387

(489,914) Oral cancer 2007~2010 23,981 591,724

(460,749) 2011~2014 26,803 587,192

(457,721) Leukemia 2007~2010 6,597 837,849

(1,279,087) 2011~2014 7,679 867,727

(1,241,425)

doi:10.6342/NTU201901297

Table 4-7. Direct and indirect costs in different year of diagnosis, grouped by 4-year intervals (in TWD) (cont.)

Cancers Year of

Prostate cancer

2007~2010 15,757 328,153 (274,119) 2011~2014 19,329 340,755

(299,328) 2011~2014 8,815 547,749

(541,471)

(1,217,983) 0(0-277,792)

1,025,884 Gastric

cancer

2007~2010 15,260 345,121 (366,594) 2011~2014 15,399 367,786

(421,150)

2007~2010 8,308 584,362 (431,196) 2011~2014 9,883 603,009

(447,858) 2011~2014 84,714 186,088

(216,760) NHL, Non-Hodgkin lymphoma; ACS, acute coronary syndrome; SD, standard deviation

doi:10.6342/NTU201901297

Table 4-8. Direct medical costs with specified drug costs in different year of diagnosis, grouped by 4-year intervals (in TWD)

Cancers Year of

diagnosis N Direct medical cost Sum of all medication costs Sum of anti-cancer drug cost Mean (SD) Median (IQR) Mean (SD) Median (IQR) Mean (SD) Median (IQR) Lung cancer 2007~2010 40,533 536,377

(553,902) 2011~2014 47,035 565,997

(546,699) Female breast

cancer

2007~2010 38,691 393,334 (431,657) 2011~2014 49,725 437,867

(492,982)

2007~2010 48,551 375,015 (367,587) 2011~2014 64,435 348,570

(412,763) Liver cancer 2007~2010 44,965 284,288

(354,281) 2011~2014 46,022 360,387

(489,914) Oral cancer 2007~2010 23,981 591,724

(460,749) 2011~2014 26,803 587,192

(457,721) Leukemia 2007~2010 6,597 837,849

(1,279,087) 2011~2014 7,679 867,727

(1,241,425)

doi:10.6342/NTU201901297

Table 4-8. Direct medical costs with specified drug costs in different year of diagnosis, grouped by 4-year intervals (in TWD) (cont.)

Cancers Year of

(274,119) 2011~2014 19,329 340,755

(299,328) 2011~2014 8,999 547,749

(541,471) Gastric cancer 2007~2010 15,260 345,121

(366,594) 2011~2014 15,399 367,786

(421,150)

2007~2010 8,308 584,362 (431,196) 2011~2014 9,883 603,009

(447,858)

2011~2014 84,714 186,088 (216,760)

NHL, Non-Hodgkin lymphoma; ACS, acute coronary syndrome; SD, standard deviation

doi:10.6342/NTU201901297

Figure 4-5. Bar chart of direct and indirect mean costs in different year of diagnosis, grouped by 4-year intervals (in TWD)

NHL, Non-Hodgkin lymphoma; ACS, acute coronary syndrome

45 50 55 60 65 70 75 80 85

0 500 1000 1500 2000 2500 3000

2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014 2007~2010 2011~2014

Lung cancer Female breast cancer

Colorectal cancer

Liver cancer Oral cancer Leukemia Prostate cancer

Non-Hodgkin lymphoma

Gastric cancer

Esophageal cancer

Acute cornonary syndrome Direct: Anticancer drug cost

Direct: Non-anticancer drug medication cost Direct: Non-medication medical cost Indirect: Morbidity cost

Indirect: Mortality cost Age at death

thousands years old

doi:10.6342/NTU201901297

在文檔中臺灣癌症經濟負擔探討：2007至2017年之直接與間接成本分析 (頁 66-76)

第 4 章 研究結果

第四節 癌症與急性冠心症之三年內直接與間接成本

4-4-1. 癌症與急性冠心症之直接與間接成本

Table 4-4 呈現各個癌症和急性冠心症在診斷後三年內之直接醫療成本

Table 4-5 呈現診斷後三年內之直接醫療成本中所有藥品、抗癌藥品的花費

4-3-1 及 4-3-2 所

doi:10.6342/NTU201901297

Table 4-5. Direct and indirect costs of first three years after diagnosis of cancers or ACS, per patient (in TWD)

doi:10.6342/NTU201901297

Table 4-6. Direct medical costs with specified drug costs of first three years after diagnosis of cancers or ACS, per patient (in TWD)

doi:10.6342/NTU201901297

Figure 4-3. Percentage distribution of direct and indirect mean costs

Figure 4-4. Bar chart of direct and indirect mean costs (in TWD)

doi:10.6342/NTU201901297

4-4-2. 依診斷年分進行次群組分析之結果

doi:10.6342/NTU201901297

Table 4-7. Direct and indirect costs in different year of diagnosis, grouped by 4-year intervals (in TWD)

doi:10.6342/NTU201901297

Table 4-7. Direct and indirect costs in different year of diagnosis, grouped by 4-year intervals (in TWD) (cont.)

doi:10.6342/NTU201901297

Table 4-8. Direct medical costs with specified drug costs in different year of diagnosis, grouped by 4-year intervals (in TWD)

doi:10.6342/NTU201901297

Table 4-8. Direct medical costs with specified drug costs in different year of diagnosis, grouped by 4-year intervals (in TWD) (cont.)

doi:10.6342/NTU201901297

Figure 4-5. Bar chart of direct and indirect mean costs in different year of diagnosis, grouped by 4-year intervals (in TWD)

doi:10.6342/NTU201901297

第 4 章研究結果

第四節癌症與急性冠心症之三年內直接與間接成本