「外科手術」與「電腦刀處置」治療聽神經瘤之成本效益比
較 - 以某醫學中心為例
研究目的：此研究目的在於評估外科手術與電腦刀處置在治療聽神經瘤之醫療總收入、
治療成本、治療效果、治療損益及醫院整體獲利率。
研究材料及方法：本研究採兩組回溯性個案研究，在研究之個案醫院申請人體試驗委員
會審查通過，進行資料回顧。資料期間：日期自 2000 年 -2008 年，八年資料。條件以門
、住診自費及健保病患且罹患聽神經瘤。依治療方式區分病人以「外科手術」與「電腦
刀處置」切除聽神經瘤。分析兩組醫療總收入、治療效果 ( 包含：住院天數、手術時間、
麻醉時間等 ) 、治療成本 ( 包含：人力成本、藥品成本、衛材成本、檢驗成本、檢查成本
、病房成本、設備費用、作業費用和行政管理費用 ) 、治療損益及醫院獲利率。利用卡方
、 t 檢定、變異數分析、複迴歸等方式來做統計學上分析。
結果：外科手術之平均住院天數為 44.15±48.04 天。而電腦刀處置之平均住院天數為 0.73
±1.5 天 ( 外科手術對電腦刀 P<0.01) ，平均手術時間於外科手術為 436.85±190.16 分鐘。
平均麻醉時間於外科手術為 463.15±194.58 分鐘。而電腦刀處置為 210±0 分鐘，且不需麻
醉 ( 外科手術對電腦刀 P<0.01) 。
外科手術平均醫療總收入 ( 病患醫療費用 ) 為 511,727±565,714 元，遠高於電腦刀處置 189
,377±86,621 元， P<0.01 。外科手術平均治療損益 138,892±198,828 元，電腦刀處置 59,90
8±73,561 元， P=0.057 未達統計上顯著意義。最後，醫院整體獲利率，外科手術 23.02±6.
65 低於電腦刀處置 28.24±8.32 ， P<0.01 。
結論：由以上結果引導我們結論，對病患而言，電腦刀處置治療聽神經瘤患者相較於外
科手術，無論腫瘤大小，年齡或性別，在病人需花費之醫療費用 ( 即醫療總收入 ) 較少
，住院天數較少，手術 ( 處置 ) 時間較短且不需麻醉。對醫院而言，雖然醫療總收入及治
療損益電腦刀處置相較於外科手術較少，但因為治療成本相對亦較少，故整體而言，對
醫院之獲利率是較高的。
Cost Benefit Comparison between Open surgery and
Cyberknife Radiosurgery For Acoustic Neuroma —Example
of a Medical Center
Purpose: This research aims at comparing the total revenues, the costs, the results, the profit profiles of treati ng acoustic neuroma with open surgery and cyberknife radiosurgery.
Material and method: This is a retrospective case control study and has been approved by the Institutional Re view Board. The study includes eight years’ data from 2000 to 2008. The study population consists of acoust ic neuroma patients regardless of their sources of payment. They were classified into two categories accordin g to the treatment methods: open surgery and cyberknife radiosurgery. We compared the two groups’ total re venues, treatment results (includeing length of stay, operation time and anaesthesia time), treatment costs (in cluding labor cost, drug cost, material cost, examination cost, lab cost, hospital ward cost, equipment expens es, operation cost and administration expenses), balances and hospital profit rates. Chi-Square, t-test, analysis of variance amd multiple regression analysis was applied to generate statistic results.
Result: Average length of stay is 44.15±48.04 days for open surgery, whereas cyberknife radiosurgery only a verages 0.73±1.5 days. The average operation time of open surgery is 436.85±190.16 minutes. And the avera ge anaesthesia time of open surgery is 463.15±194.58 minutes. But cyberknife radiosurgery doesn’t need ana esthesia and only takes 210±0 minutes.
The average total revenue of open suegery is 511,727±565,714 NT dollars. It is significantly higher than cyb erknife radiosurgery 189,377±86,621 NT dollars (p<0.01).
The average balance for open suegery is 138,892 ±198,828 NT dollars and for cyberknife radiosurgery 59,90 8±73,561 NT dollars. However, the difference is not statistically significant. Finally, the profit rate of open s urgery at 23.02% is lower than the 28.24% of cyberknife radiosurgery (p<0.01).
Conclusion: The study results indicated the following conclusions. For patients, cyberknife radiosurgery has
lower cost, shorter length of stay, shorter operation time with no anaesthesia compared with open surgery irre
spective of tumor size, age, or gender. Although the total revenue and the balance compared with open surger
y are less, and yet due to the low treatment cost, the profit rate is higher for hospital when treated with cyberk
nife.
