國家衛生研究院 NHRI:Item 3990099045/6538
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    題名: Cost-effectiveness of applying prolonged mechanical ventilation in Taiwan
    其他題名: PMD58 Cost-effectiveness of applying prolonged mechanical ventilation in Taiwan
    作者: Hung, MC;Lu, HM;Chen, L;Lin, MS;Chen, CR;Yu, CJ;Wang, JD
    貢獻者: Division of Health Services and Preventive Medicine
    摘要: Objectives: The conventional incremental cost-effectiveness ratio (ICER) and cost-per-expected life in patients undergoing prolongedmechanicalventilation (PMV), stratified by different underlying diseases, were determined. Methods: A nationwide sample of 50,481 patients who had received continual mechanicalventilation for more than 21 days was collected during 1997-2007. After stratifying the patients according to specific diagnoses, a latent class analysis (LCA) was performed to categorize PMV patients with multiple co-morbidities into several homogeneous groups. The survival functions were estimated for individual groups using the Kaplan-Meier method and extrapolated to 300 months through a semi-parametric method. The survival functions were adjusted with a utility value measured by EQ-5D from a convenient sample of 142 PMV patients to estimate the quality-adjusted life expectancies (QALE). The lifetime expenditures paid by National Health Insurance (NHI) were estimated by multiplying the average spending with the survival probability for different duration-to-dates and summed up for different groups. Results: The results showed that PMV therapy costs over 58,000 USD (U.S.dollars) per QALY for almost all patients with poor cognition. For patients with partial cognition, PMV therapy costs less than 33,000 USD per QALY for those with cancer, liver cirrhosis, intracranial or spinal cord injuries, or multiple co-morbidities who are less than 65 years of age; it costs about 52,000-63,400 USD per QALY for those with end stage renal disease, degenerative neurological diseases, or multiple co-morbidities over age 85. All costs-per-expected life were below 38,000 USD except for those with a longer life expectancy or QALE. Conclusions: The conventional ICER for PMV varies greatly depending on the different underlying causes and co-morbidities. The maintenance treatment for PMV patients with poor cognition is the least cost-effective. The indicator of cost-per-expected life could be considered to improve fairness in resource allocation.
    日期: 2012-06
    關聯: Value in Health. 2012 Jun;15(4):A72.
    Link to: http://dx.doi.org/10.1016/j.jval.2012.03.398
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=1098-3015&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000304468200374
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