目的：
本研究以於2010年及2014年首次被診斷為晚期使用標靶藥物之肺癌患者，不同世代之醫療費用與三年存活率為主要研究重點，探討不同世代對晚期使用標靶藥物之肺癌患者其醫療費用與三年存活率之分析。
方法：
本研究為回溯性研究，以全民健保資料庫進行次級資料分析。依據病患不同世代首次被確診為晚期使用標靶藥物之肺癌患者將其分為個案組與對照組，對照組乃依個案組之性別、年齡及共病性權重指數經傾向分數配對法(Propensity Score Matching)以1:1比例產生，以降低兩組別間干擾因素之影響。採用t檢定、卡方檢定、迴歸分析、Kaplan-Meier生存曲線與Cox比例風險模型分析探討研究組別於其醫療費用與總生存率之結果。
結果：
經線性複迴歸分析後發現，於2014年首次被確診之晚期使用標靶藥物肺癌患者有較高之門診相關費用、較低住院藥物費用，且達統計上之顯著意義(p< .05)。根據邏輯斯迴歸結果與生存曲線得知，於2014年首次被確診之晚期使用標靶藥物肺癌患者之死亡風險較低(OR= .03；95%CI=.03- .04)且存活率34.69%較對照組13.61%佳，於三年內有較低之風險會死亡(HR= .64；95%CI= .49- .84)，均達顯著水準(p< .05)。
結論：
由研究結果得知，於2014年首次被確診之晚期使用標靶藥物肺癌患者雖有較高之門診相關費用，但亦有較佳之存活率。盼全民對於晚期肺癌之重視，亦藉此盼政府與醫療相關單位能對於高風險之肺癌患者進行定期篩檢，進而達到早期發現與治療，提升較佳治療結果之目的。

關鍵字：晚期肺癌、使用標靶藥物、醫療費用、生存曲線、三年存活率

Objective:
This study features the medical expenditures and the three-year survival rate of patients using targeted medication when first diagnosed with last-stage lung cancer in 2010 and 2014, aiming to analyze the differences in the medical expenditures and the three-year survival rate of lung cancer patients from different generations.
Methods:
As a retrospective study, this paper carries out a secondary data analysis of the statistics from National Health Insurance Databases and, according to their generations, divides patients who used targeted medication when first diagnosed with last-stage lung cancer into two groups: the case group and the control group. In order to reduce the effects of interference factors between the two groups, the case group is formed by using propensity score matching for patients’ gender, age, and Charlson Comorbidity Index in 1:1 proportion. Moreover, t-tests, chi-square tests, regression analysis, Kaplan–Meier survival curves and Cox proportional hazards models are adopted in the study to analyze and discuss the differences in medical expenditures and overall survival rate between the two groups.
Results:
Via the linear regression analysis, it is shown that patients using targeted medication when first diagnosed with last-stage lung cancer in 2014 have the higher expenditures on outpatient services and the lower ones on hospitalization and medication. The results are statistically significant (p< .05). On the other hand, with the outcomes of multivariate logistic regression and the survival curves, it is manifested that patients using targeted medication when first diagnosed with last-stage lung cancer in 2014 have a lower death risk (OR= .03; 95%CI= .03- .04) and a higher survival rate at 34.69% than the one at 13.61% in the control group, and patients in the case group have a lower risk of death within three years (HP= .64; 95%CI= .49- .84). These data are all significant in statistics (p< .05).
Conclusion:
According to the research results, though the patients using targeted medication when first diagnosed with last-stage lung cancer have the higher expenditures on outpatient services, they also have the higher survival rate. It is hoped that the public will attach more importance to last-stage lung cancer and the government as well as health authorities will perform periodic screenings on high-risk lung cancer patients to have early detection and treatment of cancer so that treatment efficacy can be enhanced.

Keywords: last-stage lung cancer, targeted medication usage, medical expenditure, survival curve, three-year survival rate

論文審定書 i
誌謝 ii
摘要 iii
Abstract iv
目錄 vi
圖次 viii
表次 viii
第一章 研究背景與目的 1
第一節 研究背景 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 肺癌之介紹 4
第二節 罹患肺癌之醫療費用與存活率之相關性 8
第三章 研究方法 13
第一節 研究設計與架構 13
第二節 研究問題與假設 16
第三節 研究樣本與資料來源 17
第四節 研究變項之操作型定義 23
第五節 資料處理與分析方法 26
第四章 研究結果 28
第一節 研究樣本基本資料及就醫特性描述 28
第二節 人口學特質於研究組別之醫療費用資料分布與描述 37
第三節 醫療機構特性於研究組別之醫療費用資料分布與描述 42
第四節 各變項對醫療費用及總生存率之影響 46
第五節 假設驗證 64
第五章 研究討論 65
第一節 醫療費用 65
第二節 總體存活率 67
第六章 研究結果與建議 68
第一節 研究結論 68
第二節 研究限制 69
第三節 研究建議 70
第四節 研究貢獻 71
第七章 參考文獻 72
圖次
圖3-1 研究架構圖 15
圖4-1 兩研究組別之三年存活曲線圖 56
圖4-2 兩研究組別與性別之三年存活曲線圖 57
圖4-3 兩研究組別與年齡層之三年存活曲線圖 58
圖4-4 兩研究組別與共病性權重指數之三年存活曲線圖 59
圖4-5 兩研究組別與醫療機構權屬別之三年存活曲線圖 60
圖4-6 兩研究組別與醫療機構特約類別之三年存活曲線圖 61
表次
表2-1 IASLC 第八版肺癌分期表 4
表2-2 罹患肺癌之醫療費用與存活率之相關性相關文獻整理 8
表3-1 肺癌ICD-O-3 原發性腫瘤碼 17
表3-2 2010 年與2014 年全民健保給付之肺癌標靶藥物 18
表3-3 本研究之研究變項及操作型定義 23
表4-1 門急診之研究樣本於之人口學特質資料分步與卡方檢定 28
表4-2 住院之研究樣本人口學特質資料分步與卡方檢定 29
表4-3 門急診研究樣本就醫之醫療機構資料分布與卡方檢定 32
表4-4 住院研究樣本就醫之醫療機構資料分布與卡方檢定 32
表4-5 門急診之研究組別醫療費用資料分布與t 檢定 34
表4-6 住院之研究組別醫療費用資料分布與t 檢定 34
表4-7 研究組別總體生存率與卡方檢定 36
表4-8 門急診研究樣本之性別於研究組別之醫療費用資料分布與t 檢定 37
表4-9 住院研究樣本之性別於研究組別之醫療費用資料分布與t 檢定 37
表4-10 門急診研究樣本之年齡於研究組別之醫療費用資料分布與t 檢定 38
表4-11 住院研究樣本之年齡於研究組別之醫療費用資料分布與t 檢定 38
表4-12 門急診研究樣本之共病性權重指數於研究組別之醫療費用資料分布與t 檢定 40
表4-13 住院研究樣本之共病性權重指數於研究組別之醫療費用資料分布與t 檢定 40
表4-14 門急診研究樣本就醫之醫療機構權屬別之醫療費用資料分布與t 檢定 42
表4-15 住院研究樣本就醫之醫療機構權屬別之醫療費用資料分布與t 檢定 42
表4-16 門急診研究樣本就醫之醫療機構特約類別之醫療費用資料分布與t 檢定 44
表4-17 住院研究樣本就醫之醫療機構特約類別之醫療費用資料分布與t 檢定 44
表4-18 各變項對平均門急診藥物費用之線性複迴歸分析 46
表4-19 各變項對平均門急診總費用之線性複迴歸分析 48
表4-20 各變項對平均住院藥物費用之線性複迴歸分析 50
表4-21 各變項對平均住院總費用之線性複迴歸分析 52
表4-22 各變項對死亡與否之邏輯斯迴歸分析 54
表4-23 各變項對發生死亡之Cox 比例風險分析 62
表4-24 研究假設驗證 64

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