| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 97 === Objective: To investigate the medical utilization and survival rate of hematopoietic stem cell transplantation (HSCT) in Taiwan.
Design: Retrospective study analysis.
Subjects: Data on a total of 504 patients who had undergone hematopoietic stem cell transplantation, excluding those who had a second transplant or more, were collected from National Health Insurance research database (2003 to 2006).
Results: In terms of medical resource usage, there were more adults than non-adults (under 18), more males than females. Acute myeloid leukaemia ranked highest among diseases, most patients had a Charlson Comorbidity Index (CCI) score of 0, about 64% of total patients received autologous grafts, the most used stem cell source was peripheral blood. In terms of medical institution selected, the majority of patients received care from medical centers and Taipei Branch. In terms of mortality, 175 patients died during the studied period (23 patients died during the initial transplant period). The median lengths of stay (LOS) was 42 days, with a total medical expenditures of NT $875,177.00, the LOS during the first 100 days after transplantation were 53 days with an expenditure of NT $1,047,356.75, and for the first year, the LOS and expenditure were 71 days and NT $1,399,816.00, respectively.
The LOS during the initial transplant period was significantly higher for allogeneic HSCT than that of autologous HSCT. The diagnosis and year of transplantation were the important factors for the LOS of autologous HSCT while age, the stem cell source and survival status were that of allogeneic HSCT. The LOS during the first 100 days was significantly higher for allogeneic HSCT than autologous HSCT, with diagnosis, hospital ownership, hospital regions, and survival status being the important factors associated with the LOS of autologous HSCT. Hospital ownership and hospital regions were the important factors associated with the LOS of allogeneic HSCT. The LOS during the first year for allogeneic HSCT was significantly higher than that of autologous HSCT, with age, hospital ownership, hospital regions, and survival status being the important factors associated with the LOS of autologous HSCT. Hospital ownership and hospital regions were the important factors associated with the LOS of allogeneic HSCT.
The medical expenditures during the initial transplant period for allogeneic HSCT was significantly higher than that of autologous HSCT. The important factors associated with the expenditures of autologous HSCT were diagnosis, hospital ownership, and survival status while that for allogeneic HSCT were diagnosis, year of transplantation, the stem cell source, hospital ownership and hospital regions. The expenditures during the first 100 days for allogeneic HSCT was significantly higher than that of autologous HSCT. The important factors associated with the expenditures of autologous HSCT were diagnosis, hospital ownership, and survival status and for allogeneic HSCT were diagnosis, year of transplantation, the stem cell source, hospital ownership, hospital regions, and survival status. The expenditure during the first year for allogeneic HSCT was significantly higher than that of autologous HSCT. The important factors associated with the expenditures of autologous HSCT were hospital ownership and survival status and that for allogeneic HSCT were the stem cell source, hospital regions, and survival status. Diagnosis, CCI scores, year of transplantation and donor type were the important factors associated with survival of HSCT.
Conclusions: Age, diagnosis, year of transplantation, donor type, the stem cell source, hospital ownership, hospital regions and survival status were important factors associated with the medical utilization of HSCT. Diagnosis, CCI scores, year of transplantation, and donor type were important factors associated with the survival of HSCT. Finally, autologous HSCT has lower medical utilization and better survival rate than allogeneic.
|
|---|
