• Korean Journal of Radiology
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• 제24권12호
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• pp.1249-1259
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• 2023

Objective: This study aimed to evaluate the clinical outcomes and cost-effectiveness of dual-energy X-ray absorptiometry (DXA) for osteoporosis screening. Materials and Methods: Eligible patients who had and had not undergone DXA screening were identified from among those aged 50 years or older at Kaohsiung Veterans General Hospital, Taiwan. Age, sex, screening year (index year), and Charlson comorbidity index of the DXA and non-DXA groups were matched using inverse probability of treatment weighting (IPTW) for propensity score analysis. For cost-effectiveness analysis, a societal perspective, 1-year cycle length, 20-year time horizon, and discount rate of 2% per year for both effectiveness and costs were adopted in the incremental cost-effectiveness (ICER) model. Results: The outcome analysis included 10337 patients (female:male, 63.8%:36.2%) who were screened for osteoporosis in southern Taiwan between January 1, 2012, and December 31, 2021. The DXA group had significantly better outcomes than the non-DXA group in terms of fragility fractures (7.6% vs. 12.5%, P < 0.001) and mortality (0.6% vs. 4.3%, P < 0.001). The DXA screening strategy gained an ICER of US$ -2794 per quality-adjusted life year (QALY) relative to the non-DXA at the willingness-to-pay threshold of US$ 33004 (Taiwan's per capita gross domestic product). The ICER after stratifying by ages of 50-59, 60-69, 70-79, and ≥ 80 years were US$ -17815, US$ -26862, US$ -28981, and US$ -34816 per QALY, respectively. Conclusion: Using DXA to screen adults aged 50 years or older for osteoporosis resulted in a reduced incidence of fragility fractures, lower mortality rate, and reduced total costs. Screening for osteoporosis is a cost-saving strategy and its effectiveness increases with age. However, caution is needed when generalizing these cost-effectiveness results to all older populations because the study population consisted mainly of women.

• 척추신경추나의학회지
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• 제16권2호
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• pp.97-105
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• 2021

Objectives This study is aimed to evaluate cost-effectiveness of treatment of Korean Medicine for whiplash associated disorders (WAD) and to suggest the direction of future research. Methods We searched papers in Pubmed database to use some keywords indicating whiplash injury syndrome, treatment of Korean Medicine and cost-effectiveness. After searching, appropriate papers were selected depending on the exclusion criteria. The selected papers were analyzed in the sections of author, publication year, intervention and control groups, outcome measurement, the list including in the cost, cost-effectiveness, cost-utility and study design. Results Four studies about effect of Korean medicine and 3 studies about economic evaluation were finally included. Acupuncture was effective for balance disorder and neck pain. Economic evaluation studies used analytical decision model or cost-consequence analysis. Cost-effectiveness analysis using visual analog scale and cost-utility analysis using quality adjusted life years were performed. Initiating timing of proper management affected the consequence of treatments. Direct and indirect medical costs including supportive devices, and non-medical costs such as litigation were considered. Conclusions We conclude that studies haven't been conducted so far to evaluate the cost-effectiveness of Korean Medicine in whiplash injury syndrome. Thus, future studies are needed in this section.

• 대한핵의학회지
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• 제34권3호
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• pp.207-221
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• 2000

목적: 우리 나라에서 관동맥질 환자에게 시행되는 치료방법의 빈도와 현행수가와 개정 발표될 수가를 바탕으로 검사 전 유병률에 따라 비용효과 분석을 하였다. 대상 및 방법: 심근관류 SPECT를 한 후 관동맥조영술을 하는 경우, 운동부하심전도 후에 관동맥조영술을 한 경우, 바로 관동맥조영술을 한 경우, 그리고 운동부하심전도 후에 심근 SPECT 후에 관동맥조영술을 한 각각의 경우에 따라 비용을 계산하고 삶의 질을 고려한 여명(Quality Adjusted Life Year: QALY)가 각 치료하거나 치료하지 않았을 때 획득되는 여명의 차이(${\Delta}QALY$)를 산출하여 비용/${\Delta}QALY$가 검사 전 유병률에 따라 달라지는 양상을 제시하였다. 결과: 검사 전 유병률이 0.6이상일 때는 관동맥조영술을 바로 실시하는 것이 가장 비용대비효과가 높았다. 검사 전 유병률이 $0.2{\sim}0.6$이었을 때는 운동부하심전도 후에 심근 SPECT 후에 관동맥조영술을 하는 것이 비용대비 효과가 높았다. 심근 SPECT 후에 관동맥조영술을 하는 것이 차선책이었다. 운동부하심전도의 개정수가와 개정희망수가를 근거로 산출하였을 때에도 비용효과의 순서는 비슷하였다. 운동부하심전도 후 바로 관동맥조영술을 시행하는 것은 언제나 비용대비효과가 가장 낮았다. 결론: 심근관류 SPECT는 우리나라의 현행수가체계에서나 변동된 수가체계에서나 검사 전 유병률에 상관없이 비용효과면에서 우수하고 꼭 필요한 검사로 나타났다.

• 농촌의학ㆍ지역보건
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• 제36권2호
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• pp.120-129
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• 2011

목적: 뇌졸중으로 인한 장애인이 증가하고 있으나 이들을 대상으로 질보정수명을 구한 연구가 없었다. 이 연구의 목적은 일개 시에서 뇌졸중 장애인을 대상으로 EQ-5D로 그들의 건강 관련 삶의 질 수준을 평가하고, 우리나라 전체 뇌졸중 장애인의 QALYs 감소분을 추정하기 위하여 수행 하였다. 방법: 2008년 3월을 기준으로 경주시 장애인 등록현황에서 50세 이상인 장애인 중 뇌졸중이 원인으로 파악된 982명을 대상으로 설문조사자들이 방문하여 대면면접조사를 통해 일반적 특성, 임상적 특성, EQ-5D 등의 자료를 수집하였다. 제4기 국민건강영양조사 에서 일반인구집단과 동반질환이 없는 군을 건강비교군으로 선정하여 성별, 연령별 표준화를 통해 비교함으로써 효용 가중치 차이를 구하였다. 이 효용 가중치 차이를 우리나라 전체 뇌졸중 장애인에 적용하여 전체 QALYs 감소분을 추정하였다. 결과: 대상자 982명 중 조사응답자는 566명으로 응답률은 57.6%였다. 여성, 70대 이상군에서 EQ-5D 지표값이 남성이나 60대 이하군에 비해 더 낮았고, 상대 비교군과의 차이도 크게 나타났다. 건강비교군과 일반인구집단 비교군과의 비교에 따른 전체 QALYs 감소분은 각각 연간 67,011.6 QALYs와 54,167.1 QALYs로 추정되었다. 결론: EQ-5D로 우리나라 전체 뇌졸중장애인의 QALYs 감소분을 추정하였고, 이 연구를 바탕으로 뇌졸중 장애인을 대상으로 한 공중보건정책의 집행이나 평가를 수행하여 보다 근거에 기반한 장애인 정책을 수행할 수 있을 것으로 생각한다.

• 병원약사회지
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• 제35권4호
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• pp.409-417
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• 2018

Background : Febrile neutropenia (FN) is one of the side effects in the patients treated with chemotherapy, and the patients who have FN generally need immediate treatment with extended-spectrum antibiotics and hospitalization. Pegfilgrastim and pegteograstim, which are used for the prevention of FN as a granulocyte-colony stimulating factor (G-CSF), have been granted insurance coverage in the Republic of Korea for certain breast cancer patients using doxorubicin and cyclophosphamide (AC) from September 2016. Methods : The data of the patients with breast cancer using AC regimen and G-CSF were collected retrospectively. This study involves cost-utility analysis of pegfilgrastim and pegteograstim. In this study, we constructed a simple decision tree model for short-term observation and calculated quality-adjusted life year (QALY) and the direct medical costs from the medical provider's perspective. Results : From September 2016 to May 2017, 15 patients were treated with pegfilgrastim and 15 patients were treated with pegteograstim. As a result of dividing the average cost by QALY for each treatment group, it was observed that pegfilgrastim and pegteograstim were consumed 24,923,384 won and 22,808,336 won per 1QALY, respectively. Consequently, incremental cost effectiveness ratio (ICER) showed 2,115,048 won more per pegfilgrastim than pegteograstim per 1QALY, and the cost per 1QALY of both the drugs was lower than 30,500,000 won; the Koreans were willing to pay this amount. Conclusions : This study suggests that pegfilgrastim and pegteograstim can be used to improve the quality of life of breast cancer patients undergoing AC therapy. Among the two drugs, pegteograstim seems to be more cost-effective. However, since this study was conducted as a retrospective observation method on a small scale, it is associated with many limitations. Therefore, a long-term prospective cohort study is needed to supplement the present findings.