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    题名: 台灣慢性B型肝炎治療準則及給付條件放寬之可行性分析
    Improving the management success of chronic hepatitis B patients: a cost-effective analysis
    作者: 應雅婷
    Ying, Ya-Ting
    贡献者: 周冠男
    Chou, Robin. K
    應雅婷
    Ying, Ya-Ting
    关键词: 慢性Ｂ型肝炎
    成本效益分析
    次級預防
    Chronic hepatitis B
    Cost effective analysis
    Secondary prevention
    日期: 2023
    上传时间: 2023-09-01 15:05:02 (UTC+8)
    摘要: 本論文旨在對台灣的B型肝炎患者提出數種符合經濟效益的可能治療方式和補助以及報銷政策的改善方式。本論文的第一部分著重於對台灣和其他國家以及地區對於B型肝炎的保險報銷政策和醫療狀況進行全面回顧和比較分析，同時將目前的現行法案政策和世界衛生組織的B型肝炎預防願景進行比對。
    第二部分則著重於探討B型肝炎與肝癌等其他肝臟疾病之發展的關係，透過探討關鍵因素和指標，例如病毒載量、ALT正常化和肝硬化指數。透過識別B型肝炎的症狀和肝臟疾病以及上述關鍵指標之間的關係，本論文提出了數個對於目前法規和政策的可行改進方案，以用於肝臟疾病的早期檢測。
    在第三部分，本論文進一步探討有關B型肝炎的初級和次級預防方式，並同時提出了數個對於目前的初級以及次及預防政策的可行改進方案，透過在這些領域擴大和調整全民健保的報銷和補助標準以期改善全體國民的健康狀況。
    本論文最後對於調整預防策略放寬報銷標準的經濟影響進行評估，並且針對文中所提出的調整方式等可行方案進行成本效益分析，進以確認這些針對B型肝炎的治療案預防方案的經濟可行性。
    This thesis aims to provide a cost-effective analysis of improving the management success of chronic hepatitis B (CHB) patients in Taiwan. The first section of the paper presents a comprehensive review and comparative analysis of CHB reimbursement policies and medical conditions in Taiwan and other countries.
    The second section focuses on exploring the relationship between CHB and key factors associated with the development of hepatocellular carcinoma (HCC), such as viral load, ALT normalization, and liver cirrhosis, by identifying the symptomatology of CHB in conjunction with these factors, we can provide several feasible improvements of current policies for early detection and intervention.
    In the third part, we delve into the prospects of primary and secondary prevention for CHB and provide several possible improvements toward the current policies in Taiwan. We aim to identify potential areas where expanding reimbursement criteria could lead to improved health outcomes and a more comprehensive approach to CHB management.
    Finally, the paper evaluates the economic implications of relaxing reimbursement criteria for secondary prevention strategies. By conducting a cost-benefit analysis, we assess the economic feasibility of proposed improvements to preventive measures, early diagnosis, and efficient management of CHB.
    參考文獻: 1. World Health Organization. Global health sector strategy on viral hepatitis 2016-2021.
    2. Fattovich G. Natural history of hepatitis B. J Hepatol. 2003;39 Suppl 1:S50-8.
    3. Fattovich G, et al. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48(2):335-352.
    4. Chien RN, et al. Taiwan consensus statement on the management of chronic hepatitis B. J Formos Med Assoc. 2019 Jan;118(1 Pt 1):7-38.
    5. Terrault NA, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-1599.
    6. Iloeje UH, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006 Mar;130(3):678-86.
    7. Wong GL, et, al. Normal on-treatment ALT during antiviral treatment is associated with a lower risk of hepatic events in patients with chronic hepatitis B. J Hepatol. 2018 Oct;69(4):793-802.
    8. Tarao K, et al. Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases-meta-analytic assessment. Cancer Med. 2019 Mar;8(3):1054-1065.
    9. Ni YH, et al. Continuing Decrease in Hepatitis B Virus Infection 30 Years After Initiation of Infant Vaccination Program in Taiwan. Clin Gastroenterol Hepatol. 2016 Sep;14(9):1324-30.
    10. Chang MH, et al. Long-term Effects of Hepatitis B Immunization of Infants in Preventing Liver Cancer. Gastroenterology. 2016 Sep;151(3):472-480.
    11. Tseng CH, et al. Increasing Age and Nonliver Comorbidities in Patients with Chronic Hepatitis B in Taiwan: A Nationwide Population-Based Analysis. Dig Dis. 2021;39(3):266-274.
    12. Dalal K, et al. Economics of global burden of road traffic injuries and their relationship with health system variables. Int J Prev Med. 2013 Dec;4(12):1442-50.
    描述: 碩士
    國立政治大學
    經營管理碩士學程(EMBA)
    107932169
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0107932169
    数据类型: thesis
    显示于类别:[經營管理碩士學程EMBA] 學位論文

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