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題名：心臟血管疾病預防之經濟效益評估─疾病成本法與群體歸因風險模式之應用
作者：李杰憲
校院名稱：東吳大學
系所名稱：經濟學系
指導教授：傅祖壇
學位類別：博士
出版日期：2004
主題關鍵詞：心臟血管疾病；經濟效益；疾病成本法；群體歸因風險；Cardiovascular Disease；Economic Benefits；Cost of Illnes；Population Attributable Risk
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近來，由於經濟發展，生活水準的提高，使得國人罹病的型態亦逐漸由急性傳染病演變成以慢性疾病為主。美國心臟學會(AHA)就預測至西元2020年心臟血管相關疾病將成為全球主要死亡疾病，亦是造成世界各國疾病成本負擔最大的疾病。
目前國內外對於心臟血管疾病的研究只概括出罹患心臟血管疾病的風險因子、罹病機率及事後醫療成本，但對於人們的經濟行為及效用並未考量。這樣對於經濟個體行為研究來說，可能不夠完善。本文首先嘗試承襲流行病學風險方程式的概念，建立心臟血管疾病的盛行率與風險因子之間的關係，再運用特徵價格法（Hedonic Price Method）建立成本函數，發展出適合評估含有經濟行為的評估模型以估計台灣地區心臟血管疾病預防之經濟效益。
其次，運用建立之模型，探究影響心臟血管疾病的盛行率及醫療成本的健康特徵和其他決定因素，並使用台灣地區的資料探索因為心臟血管疾病風險因子的改善，進而降低罹患心臟血管疾病的機率，所產生的經濟效益及福利變化。最後，利用本文發展出來的經濟評估模型及估計結果與傳統的群體歸因風險模式作一比較。
經由理論建構及實證估計所得到的結論如下：
一、在經濟評估模型方面，罹患心臟血管疾病者若能改善高血壓、糖尿 病、膽固醇、肥胖狀況至平常人的水準，則整體的心臟血管疾病醫療成本約可以減少9.73﹪、10.0﹪、5.70﹪、8.37﹪的水準。以估計之民國89年心臟血管疾病的醫療支出(門診住院費用)142.3億元而言，因為高血壓、糖尿病、膽固醇、肥胖狀況的改善可減少13.8億元、14.2億元、8.1億元、11.9億元的心臟血管疾病的醫療支出。估計值
二、群體歸因風險模式方面，罹患心臟血管疾病者若能改善高血壓、糖尿病、膽固醇、肥胖狀況至平常人的水準，則整體的心臟血管疾病的醫療成本約可以減少27.7﹪、6.88﹪、4.32﹪、9.53﹪的水準。以估計之民國89年心臟血管疾病的醫療支出(門診住院費用)142.3億元而言，因為高血壓、糖尿病、膽固醇、肥胖狀況的改善可減少39.4億元、9.7億元、6.1億元、13.5億元的心臟血管疾病的醫療支出。
三、運用本文建立的多因子群體歸因風險模式，估算全體樣本中，高血壓、糖尿病、膽固醇、肥胖等四種風險因子對於心臟血管疾病的群體歸因風險為35.77﹪。亦即改善樣本中罹患心臟血管疾病者的高血壓、糖尿病、膽固醇、肥胖情形至平常人的水準，則整體的心臟血管疾病的醫療成本約可以減少35.77﹪。以估計之民國89年心臟血管疾病的醫療支出(門診住院費用)142.3億元而言，約可以減少51億元醫療支出。
As a result of economic development and high standard of living, compatriot diseases have developed from acute diseases to chronic diseases. American Heart Association predict that Cardiovascular Disease（CVD） will be a global main death disease and the disease of maximum medical cost for every country in the world at 2020.
Recently, the study for CVD was just for the risk factor, prevalence and post medical cost of CVD. It was not faultless that the study did not consider the economic behavior and utility of people in microeconomic research. This dissertation will build up prevalence function of CVD by using the concept of risk function of epidemiology. We also try to make use of Hedonic Price Method（HPM）to establish the medical cost function and continue to develop an economic model to evaluate the economic benefits of CVD prevention.
The next, we make use of our economic model to investigate the decisive factor of prevalence and medical cost of CVD and use Taiwan’s local data to explore the economic benefits and the change of welfare by improving the risk factor of CVD and reducing the prevalence of CVD.
At last, we make a comparison for the estimative result of our economic model and traditional Population Attributable Risk.
The conclusion of estimation as follow：
1.By the economic model, we have the following result. If the patient of CVD could improve their condition of hypertension, cholesterol, diabetes and obesity to ordinary standard, then the medical cost of CVD will reduce 9.73﹪,10.0﹪,5.70﹪,8.37﹪respectively. It means the medical cost of CVD can reduce 13.8 hundred million,14.2 hundred million,8.1 hundred million,11.9 hundred million respectively by the total medical cost of CVD 142.3 hundred million（estimative value）at Taiwan in 2000.
2.By Population Attributable Risk Method, we also have the following result. If the patient of CVD could improve their condition of hypertension, cholesterol, diabetes and obesity to ordinary standard, then the medical cost of CVD will reduce 27.7﹪,6.88﹪,4.32﹪,9.53﹪respectively. It means the medical cost of CVD can reduce 39.4 hundred million,9.7 hundred million,6.1 hundred million,13.5 hundred million respectively by the total medical cost of CVD 142.3 hundred million（estimative value）at Taiwan in 2000.
3.By multifactor Population Attributable Risk method, we estimate that the Population Attributable Risk of hypertension, cholesterol, diabetes and obesity with regard to CVD is 35.77﹪in sample. If the patient of CVD could improve their condition of hypertension, cholesterol, diabetes and obesity to ordinary standard at the same time, then the medical cost of CVD will reduce 27.7﹪. I t means the medical cost of CVD can reduce 51 hundred million by the total medical cost of CVD 142.3 hundred million（estimative value）at Taiwan in 2000.
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