• 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.

• 한방안이비인후피부과학회지
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• 제23권1호
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• pp.260-269
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• 2010

Background : Bojungikgitang(BJT) and Banhabaekchulchonmatang(BBT) are known to treat the tinnitus patients, which were registered Korean National Health Insurance coverage lists. Objective : Few studies have evaluated economic benefits of both herbal medicines. This research is to investigate the cost-effectiveness of Bojungikgitang(BJT) and Banhabaekchulchonmatang(BBT) in chronic tinnitus patients over nineteen years old. Method : We built the decision tree model of chronic tinnitus and executed the deterministic analysis and threshold sensitivity analysis based on randomized clinical trial. Effectiveness was measured in quality-adjusted life-years(QALYs), and costs were in 2009 KRW(South Korean Currency). The perspective is societal, time horizon is 10 weeks, and Korean willingness to pay threshold is assumed to 20,000,000KRW. Results : In the base case analysis, BJT treatment resulted is better outcomes as low cost, so BJT is dominant medicine and BBT is dominated. But both cost per QALYs (BJT is 3,120,339KWN per QALY, BBT is 3,505,780KWN per QALY) are lower than the threshold, that could be covered by Korean National Health Insurance(KNHI). Conclusion : This study results showed that BJT was more cost-effective than BBT treating tinnitus patients for 10 weeks, and the cost per QALYs of both alternatives were lower than Korean national threshold.

• Clinical and Experimental Pediatrics
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• 제52권11호
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• pp.1249-1259
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• 2009

목 적:소아 성장호르몬결핍증의 저신장 치료에 사용되는 성장호르몬 생물학적 제제인 서방형 주사제의 비용-효과성을 사회적 관점에서 기존 매일 주사제와 비교하여 평가하고자 한다. 방 법:성장 호르몬 치료를 받는 환아를 대상으로 시각화 척도 방법에 의해 건강 관련 효용을 측정하였다. 2008년 7월, 이 연구에 참여한 2개 병원에서 저성장증 치료를 받고 있는 149명의 환아 보호자에게 매일 주사제에 대한 효용과 주 1회 주사제를 사용할 경우 기대되는 효용을 인터넷을 통해 설문조사 하였다. 성장호르몬 주사요법 중 매일 주사제와 주 1회 주사제 투여에 소요되는 직․간접 비용은 차이가 없으므로, 두 제형의 의약품비만을 비교하였다. 결 과:매일 주사제에서 주 1회 주사제로 전환할 경우 예상되는 효용값은 0.584에서 0.784로 증가하며, 연평균 추가비용은 4,060,811원이 발생한다. 점증적 비용-효용비는 20,304,555원/QALY (quality-adjusted life year gained)로 계산되었다. 시나리오 분석 결과, 점증적 비용-효용비는 최소 15,751,198원/QALY에서 최대 25,489,929원/QALY이다. 결 론:Base case 및 시나리오 분석결과에서 제시하는 점증적 비용-효용비는 우리 나라 1인당 GDP의 0.85-1.37배 범위 내에 있으므로 매우 안정적으로 비용-효과성이 있는 것으로 판단된다. 따라서, 매일 주사제에서 주1회 주사제로의 투약방법 변경은 비용-효과적이라 할 수 있으며, 주 1회 주사제가 추가 비용을 부담하더라도 경제성이 우수하다고 결론지을 수 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8993-9004
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• 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

• 대한한의학회지
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• 제37권1호
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• pp.41-52
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• 2016

Objectives: There are no studies which have investigated the health related quality of life(HRQOL) about stroke patients according to the medical care utilization behavior by longitudinal analysis. The purpose of this study is to analyze the quality of life(QOL) and quality adjusted life years(QALYs) of stroke patients of western and combined treatment group by longitudinal analysis. Methods: A retrospective cohort study was conducted among 37 new patients who initiated diagnosis with stroke in 2009 from Korea Health Panel Data. We analyzed the HRQOL of stroke patients and calculated the QALYs after medical use initiation for up to 3 years according to the medical care utilization behavior. Results: Overall, the quality of life of stroke patients was lowered somewhat from 0.8431 to 0.7864 in 2009~2012. Western treatment group was appeared slightly declined in from 0.8527 to 0.8231 and combined treatment group was shown to be falling from 0.8173 to 0.6875. The QALYs of total patients were calculated 2.3654 and western treatment group were 2.4436, combined treatment group were 2.1542 during the 4 year period. The difference of QALYs between two groups was 0.2894 QALYs. Conclusions: Although there was a small difference in QALYs of the two groups, it is not certain that the difference is come from medical care utilization behavior. Further studies should be needed to confirm the relation of the medical care utilization behavior and quality of life by considering severity of the stroke.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8265-8270
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• 2016

Purpose: A cost-utility analysis was performed to assess the cost-utility of neoadjuvant chemotherapy regimens containing doxorubicin and cyclophosphamide (AC) versus paclitaxel and gemcitabine (PG) for locally advanced breast cancer patients in Iran. Materials and Methods: This cross-sectional study in Namazi hospital in Shiraz, in the south of Iran covered 64 breast cancer patients. According to the random numbers, the patients were divided into two groups, 32 receiving AC and 32 PG. Costs were identified and measured from a community perspective. These items included medical and non-medical direct and indirect costs. In this study, a data collection form was used. To assess the utility of the two regimens, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30) was applied. Using a decision tree, we calculated the expected costs and quality adjusted life years (QALYs) for both methods; also, the incremental cost-effectiveness ratio was assessed. Results: The results of the decision tree showed that in the AC arm, the expected cost was 39,170 US$ and the expected QALY was 3.39 and in the PG arm, the expected cost was 43,336 dollars and the expected QALY was 2.64. Sensitivity analysis showed the cost effectiveness of the AC and ICER=-5535 US$. Conclusions: Overall, the results showed that AC to be superior to PG in treatment of patients with breast cancer, being less costly and more effective.

• 보건행정학회지
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• 제19권4호
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• pp.98-120
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• 2009

The purpose of this study is to elicit preference for drug listing decision criteria and to estimate the ICER threshold in South Korea using the discrete choice experiment (DCE) method. To collect the data, a DCE survey was administered to a subject sample either educated in the principle concepts of pharmacoeconomics or were decision makers within that field. Subjects chose between alternative drug profiles differing in four attributes: ICER, uncertainty, budget impact and severity of disease. The orthogonal and balanced designs were determined through computer algorithm to take the optimal set of drug profiles. The survey employed 15 hypothetical choice sets. A random effect probit model was used to analyze the relative importance of attributes and the probabilities of a recommendation response. Parameter estimates from the models indicated that three attributes (ICER, Impact, Severity of disease) influenced respondents' choice significantly(p${\pm}$0.001). In addition, each parameter displayed an expected sign. The Lower the ICER, the higher the probability of choosing that alternative. Respondents also preferred low levels of uncertainty and smaller impact on health service budget. They were also more likely to choose drugs for serious diseases rather than mild or moderate ones. Uncertainty however is not statistically significant. The ICER threshold, at which the probability of a recommendation was 0.5, was 29,000,000 KW/QALY in expert group and 46,500,000 KW/QALY in industry group. We also found that those in our sample were willing to accept high ICER to get medication for severe diseases. This study demonstrates that the cost-effectiveness, budget impact and severity of disease are the main reimbursement decision criteria in South Korea, and that DCE can be a useful tool in analyzing the decision making process where a variety of factors are considered and prioritized.

• 보건행정학회지
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• 제29권3호
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• pp.357-367
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• 2019

Background: This study evaluated the cost-effectiveness of 21 different national dyslipidemia screening strategies according to total cholesterol (TC) cutoff and screening interval among 40 years or more for the primary prevention of coronary heart disease over a lifetime in Korea, from a societal perspective. Methods: A decision tree was used to estimate disease detection with the 21 different screening strategies, while a Markov model was used to model disease progression until death, quality-adjusted life years (QALYs) and costs from a Korea societal perspective. Results: The results showed that the strategy with TC 200 mg/dL and 4-year interval cost \4,625,446 for 16.65105 QALYs per person and strategy with TC 200 mg/dL and 3-year interval cost \4,691,771 for 16.65164 QALYs compared with \3,061,371 for 16.59877 QALYs for strategy with no screening. The incremental cost-effectiveness ratio of strategy with TC 200 mg/dL and 4-year interval versus strategy with no screening was \29,916,271/QALY. At a Korea willingness-to-pay threshold of \30,500,000/QALY, strategy with TC 200 mg/dL and 4-year interval is cost-effective compared with strategy with no screening. Sensitivity analyses showed that results were robust to reasonable variations in model parameters. Conclusion: In this study, revised national dyslipidemia screening strategy with TC 200 mg/dL and 4-year interval could be a cost-effective option. A better understanding of the Korean dyslipidemia population may be necessary to aid in future efforts to improve dyslipidemia diagnosis and management.

• 한국학교ㆍ지역보건교육학회지
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• 제22권2호
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• pp.75-91
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• 2021

Purpose: The purpose of this article is to clearly describe research trends on health life expectancy using oral health indicators that have been published from 2010 to 2020 then suggest the direction of future research. Methods: Online academic databases in English (PubMed, Web of Science and Embase) were used to find those articles by applying a variety of keywords, including terms (adjusted life year, adjusted life expectancy, dental and oral). We identified relevant articles based on the following classification method of Mathers: (1) health gaps, (2) health expectancies. Results: Among 1,728 articles from the online databases, the final 13 studies satisfied the inclusion criteria and were selected for analysis. Health life expectancy studies indicate that research growth was recently achieved overseas. Among the literature collected in this study, 10 studies using health gap indicators yielded seven Disability-Adjusted Life Year (DALY), and three calculated Quality-Adjusted Life Year (QALY), which differed in the nature of the survey data used in the study measuring DALY and QALY. There are only three health expectancies and the number of papers were smaller than the health gap study. Conclusion: Establishing a foundation to calculate health life expectancy indicators through the development and improvement of oral health level are needed. More studies in the area of health life expectancy estimation research is based on actual prevalence and oral health-related quality of life are also needed.

• Pediatric Infection and Vaccine
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• 제15권1호
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• pp.20-29
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• 2008

The basis of the economic evaluation of vaccination is the balance between the use of the resources (input) and the improvements that result from the vaccination (output). Techniques used for economic evaluation of vaccination are cost analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. Cost analysis seeks to characterize the costs of a given vaccination program. Cost-effective analysis is to helps policy-makers decide on the best use of allocated resources, whether cost-benefit analysis is to helps policy-makers decide on the overall allocation of resources. Cost-utility analysis is a specific form of cost-effective analysis in which outcomes are reduced to a common denominator such as the quality-adjusted life year (QALY) or disability-adjusted life year (DALY). Many economic analyses have been conducted on vaccines in the world, but there have been a little studies on economic evaluation on vaccines in Korea. This paper reviewed the methodology used to economic evaluation on vaccines and immunizations and addressed some examples of the methods.