以全民健康保險資料庫分析類風濕性關節炎新診斷率及藥物處方趨勢與市場潛力評估

Abstract

本研究試圖以健保資料庫的回溯性分析來探討新藥上市的市場評估。研究方法是利用國家衛生研究院所提供之全民健保承保抽樣歸人檔為研究材料，資料是包含2003至2008年其間20萬人就醫資料。研究期間為2004年月1日至2008年12月31日，為期五年。主要是利用「門診處方及治療明細檔」分析台灣地區新診斷類風濕關節炎的診斷率，配合「門診處方醫令明細檔」分析從2004年至2008年間每年新診斷類風濕關節炎的用藥趨勢及組合，另外以2004年新診斷病人為追蹤對象，追蹤從2004年至2008年，同一群病人的每年用藥趨勢及組合。 結果顯示新類風濕性關節炎個案診斷率自2004年的0.38%降至2008年的0.24%。41至60歲的族群發生率最高，61至80歲的族群次之，20歲以下的族群最低；整體而言，女性高於男性。每年約有65%新診斷病人於初診斷時即開始用藥，多以傳統型消炎止痛藥物為優先選擇(開立率>90%)，且以單方使用為主。追蹤2004年新診斷病人的藥物處方，發現傳統止痛藥物逐年減少，而疾病緩解藥物（DMARDs）的處方逐年增加且DMARDs的組合處方也是逐年增加。平均186.8天後會開始使用DMARDs，平均344.1天後會開始DMARDs組合處方，平均593.3天會開始處方生物製劑。而生物製劑的處方率以每年20%的速度成長。 透過健保資料庫的回溯性研究，本研究建立使用生物製劑的病人流 （Patient Flow），可清楚說明生物製劑的市場狀況，以及預估未來的市場潛力。此外，中區比其他區域有較大的市場潛力，而醫學中心與區域醫院將是行銷的重點區域。

The purpose of this research is trying to use retrospective analysis of National Health Insurance Research Database (NHIRD) to understand the trend of medication for rheumatoid arthritis (RA) and to estimate the market potential of RA. The research approach is to utilize systemic sampling cohort database of 200,000 insurers were provided by the National Health Research Institutes (NHRI) for research material. The duration of sampling cohort database was from year 2003 to 2008. We mainly utilized ‘ clinical prescription and treatment detail shelf ’ to analyze the new incidence rate of RA in Taiwan and cross link to ‘ outpatient order detail shelf‘ to analyze the trend of medication and combination from 2004 to 2008. Meanwhile, we target the annual incidence patients in 2004 to trace their trend of medication and combination in each year during 2004 to 2008. The result of study found the incidence rate of new rheumatoid arthritis case from 0.38% in 2004 dropped to 0.24% in 2008. The new incidence rate of group of 41 to 60 years old is the highest; the group of 61 to 80 years old takes second place, the group under the age of 20 is the lowest; overall, the new incidence rate of women are higher than man. 65% of new incidence cases were prescribed medication at their first visit. Non-Steroid Anti-Inflammatory Drugs (NSAID) was the first choice (above 90% prescription and mainly single use). Tracing prescription of annual incidence patients in 2004, we found that the prescription of NSAID decreased by years and the prescription of Disease Modifying Anti-Rheumatic Drugs (DMARDs) was increase by years and so did the prescription of DMARDs combinations. The average of beginning to prescribe DMARDs, DMARDs combination and biologics are 186.8, 344.1, 593.3 days. The prescription rate of biologics grows up at the speed of 20% for every year. Via retrospective analysis of NHIRD, this research set up Patient Flow which can clearly show the market situation of biologics and moreover can forecast the market potential in the future. In addition, there is a greater market potential than other areas in the center district, and the medical center and regional hospital will be the key area of marketing.