目的：使用成本效果分析方法，找出台灣地區男性尿道炎(尿道不正常分泌物)與生 殖器潰瘍(梅毒)中最符合成本效果的處理模式。

方法：本研究利用決策樹的概念建立一電腦模擬模式，以TreeAge的軟體來比較性傳染病專責診所就診的男性病患，在「病因學診斷」、「症候群處理」與「性病防治所修飾的方式」三種不同性傳染病處理流程之成本效果。單維與機率性敏感度分析用來決定影響結果的參數。

結果：成本效果分析發現尿道炎方面，「症候群處理」的總治療花費為67,138.5元，為三種方案中最低的總治療花費，而且其成本效果比值（CER）也最低，為每位痊癒的病人需花費504.8元，其次為「病因學診斷」，其差異成本效果比（ICER）為3,676，而「性病防治所修飾的方式」最不具優勢。而在診斷梅毒方面，以「症候群處理」的總治療成本最低，為64,676.2元，但以成本效果比值來說，是以「病因學診斷」最好，為每位痊癒的病人需花費449.7元，其次是「症候群處理」，成本效果最低的則為「性病防治所修飾的方式」。敏感度分析在尿道炎方面較穩定，梅毒方面，由於「症候群處理」與「病因學診斷」的成本與效果相近，參數的變動較容易影響結果。

結論：性傳染病仍是台灣地區重要公共衛生問題。本研究的評估結果認為並沒有任何一種性病處理模式可以兼顧所有的情況，治療模式的成本效果會受到盛行率與就醫行為等參數的影響。

Objectives：The purpose of this study was to identify the most cost-effective protocol for the treatment of urethral discharge (urethritis) and genital ulcer (syphilis) for male in a hypothetical model in Taipei, Taiwan.

Methods：A decision tree model was constructed for each of the protocol. The cost-effectiveness of aetiological diagnosis, syndromic management, and modified management by STD clinic (modified management) protocols were compared by DATA Pro, a computer-based decision tree program. One-way and probabilistic sensitivity analyses were conducted to determine what effect a variation in one or more of the effectiveness or costs would have on the outcome.

Results：From cost-effectiveness analysis, we found that syndromic management had the lowest total cost of treatment for urethral discharge. The total cost spent NT＄67,138.5. ; and the cost-effectiveness ratio (CER)was also the lowest, CER was NT＄504.8 per cure, in other words, for urethral discharge, syndromic management was the most cost-effective treated protocols in terms of the cost per cure. As compared to the syndromic management, the incremental cost-effectiveness ratio (ICER)of aetiological diagnosis was NT＄3,676 per cure. The modified management by STD clinic (modified management ) was the lowest cost-effective. In genital ulcer, total cost of treatment was the lowest by syndromic management with cost NT＄6,4676.2 per cure , but the cost per cure of the aetiological diagnosis spent NT＄449.7 per cure was the highest cost-effective among the three protocols. For genital ulcer, modified management was also the lowest cost-effective protocol. For urethral discharge, it was insensitivity (steady) by using sensitivity analysis. However, the total cost and effectiveness were almost the same between syndromic management and aetiological diagnosis, so the variables including prevalence of clinical symptoms, treatment-seeking behavior, and accuracy of test ... etc. were sensitive to the ICER of the genital ulcer.

Conclusion：Sexually transmitted diseases are still serious public health problems in Taiwan. No single protocol carries with it all desired conditions of an optimal cost-effectiveness program. The treatment-seeking behavior, STD prevalence must be evaluated to determine the most effective and highest impact program.

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