成功大學博碩士論文系統

簡易檢索 / 詳目顯示

回結果列表

研究生：	葉又華 Yeh, Yu-Hua
論文名稱：	以風險方程式模型分析Insultrate® 於台灣第二型糖尿病使用基礎胰島素的患者之醫療成本效益 Risk equation-based modeling analysis for cost-effectiveness of Insultrate® for type 2 diabetes patients using basal insulin in Taiwan
指導教授：	歐凰姿 Ou, Huang-Tz
學位類別：	碩士 Master
系所名稱：	醫學院 - 臨床藥學與藥物科技研究所 Institute of Clinical Pharmacy and Pharmaceutical sciences
論文出版年：	2025
畢業學年度：	113
語文別：	中文
論文頁數：	132
中文關鍵詞：	第二型糖尿病、數位療法、成本效益分析、風險方程式、價值基礎定價
外文關鍵詞：	type 2 diabetes, digital therapeutic, cost-effectiveness analysis, risk equation, value-based price
相關次數：	點閱：11 下載：0
分享至:	分享至facebook 分享至twitter

查詢本校圖書館目錄查詢臺灣博碩士論文知識加值系統勘誤回報

研究背景與目的
第二型糖尿病常導致多種大小血管病變，產生高昂的醫療費用，增加患者與政府的醫療和經濟負擔。過去研究顯示，積極控制患者的血糖有助於減低併發症的風險。美國糖尿病學會 (American Diabetes Association, ADA) 照護指引建議對於一般第二型糖尿病患者應將其HbA1c控制到小於7% 以下，並且必要時可合併多種口服降血糖藥物與胰島素進行治療。儘管如此，基礎胰島素治療在第二型糖尿病中常有臨床惰性 (clinical inertia) 的問題。與亞洲其他國家相比，台灣第二型糖尿病患者的胰島素治療成功率與使用劑量都相對較低，僅有7.4 % ~ 10.7% 的患者經24周的胰島素治療後可達血糖控制目標。
而Insultrate®是個用於第二型糖尿病患者基礎胰島素劑量調整的數位療法，其可透過患者每日量測的空腹血糖值和醫師設定的治療計畫，計算出患者每日應施打的胰島素劑量。臨床試驗結果顯示與傳統標準照護 (standard of care, SOC) 相比，使用12周Insultrate® 可顯著改善患者的血糖，並且此療效可持續至第24周。
儘管如此，現今對於Insultrate® 長期臨床與經濟效益的研究仍然缺乏。因此本研究將採用台灣健保署 (Taiwan’s National Health Insurance Administration, NHIA) 的角度，依據臨床試驗結果，以1 ~ 3倍台灣人均國內生產毛額 (gross domestic product per capita, GDP per capita) 作為願付價格 (willingness-to-pay, WTP) 閾值，評估使用Insultrate® 相較於SOC是否具有成本效益，並依據基礎研究分析的結果進行Insultrate®的價值基礎定價分析。
研究方法
本研究應用給予風險方程式之馬可夫模型，模擬台灣使用基礎胰島素的第二型糖尿病患者分別使用Insultrate® 和SOC，在十年評估期間的成本與臨床效益。研究中使用的馬可夫模型共包含六個健康狀態：第二型糖尿病、心肌梗塞、中風、心衰竭、末期腎臟病與死亡。
在研究參數的部分，本研究利用成大醫院資料庫，擷取出與Insultrate® 臨床試驗族群之基本特質相似的患者，並將其個人資料結合Insultrate® 臨床試驗中第12周之療效，帶入風險方程式計算從第二型糖尿病到心腎事件狀態的轉移機率；而其餘健康狀態間的轉移機率、健康效用和費用則是參考過往台灣第二型糖尿病之文獻。本研究以經健康生活品質校正生命年 (quality-adjusted life year, QALY) 作為主要效益評估指標，並將整體費用校正至2024美元，所有成本和效益皆以3% 進行折現。
本研究除基礎研究分析外，另針對Insultrate®的價格進行價值基礎定價分析，以及多項敏感度分析，包含：單因子敏感度分析、機率性敏感度分析和情境敏感度分析。
研究結果
經過十年模擬後，Insultrate® 組整體糖尿病併發症的發生率較低，相較於SOC組可額外獲得0.0069單位QALY，同時增加448美元的成本，表示使用Insultrate® 每增加一單位QALY，其成本將增加65,306美元，小於3倍GDP per capita，顯示Insultrate® 的介入為符合成本效益之治療選擇，並且機率性敏感度分析也顯示使用Insultrate® 有100% 機率具有成本效益。除此之外，單因子敏感度分析結果顯示治療組與比較組的每日平均基礎胰島素使用劑量為兩個最敏感之因子。而除評估時間縮短至五年的情境分析外，所有敏感度分析與基礎研究分析結果之方向性皆一致，證實了本研究模型和分析之穩健性。另一方面，若以1倍GDP per capita作為WTP閾值，Insultrate® 價值基礎定價相較於其目前價格需調降55.8%才可符合高度成本效益；而當WTP為2 ~ 3倍GDP per capita時，Insultrate® 的價格則可再增長4.74% ~ 65.3%，顯示WTP對價值基礎定價的影響與重要性。
研究結論
本研究顯示對於台灣使用基礎胰島素的第二型糖尿病患者，使用Insultrate® 相較於SOC可降低患者心腎事件的風險，且為具有成本效益的治療選擇。此結果可作為後續Insultrate® 醫療科技評估時之參考依據，協助政府進行決策擬定，優化資源分配；此外，Insultrate® 的價值基礎定價分析也可提供未來台灣健保署考量其健保給付時之價格建議，加速數位療法之應用，減輕健保負擔。

Intensive glycemic control through combined multiple oral antidiabetic agents and insulin therapy allows type 2 diabetes (T2D) patients to achieve the optimal glycemic control, subsequently reducing the risk of T2D-related complications. However, in Taiwan, insulin doses and glycemic control rates remain relatively low compared to other Asian countries, partly due to clinical inertia. Insultrate® is a digital therapeutic that assists T2D patients in self-titrating basal insulin doses according to a physician-prescribed algorithm, potentially addressing this inertia. This study employed a risk-equation-based Markov model to estimate the 10-year incremental cost-effectiveness ratio (ICER) of Insultrate® versus standard of care (SOC) and the value-based price (VBP) of Insultrate® from the perspective of Taiwan’s NHIA. Both costs and quality-adjusted life year (QALY) were discounted at 3% annually, and the cost was presented in 2024 USD. The base-case analysis showed that Insultrate® was cost-effective, with an ICER of $65,306 per QALY gained—well below the cost-effectiveness threshold of three times Taiwan’s GDP per capita ($101,949). Compared to the base-case price, the VBP of Insultrate® decreases by 55.8% and increases by 65.3% at the WTP of one- and three-times GDP per capita, respectively. Results from the probabilistic analysis showed that 100% of the ICER estimates fell below the WTP threshold of $101,949. In conclusion, for Taiwanese T2D patients requiring basal insulin, Insultrate® offers a cost-effective strategy that can improve long-term clinical outcomes and support efficient resource allocation. These findings provide timely evidence for reimbursement and pricing decision-making regarding digital therapeutics in Taiwan’s healthcare system.

中文摘要	i
Extended Abstract	iii
誌謝	vi
目錄	vii
表目錄	xi
圖目錄	xiii
第一篇 以風險方程式模型分析Insultrate® 於台灣第二型糖尿病使用基礎胰島素的患者之醫療成本效益	1
第一章 研究背景	2
第二章 文獻回顧	3
第一節 第二型糖尿病簡介	3
2.1.1 第二型糖尿病之定義與診斷	3
2.1.2 第二型糖尿病的流行病學	3
第二節 第二型糖尿病之相關併發症與醫療負擔	4
2.2.1 第二型糖尿病併發症與流行病學	4
2.2.2 第二型糖尿病之醫療與經濟負擔	5
第三節 第二型糖尿病治療現況	6
2.3.1 第二型糖尿病的治療	6
2.3.2 胰島素於台灣第二型糖尿病之治療角色與困境	12
第四節 數位療法	15
2.4.1 數位療法介紹	15
2.4.2 台灣數位療法發展現況	15
2.4.3 Insultrate® 於第二型糖尿病之治療效益	16
第三章 研究動機與目的	18
3.1.1 研究動機	18
3.1.2 研究目的	18
第四章 研究方法	19
第一節、研究設計	19
4.1.1 研究設計	19
4.1.2 比較組與治療組	19
4.1.3 評估期間 (time horizon)	20
4.1.4 折現 (discounting)	20
第二節、研究模型	20
第三節、研究參數	21
4.3.1 轉移機率	22
4.3.1.1 從第二型糖尿病至心腎事件之轉移幾率	22
4.3.1.2 成大醫院配對族群 (NCKUH cohort)	28
4.3.1.2.1 研究材料	28
4.3.1.2.2 研究族群	28
4.3.1.2.3 基本特質資料蒐集區間	30
4.3.1.2.4 NCKUH cohort之基本特質	30
4.3.1.2.5 遺失值的插補	31
4.3.1.2.6 資料分析方法	31
4.3.1.3 研究名詞及操作型定義	32
4.3.1.4 成大醫院配對族群之篩選流程	35
4.3.1.5 成大醫院配對族群之基本特徵	35
4.3.1.6 應用風險方程式計算之從第二型糖尿病至心腎事件之轉移機率	40
4.3.1.7 從第二型糖尿病或心腎事件至死亡之轉移機率	43
4.3.2 健康效用	45
4.3.3 費用	48
4.3.4 研究基本假設	55
第四節、成本效益分析方法	55
4.4.1 基礎研究分析	55
4.4.2 價值基礎定價分析	56
4.4.3 敏感度分析	56
4.4.4 統計分析工具	59
第五章 研究結果	60
第一節、基礎研究分析	60
5.1.1 臨床效益與費用	60
5.1.2 成本效益分析基礎研究結果	63
5.1.3 價值基礎定價分析結果	64
第二節、敏感度分析	64
5.2.1 單因子敏感度分析	64
5.2.2 機率性敏感度分析	67
5.2.3 情境敏感度分析	68
第六章 討論	73
第一節、研究分析結果與討論	73
6.1.1 基礎研究分析	73
6.1.2 價值基礎定價分析	74
6.1.3 敏感度分析	75
6.1.3.1 單因子與機率性敏感度分析	75
6.1.3.2 情境敏感度分析	76
第二節、和過去文獻比較	79
6.2.1 研究結果	79
6.2.2 研究方法	80
第三節、數位療法的成本效益分析研究之挑戰與方法學考量和建議	81
第七章 研究優勢與限制	83
第一節、研究優勢	83
第二節、研究限制	84
第八章 未來方向	86
第九章 結論與建議	87
第二篇 大腸鏡檢查前清腸準備現況把握問卷調查	88
第一章 前言	89
第一節、臨床藥事服務背景介紹	89
1.1.1 大腸直腸癌與大腸鏡檢查	89
1.1.2 成大醫院大腸鏡衛教之流程	90
1.1.3 成大醫院大腸鏡檢查品質	92
第二章、臨床藥事服務目的與方法	95
第一節、服務目的	95
第二節、服務方法	95
2.2.1 成大醫院大腸鏡衛教現況調查	95
2.2.2 訪談調查結果分析	98
2.2.2.1 柏拉圖分析	98
2.2.2.2 魚骨圖分析	98
2.2.3 統計分析工具	98
第三章、結果分析	100
第一節、訪談調查結果	100
3.1.1 基本資料	100
3.1.2 清腸準備過程	100
3.1.3 藥師衛教之可理解性	101
3.1.4 衛教單張之易讀性	102
3.1.5 其他	103
第二節、柏拉圖分析	104
第三節、魚骨圖分析	105
第四章、結果討論	107
第五章、結論與未來方向	108
附錄	109
附錄1、NCKUH cohort藥品之ATC代碼	109
附錄2、NCKUH cohort共病症之ICD-9-CM、ICD-10-CM 診斷碼	110
參考文獻	111
                                    

1. Cicek M, Buckley J, Pearson-Stuttard J, Gregg EW. Characterizing Multimorbidity from Type 2 Diabetes: Insights from Clustering Approaches. Endocrinol Metab Clin North Am. Sep 2021;50(3):531-558.
2. 衛生福利部國民健康署. 中華民國111年健康促進統計年報衛生福利部國民健康署. Available from: https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=268&pid=18596
3. 社團法人中華民國糖尿病學會. 2022第2型糖尿病臨床照護指引. 2022. Accessed 22 March 2025.
4. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. Aug 12 2000;321(7258):405-12.
5. Ji L, Tsai ST, Lin J, Bhambani S. National Variations in Comorbidities, Glycosylated Hemoglobin Reduction, and Insulin Dosage in Asian Patients with Type 2 Diabetes: The FINE-Asia Registry. Diabetes Ther. Dec 2015;6(4):519-530.
6. Chien MN, Chen YL, Hung YJ, et al. Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus. J Diabetes Investig. Nov 2016;7(6):881-888.
7. 社團法人台灣數位健康產業發展協會. 2024台灣數位療法產業發展趨勢. Accessed 24 November. 2024. Available from: https://www.pwc.tw/zh/publications/bio-insights/digital-therapeutics-trends-in-taiwan.html
8. Chih-Yuan Wang C-HL, Chih-Hsun Chu, Yao-Hsien Tseng, Chung-Ze Wu, Yi-Sun Yang, Sze-Ting Ching, Horng-Yih Ou. Optimal basal insulin titration in type 2 diabetes: Results of the first effectiveness and safety randomized controlled trial of Insultrate - A digital titration application. presented at: Advanced Technologies & Treatments In Diabetes; March 19–22 2025; Amsterdam, The Netherlands. Available from: https://www.liebertpub.com/doi/10.1089/dia.2024.78502.abstracts.part4b
9. 社團法人中華民國糖尿病衛教學會. 臺灣糖尿病年鑑2019第2型糖尿病公告. 2019. Accessed 23 March 2025.
10. Federation ID. IDF Diabetes Atlas 2025 report. Accessed 23 March 2025. Available from: https://diabetesatlas.org/
11. Organization WH. Noncommunicable diseases. Accessed 23 December, 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
12. Chiang JI, Hanlon P, Li TC, et al. Multimorbidity, mortality, and HbA1c in type 2 diabetes: A cohort study with UK and Taiwanese cohorts. PLoS Med. May 2020;17(5):e1003094.
13. Yen FS, Lo YR, Hwu CM, Hsu CC. Early-onset type 2 diabetes <60 years and risk of vascular complications. Diabetes Res Clin Pract. Dec 2021;182:109129.
14. Paneni F, Beckman JA, Creager MA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Eur Heart J. Aug 2013;34(31):2436-43.
15. Li Y, Liu Y, Liu S, et al. Diabetic vascular diseases: molecular mechanisms and therapeutic strategies. Signal Transduct Target Ther. Apr 10 2023;8(1):152.
16. Collaborators GBDD. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. Jul 15 2023;402(10397):203-234.
17. American Diabetes Association Professional Practice C. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025. Diabetes Care. Jan 1 2025;48(Supplement_1):S128-S145.
18. Marx N, Federici M, Schutt K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. Oct 14 2023;44(39):4043-4140.
19. Kidney Disease: Improving Global Outcomes Diabetes Work G. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. Nov 2022;102(5S):S1-S127.
20. Kunutsor SK, Balasubramanian VG, Zaccardi F, et al. Glycaemic control and macrovascular and microvascular outcomes: A systematic review and meta-analysis of trials investigating intensive glucose-lowering strategies in people with type 2 diabetes. Diabetes Obes Metab. Jun 2024;26(6):2069-2081.
21. American Diabetes Association Professional Practice C. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. Jan 1 2025;48(Supplement_1):S167-S180.
22. American Diabetes Association Professional Practice C. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2025. Diabetes Care. Jan 1 2025;48(Supplement_1):S181-S206.
23. Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. Nov 1 2022;45(11):2753-2786.
24. Chun J, Strong J, Urquhart S. Insulin Initiation and Titration in Patients With Type 2 Diabetes. Diabetes Spectr. May 2019;32(2):104-111.
25. Garber AJ, Handelsman Y, Grunberger G, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm-. Endocr Pract. Jan 2020;26(1):107-139.
26. Kim SS, Kim IJ, Kim YK, et al. Duration of diabetes and effectiveness of insulin in the management of insulin-naive Korean patients uncontrolled on oral antidiabetic drugs: a sub-analysis of the MOdaliTy of Insulin treatment eValuation (MOTIV) registry results. Acta Diabetol. Aug 2014;51(4):655-61.
27. 台灣數位健康產業發展協會. 借鏡國際先例產官學專家深度對話助台灣躋身數位療法先進國. Accessed April 28, 2025. Available from: https://www.pwc.tw/zh/publications/bio-insights/digital-therapeutics-trends-in-taiwan.html
28. Growth G. Available from: https://www.galengrowth.com/
29. Health Management PaI. The Need for Accelerated Medicare Coverage of Innovative Technologies: Impact on Patient Access and the Innovation Ecosystem. Available from: https://hmpi.org/2022/01/17/the-need-for-acceleratedmedicare-coverage-of-innovative-technologies-impact-onpatient-access-and-the-innovation-ecosystem/
30. The Fast-Track Process for Digital Health Applications (DiGA) according to Section 139e SGB V (2020).
31. 彭文暉. 數位療法相關法制問題研析. Available from: https://www.ly.gov.tw/Pages/Detail.aspx?nodeid=6590&pid=241877
32. Protocol of Prospective Comparison of Connected Solution (Health2Sync) and Usual Care in Adult Participants with Type 2 Diabetes Mellitus Using Basal Insulin in Taiwan. 2022.
33. 財團法人醫藥品查驗中心. 貳、醫療科技評估成本效益分析方法學指引. 2024. August, 2024. Available from: https://www.cde.org.tw/hta/1444/1834/2155/12989/simpleList
34. Chen HY, Kuo S, Su PF, Wu JS, Ou HT. Health Care Costs Associated With Macrovascular, Microvascular, and Metabolic Complications of Type 2 Diabetes Across Time: Estimates From a Population-Based Cohort of More Than 0.8 Million Individuals With Up to 15 Years of Follow-up. Diabetes Care. Aug 2020;43(8):1732-1740.
35. Attema AE, Brouwer WBF, Claxton K. Discounting in Economic Evaluations. Pharmacoeconomics. Jul 2018;36(7):745-758.
36. (TaSPOR) TSfPaOR. Guidelines of Methodological Standards for Pharmacoeconomic Evaluations (2006). Updated February 14. Available from: https://www.ispor.org/heor-resources/more-heor-resources/pharmacoeconomic-guidelines/pe-guideline-detail/taiwan
37. Carta A, Conversano C. On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers. Front Public Health. 2020;8:569500.
38. Affairs USDoV. Decision Analysis: Decision trees, Simulation Models, Sensitivity Analyses. Accessed 24 May. 2025. Available from: https://www.herc.research.va.gov/include/page.asp?id=decision-analysis
39. Ademi Z, Kim H, Zomer E, Reid CM, Hollingsworth B, Liew D. Overview of pharmacoeconomic modelling methods. Br J Clin Pharmacol. Apr 2013;75(4):944-50.
40. Su HY, Nguyen TTD, Lin WH, Ou HT, Kuo S. External validation and calibration of risk equations for prediction of diabetic kidney diseases among patients with type 2 diabetes in Taiwan. Cardiovasc Diabetol. Oct 9 2024;23(1):357.
41. Yang CT, Chong KS, Wang CC, Ou HT, Kuo S. Adaptation of risk prediction equations for cardiovascular outcomes among patients with type 2 diabetes in real-world settings: a cross-institutional study using common data model approach. Cardiovasc Diabetol. Jul 10 2024;23(1):244.
42. Quan J, Ng CS, Kwok HHY, et al. Development and validation of the CHIME simulation model to assess lifetime health outcomes of prediabetes and type 2 diabetes in Chinese populations: A modeling study. PLoS Med. Jun 2021;18(6):e1003692.
43. Li P, Stuart EA, Allison DB. Multiple Imputation: A Flexible Tool for Handling Missing Data. JAMA. Nov 10 2015;314(18):1966-7.
44. Leal J, Alva M, Gregory V, et al. Estimating risk factor progression equations for the UKPDS Outcomes Model 2 (UKPDS 90). Diabet Med. Oct 2021;38(10):e14656.
45. Abridged life table in Republic of China Area, 2023 (2023).
46. TreeAge Software L. TreeAge Software, LLC - 35.2 Probability/rate conversion functions. Accessed 25 May. 2025. Available from: https://www.treeage.com/help/Content/71-Advanced-Markov-Models/2-Probability-Rate-conversions.htm
47. Wu BS, Wei CH, Yang CY, et al. Mortality rate of end-stage kidney disease patients in Taiwan. J Formos Med Assoc. Feb 2022;121 Suppl 1:S12-S19.
48. Kuo S, Yang CT, Chen HY, Ou HT. Valuing health states of people with type 2 diabetes: Analyses of the nationwide representative linked databases. J Diabetes Investig. Sep 2021;12(9):1749-1758.
49. 中華民國統計資訊網. 消費者物價基本分類暨項目群指數. Accessed 28 May. 2025. Available from: https://nstatdb.dgbas.gov.tw/dgbasAll/webMain.aspx?sys=100&funid=dgmaine
50. 門住診醫療費用申報狀況－按保險對象類別分(113.08.26更新) (2025).
51. 健保用藥品項114年6月查詢檔 (2025).
52. Karen L. Rascati P. Essentials of Pharmacoeconomics. 2nd ed. Lippincott Williams & Wilkins; 2014.
53. Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. Dec 1 2016;94(12):925-930.
54. WHO guideline on country pharmaceutical pricing policies. 2020. WHO Guidelines Approved by the Guidelines Review Committee.
55. world health o. External Reference Pricing : WHO Guideline on Country Pharmaceutical Pricing Policies. a Plain Language Summary. 1st ed. World Health Organization; 2021.
56. world health o. Value-Based Pricing : WHO Guideline on Country Pharmaceutical Pricing Policies. a Plain Language Summary. 1st ed. World Health Organization; 2021.
57. Briggs AH, Weinstein MC, Fenwick EA, et al. Model parameter estimation and uncertainty: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--6. Value Health. Sep-Oct 2012;15(6):835-42.
58. Patricia M. Danzon P, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA. Value-Based Pricing, Cost-Effectiveness Thresholds, and Affordability: Are They Compatible? Value & Outcomes Spotlight. 2020;6(4):25-27.
59. Healthcare M. International Reference Pricing vs. Value-Based Pricing: Drug Pricing Strategies. Accessed June 27. 2025. Available from: https://marksmanhealthcare.com/2023/09/11/international-reference-pricing-vs-value-based-pricing-navigating-drug-pricing-strategies/
60. Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res. 2020;4:16.
61. Neumann PJ, Garrison LP, Willke RJ. The History and Future of the "ISPOR Value Flower": Addressing Limitations of Conventional Cost-Effectiveness Analysis. Value in Health. Apr 2022;25(4):558-565.
62. Nguyen TTD, Lee YH, Lin YJ, et al. Value Framework Based on Multiple-Criteria Decision Analysis for Assessment of New Health Technologies Under Universal Healthcare Coverage System in Taiwan. Value in Health. Feb 2025;28(2):241-249.
63. Malaviya S, Shajarizadeh A, Tremblay G. Is Cost-Effectiveness Analysis a Tool to Exercise Value-Based Pricing or Monopsony Power? Evidence from Canada and Other Countries. Value in Health. Jun 2023;26(6):S234-S234.
64. Willems R, Annemans L, Siopis G, et al. Cost effectiveness review of text messaging, smartphone application, and website interventions targeting T2DM or hypertension. NPJ Digit Med. Aug 18 2023;6(1):150.
65. Davison NJ, Guthrie NL, Medland S, Lupinacci P, Nordyke RJ, Berman MA. Cost-Effectiveness Analysis of a Prescription Digital Therapeutic in Type 2 Diabetes. Adv Ther. Feb 2024;41(2):806-825.
66. Nordyke RJ, Appelbaum K, Berman MA. Estimating the Impact of Novel Digital Therapeutics in Type 2 Diabetes and Hypertension: Health Economic Analysis. J Med Internet Res. Oct 9 2019;21(10):e15814.
67. Van Wilder L, De Smedt D, Sandra L, et al. Cost-effectiveness of a digital supportive healthcare pathway for type 2 diabetes compared to usual care in Belgium. Digit Health. Jan-Dec 2025;11:20552076251319169.
68. Erskine J, Abrishami P, Bernhard J-C, et al. An international consensus panel on the potential value of Digital Surgery. BMJ open. 2024;14(9):e082875.
69. Arcà E, Heldt D, Smith M. Comparison of health technology assessments for digital therapeutics in Germany, the United Kingdom and France. Digital Health. 2025;11
70. Excellence NIfHaC. Evidence standards framework for digital health technologies. Updated 09 August 2022. Accessed 14 July. 2025. Available from: https://www.nice.org.uk/corporate/ecd7
71. Excellence NIfHaC. NICE health technology evaluations: the manual. Updated 13 May 2025. Accessed 14 July. 2025. Available from: https://www.nice.org.uk/process/pmg36/chapter/economic-evaluation-2#the-reference-case-framework
72. Hermanns N, Ehrmann D, Finke-Groene K, et al. Use of smartphone application versus written titration charts for basal insulin titration in adults with type 2 diabetes and suboptimal glycaemic control (My Dose Coach): multicentre, open-label, parallel, randomised controlled trial. Lancet Reg Health Eur. Oct 2023;33:100702.
73. Tews D, Gouveri E, Simon J, Marck C. A Smartphone-Based Application to Assist Insulin Titration in Patients Undergoing Basal Insulin-Supported Oral Antidiabetic Treatment. J Diabetes Sci Technol. Jul 2023;17(4):988-997.
74. Luo Y, Chang Y, Zhao Z, et al. Device-supported automated basal insulin titration in adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Lancet Reg Health West Pac. Jun 2023;35:100746.
75. 財團法人醫藥品查驗中心. 參、醫療科技評估財務影響分析方法學指引. 2023. December, 2023. Available from: https://www.cde.org.tw/hta/1444/1834/2155/12989/simpleList
76. 衛生福利部國民健康署. 111年癌症登記報告. 衛生福利部國民健康署. Accessed 2 June. 2025. Available from: https://www.hpa.gov.tw/Pages/List.aspx?nodeid=119
77. Taiwan TGSo. The Taiwan Guideline for Colorectal Cancer Screening. 2023. 10 January. Available from: https://www.gest.org.tw/meeting/content.php?type=&id=11&pageNo=1&continue=Y
78. 台灣衛生福利部. 健康台灣–擴展腸癌防護網「腸」常篩檢護健康. Accessed 2 June. 2025. Available from: https://www.mohw.gov.tw/cp-16-81256-1.html
79. Millien VO, Mansour NM. Bowel Preparation for Colonoscopy in 2020: A Look at the Past, Present, and Future. Curr Gastroenterol Rep. May 6 2020;22(6):28.
80. Sulz MC, Kroger A, Prakash M, Manser CN, Heinrich H, Misselwitz B. Meta-Analysis of the Effect of Bowel Preparation on Adenoma Detection: Early Adenomas Affected Stronger than Advanced Adenomas. PLoS One. 2016;11(6):e0154149.
81. 鄭吉良, 林慧婷, 崔怡寧, 鍾雅雯, 李百萍, 郭彥麟. 大腸鏡檢查品質指標與最新進展. 臺灣醫界. 2022;65(6):24-34.
82. Kastenberg D, Bertiger G, Brogadir S. Bowel preparation quality scales for colonoscopy. World J Gastroenterol. Jul 14 2018;24(26):2833-2843.
83. Tagaram SD, Chen C. Quality Tools and Techniques (Fishbone Diagram, Pareto Chart, Process Map). StatPearls. 2025.
84. Gorelik Y, Hag E, Hananya T, Leiba R, Chowers Y, Half EE. Volume of fluid consumption during preparation for colonoscopy is possibly the single most important determinant of bowel preparation adequacy. Ann Gastroenterol. 2021;34(5):705-712.
85. Zhang YY, Niu M, Wu ZY, Wang XY, Zhao YY, Gu J. The incidence of and risk factors for inadequate bowel preparation in elderly patients: A prospective observational study. Saudi J Gastroentero. Mar-Apr 2018;24(2):87-92.
86. Hautefeuille G, Lapuelle J, Chaussade S, et al. Factors related to bowel cleansing failure before colonoscopy: Results of the PACOME study. United Eur Gastroent. Feb 2014;2(1):22-29.

校內：2030-08-18公開
校外：2030-08-18公開電子論文尚未授權公開，紙本請查館藏目錄

簡易檢索 / 詳目顯示

相關論文