背景：大腸癌發生率與死亡率持續的增加，許多針對治療的研究，希望能降低整體的死亡率。近年由於大腸癌的早期診斷率低及治療效果，因此越來越多研究關注篩檢的成效。大腸癌的篩檢被證實可降低大腸癌的發生率以及死亡率，因此政府也在2004年開始推動篩檢政策，但在有限的資源下，評估疾病的預防策略是否真正能夠帶來醫療照護支出的減少，及降低患者生產力的損失，將是提供政策重要的參考。目前有部分研究針對大腸癌篩檢醫療照顧費用的評估，但少有研究針對患者因病所造成的生產力損失做評估，且過去研究無法反映終身的生產力的狀況，更無法確切地估計篩檢政策對於生產力狀況是否帶來正向的效果。
目的：本研究以就業年數作為生產力評估指標，旨在評估台灣大腸癌患者的終身生產力損失，並以過去篩檢資料為佐證，期望能藉此使民眾瞭解疾病，以及疾病預防可能帶來的影響，提供政府大腸癌預防政策的參考。
研究方法：本研究使用全民健康保險資料庫，納入2004-2017年所有註記在癌症登記資料庫之大腸癌患者，以期別分0-4期；對照族群為年齡、性別與診斷年與大腸癌匹配之一般人。透過長期追蹤的資料，進行外推估算患者終身的存活函數，求出平均餘命(Life expectancy, LE)、及平均餘命損失(Loss of life expectancy, loss-of-LE)；再串聯大腸癌篩檢檔以取得病患是否因篩檢而提早發現大腸癌之資訊，以比較有接受篩檢及未篩檢者平均餘命損失之差異。並考慮患者65歲前每個年齡層在觀察期間之就業比例，累加起來可得出終身就業年數；將之與匹配之對照組相比，可得各期別之終身就業年數損失。以經篩檢與非經篩檢發現為各期別加權比例之依據，加總後估計並比較有接受篩檢及未篩檢者之終身就業年數損失。
研究結果：比較性別之差異，男性較女性終身就業年數損失更多，且越晚期診斷則性別差異更大。而以期別來看，第0、I期被診斷之患者幾乎無終身就業年數損失，第II~IV期之大腸癌患者診斷年齡越年輕，終身就業年數損失越大；第III期男性及女性分別都比其第IV期損失要少近6年以上。50-54歲年齡層中，男性經篩檢發現者較非經篩檢發現者之就業年數少損失1.35年，而女性經篩檢發現者少0.92年。篩檢與非經篩檢的平均餘命損失和就業年數損失，兩者皆隨年齡越大而遞減。比較性別之差異可發現，經篩檢發現較非經篩檢各年齡層所獲得的平均餘命女性大於男性，終身就業年數則為男性大於女性。
結論：在年輕者（45-54歲）以及早期治療（第0-I期）大腸癌，可以增加更多的平均餘命，並增加更多就業年數；年紀越輕經篩檢者，平均餘命損失要較非經篩檢者少越多，可見篩檢可提早發現並提早治療，延長患者的存活，並降低生產力的損失。大腸癌篩檢所獲得各年齡層所獲得的平均餘命女性大於男性，終身就業年數則為男性大於女性，有性別差異。

The aim of this study is to estimate the lifetime employment duration (LED) and loss-of lifetime employment duration (loss-of-LED), and the patients with colorectal cancer which were detected or non-detected by screening until 65-year-old. The subjects of this study were enrolled the patients with colorectal cancer who were first diagnosed in 2004 to 2017. The Kaplan-Meier method was used during the follow-up period of the patients. Simulating corresponding age-, sex-, and calendar year-matched referents for lifetime and employment duration extrapolation of the survival function by rolling-over algorithm. Multiplied each stage by the proportion for screening and non-screening groups and added them up to estimate the average benefit of screening. The finding showed that younger people (45-54 years old) and earlier stage (stage 0-I) colorectal cancer can saved lives and employment duration. The average life expectancy in younger people which detected by screened is much less than those who are not screened. According to the result of this study, colorectal screening program can lead to earlier detection and earlier treatment, prolong patients’ survival, and reduce productivity losses.

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