研究背景
台灣的藥物支出占醫療支出比例為25%，遠高於其他先進國家。在新藥與醫療支出的相關研究，依不同的醫療環境與藥物種類結果並不相同，以台灣全民健保的醫療環境，新藥與醫療支出之間的關係仍需進一步的研究。為了更精確分析兩者關係，以目前給付品項數最多且門診藥物支出歷年位居前三名的降血壓藥物為對象，其中藥理機轉最新且最晚納入健保給付的新藥為血管張力素受體阻斷劑(Angiotensin II receptor blockers；ARB)。

研究目的
分析高血壓病患中，使用血管張力素受體阻斷劑之病患相較於其他降壓藥物的使用者，於各項醫療支出的差異。

研究方法
本研究為回溯性研究，利用1997至2004年之「全民健康保險研究資料庫抽樣歸人檔」，擷取1998年2月起第一次使用口服降壓藥之病患，並以藥品占率(Proportion of days covered；PDC)方法分成ARB組與非ARB組，追蹤三年後，比較兩組平均每人三年的醫療支出，包括：總醫療支出、藥物支出、非藥物支出、門住診各項支出以及心血管相關醫療支出。以複迴歸分析與分量迴歸方法，控制病人特性、就醫環境與順從性，了解ARB的使用與各項醫療支出的關係。

研究結果
1998年2月起第一次使用口服降壓藥之病患共57,850人，經過排除標準與藥品占率>70%的條件下，共7978人納入研究，ARB組135位與非ARB組7,874位。病患用藥以單一種降壓藥治療為主，且ARB使用者分佈於年紀較長、疾病程度較嚴重與評鑑層級較高的醫院。結果顯示ARB組病人其平均每人三年的總醫療支出、藥物支出與非藥物醫療支出比非ARB組病人多；在病人特性(年齡、疾病嚴重度)與就醫環境條件相同之下的次分析，僅有醫學中心ARB組平均每人三年的總醫療支出比非ARB者多，而在其他評鑑等級醫院僅藥物花費較非ARB組多。以複迴歸方法控制各種影響因素下，ARB的使用與藥物支出、非藥物醫療支出、總醫療支出皆成正相關，而於某一定量的非藥物醫療花費(q0.75分量)與ARB的使用成負相關，但未達統計上的意義。此外，在單一用藥族群的次分析，ARB組的順從性指標，除了血管張力素轉換酶抑制劑外，皆比其他降血壓用藥組別佳。

結論
整體而言，使用降血壓新藥ARB的病人其平均每人三年的總醫療支出，較使用其他降壓藥物的使用者多，主要來自於ARB組的藥物支出多於其他降壓藥物的使用者，兩組的非藥物醫療支出沒有差異。單一用藥的病患之順從性指標，ARB組較非ARB組佳。

Background
The ratio of drug expenditure among health expenditure is about 25% in Taiwan, which is higher than other developed countries’. Studies of the relationship between new drug and health expenditure found different results by various medical environment and class of drugs. The impact of new drug on health expenditure was rarely investigation in Taiwan. Therefore, we aimed to study the expenditure of antihypertensive treatment and analyze the effect of the newest antihypertensive agents, Angiotensin II receptor blockers (ARB).

Objective
Analyze the difference of various health expenditure between Angiotensin II receptor blockers users and other antihypertensive drugs users in hypertensive patients.

Methods
This study was a retrospective study, using the sampled cohort NHI claim database from 1997 through 2004. We selected the patients, who had taken antihypertensive drugs for the first time from February 1998, and divided the patients into ARB groups and non-ARB groups by medicine proportion of days covered (PDC) in the following three years. Various health expenditure were calculated for comparison, including total expenditure, drug expenditure, non-drug expenditure, outpatient and inpatient expenditure and cardiovascular relative expenditure. Besides, we controlled patients characteristics, hospital environment and compliance to analyze the relationship between new drug and health expenditure by multiple linear regression and quantile regression.

Results
There were 7,978 patients recruited, including 135 ARB users and 7874 non-ARB users. Most patients had taken one antihypertensive drug. In general, ARB users were older, with more serious disease and cared in hospitals of higher accreditation level. The average three-year total expenditure , drug expenditure and non-drug expenditure per patient in ARB users were higher than non-ARB users. When two groups patients characteristics (age, disease level) and hospital environment were adjusted, ARB users' average three-year total expenditure per patient was higher than non-ARB users' only in medical center. In other accreditation level, ARB users' drug expenditure were more than non-ARB users'. There were the positive impacts of ARB on various expenditure by controlling various confounding factors and the negative impacts of ARB on q0.75 non-drug expenditure, but not statistically. Besides, in the subgroup analysis of single medicine group, the complicance indicator of ARB users was better than non-ARB users, excepting angiotensin converting enzyme inhibitors.

Conclusion
ARB users' total expenditure was higher than other antihypertensive drugs users. Especially in most accreditation level, ARB users' drug expenditure was higher than non-ARB users'.

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