如何有效的降低醫療成本並維持優良的醫療品質一直是我國醫療機構經營者欲關切的議題。自民國96年以來，國人因口腔相關惡性腫瘤花費逐年攀升，與90年相較，民國100年台灣癌症標準死亡率減少了7.6%的幅度，而口腔癌整體而言成長了18.1%，顯示台灣口腔癌病患並沒有受益於現今醫藥與醫療科技的發達而延長壽命。綜合國內許多口腔相關惡性腫瘤之研究，學者多著重於臨床的效益，少有研究探討不同科別治療的差異性，本研究將以醫院經營者之角度比較國內口腔癌病患分別於耳鼻喉科及口腔外科之間的成本效益與治療方式差異性，將使用衛生福利部健康資料加值應用協作中心自民國91年至97年兩百萬人抽樣檔為主要資料來源，研究對象首先篩選自門診及住院主診斷碼ICD-9為140、141、143、144、145、149，再篩選出看診科別為耳鼻喉科及口腔外科，並以就診次數最多之看診科別定義為該病患之主要科別，另外藉由癌症登記檔分類腫瘤期別以及串聯各科別間治療方式，及藉由死因檔之死亡日期往前計算病患第一次因口腔癌就診之存活天數，目的是比較不同期別(第零期及第一期、第二期、第三期、第四期)於各個科別治療下，在成本效益、存活天數及醫療費用結果上的差異性。研究結果發現相較於口腔外科醫師，耳鼻喉科醫師在各期別中有較長的住院天數與住院費用，且於治療第三期的病患有較佳的成本效益；口腔外科醫師在第一期、第二期、第四期病患的治療上有較好的成本效益。存活天數與三年、五年存活狀況於各期別間無統計上顯著差異，不同科別於各期別之間不同的治療組合方式以及其延遲治療的狀況需要再更進一步探討。

Compared with the year 2001, the cancer standard death rate reduced by 7.6% in 2011; however, a dramatic rise in oral cavity cancer grew by 18.1%. There has been a constant rise of medical expenditure on oral malignant tumor. The main preoccupation of domestic health care providers has been aiming to bring down cost and maintain medical quality. Most prior studies related to oral cavity cancer merely focused on the clinic outcomes. Therefore, this study aims to compare the cost-effectiveness between ENT (ear-nose-throat) and oral surgery departments. The samples of this study were drawn from the registered Taiwan National Health Insurance database in the period from 2002 to 2008. The total number of samples is two million strong, all randomly selected. These samples go through two more steps of reselection. First, the inclusion criteria is based on Inpatient expenditures by admission and Ambulatory care expenditures by visits from selective International Classification of Disease 9th version (ICD-9) codes 140, 141, 143, 144, 145, 149. Second, samples will be divided into ENT department or oral surgery department, whose chief medical department will later be determined by the highest number of occurrence. Classification of cancer stages and mode of treatments are also analyzed by Taiwan Cancer Registry Long form. Survival days are counted from the subtraction of patients' first clinic date and the death date. In all stages, ENT group has longer length of stays and higher hospital expenses. Better cost effectiveness is performed by ENT group on the third stage. The rest stages are performed better by oral surgery (the first, second and the fourth stage).There are no significances on survival days and treatment modes. Modes of treatment sequences and inadequate treatments should be further explored.

國立中山大學研究生學位論文審定書 i
致謝 ii
中文摘要 iii
英文摘要 iv
目錄 v
表目錄 vi
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 口腔癌的概述 5
第二節 口腔癌的治療 5
第三節 比較國內外情形 8
第四節 成本效益分析 9
第三章 研究方法 12
第一節 資料來源與研究對象 12
第二節 統計分析 15
第三節　研究架構 21
第四章 結果 22
第五章 討論 53
第六章 結論 57
第七章 研究限制與建議 58
參考文獻 60
表4-1、第一期病患的基本特性 23
表4-2、第二期病患的基本特性 26
表4-3、第三期病患的基本特性 28
表4-4、第四期病患的基本特性 31
表4-5、第一期病患的基本特性的成本效益(觀察至98年) 33
表4-6、第二期病患基本特性的成本效益(觀察至98年) 35
表4-7、第三期病患基本特性的成本效益(觀察至98年) 37
表4-8、第四期病患基本特性的成本效益(觀察至98年) 39
表4-9、第一期門住診人數、費用、住院&存活天數、治療方式及成本效益的關係 41
表4-10、第二期門住診人數、費用、住院&存活天數、治療方式及成本效益的關係 43
表4-11、第三期門住診人數、費用、住院&存活天數、治療方式及成本效益的關係 45
表4-12、第四期門住診人數、費用、住院&存活天數、治療方式及成本效益的關係 47
表4-13、各期別病患三年存活情形(觀察至98年) 49
表4-14、各期別病患五年存活情形(觀察至98年) 50
表4-15、各期別之間的成本效益逐步迴歸分析 51
表4-16、各期別於及各科別之間醫療費用、存活天數與成本效益之差異 52

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