研究背景：
台灣在2003年癌症死因別統計中，肝癌為男性癌症死因第一位、女性癌症死因第二位；全民健康保險2002年醫療費用統計資料顯示，因慢性肝炎、肝硬化及肝癌三種疾病就醫人數總計有75萬餘人，醫療費用總計約61億餘元，其中肝癌醫療費用高達24億元；由此可見肝臟疾病對國人健康及經濟有明顯影響，其中肝癌所佔花費不但高且預後極為不佳，對於社會保險更是財務上的沉重負擔，實為臺灣地區所不容忽視的公共衛生課題。
研究目的：
本研究利用全國健保資料庫、醫院臨床個案病歷與費用資料，分析肝癌的存活情形與治療費用，並進一步探討肝癌相關因子。
研究方法：
自全民健康保險資料庫所登錄之資料，以特定主題”肝癌”分檔資料進行分析，自1996年至2002年間，ICD碼為155之肝癌患者，其中包括住院與門診檔，用以探討國內肝癌患者在各年度及長期追蹤之醫療耗費情形，並推估五年累積醫療費用及五年累積存活機率。
臨床資料摘錄自南部某醫學中心之病歷檔案與費用申報檔，研究對象自1991年至2004年底，診斷為肝癌且於該院之肝膽腸胃外科接受治療及追蹤，共計189位肝癌病患，而費用檔案採用該院健保申報之住院及門診費用檔案，自2002年至2004年底確診並追蹤為肝癌者，共計62位納入分析，根據以上資料探討累積存活機率、無病存活機率、相關危險因子、及因肝癌所花費的直接醫療費用。

結果：
健保資料，本研究以1997年肝癌患者為例，五年累積醫療費用為台幣219,398元，若僅考慮存活年數超過五年者，其累積醫療費用為491,288元；五年整體存活機率為30.8%、20.9%、15.2%、11.3%、9.7%，其中女性較男性為佳，65歲以上的人存活機率相對較低；若進一步以五年仍存活個案作為治療成功者，每拯救生命之平均醫療費用，男性為2,457,214元，而女性為1,987,874元。
醫院臨床資料發現，肝癌的相關存活危險因子以TNM期別、處置方式、肝硬化、腹水、病灶部位等為主要考量因素，但因處置方式的選擇須仰賴其他相關因素決定，其中TNM的分期仍是臨床外科病房所最重要的判定因子；術前TACE組別於本研究呈現之存活情形較其他組別佳，但平均醫療費用相對較高。
結論：
本研究藉由對全國健保資料費用與存活的分析，以及臨床檔案之存活率、無病存活率、處置組別、危險因子、與醫療費用間的關係，了解國內肝癌患者所關切之處置成效與經濟效益問題。在肝癌的成效分析上，以每拯救生命成本比較評量， 可作為未來評估預防介入計畫之成本效益的參考。

Background:
Hepatocellular carcinoma (HCC) is the leading cause of cancer in Taiwan, which consumes high medical expense among the total healthcare expenditure and becomes the significant burden to the finance of National Health Insurance (NHI). However, population-based statistics about the cost with the survival rate is rare.
Objective:
Through analyzing the data from the Bureau of National Health Insurance and hospital clinical files, we estimated the medical expenditure for treating HCC patients and the factors associated with treatment outcome.
Methods:
The National Health Insurance data from 1996 to 2002 with ICD-9 code 155 were used, which include age, gender, visiting time, and medical cost for inpatient or outpatient visits. The population-based data were analyzed to estimate 1-5 year survival probability and medical cost of HCC patients.
In hospital-based data, 189 patients from 1991 to 2004 were recorded by clinical chart and 62 of them diagnosed during 2002 and 2004 were further selected to match the claim data. These informations were used for computing survival or recurrence probability, related factors, and medical cost.
Results:
For all incident cases in 1997, the average 5-year cumulated cost was NT$ 219,398, while the cumulated cost for those patients survived more than five years was NT$ 491,288. The survival probability was 30.8% for more than one year, 20.9% for more than two years, 15.2% for more than three years, 11.3% for more than four years, and 9.7% for more than five years in 1997 respectively. Female and those age >45-65 years old seemed to have better survival outcomes than male and those age ≦45 years old or >65 years old , the averaged medical cost per treated case surviving more than five years were T$2,457,214 for male and NT$ 1,987,874 for female.
Hospital clinical data indicated that TNM stages, therapy choice, liver cirrhosis, and ascites are risk factors for surviving. Although pre-TACE treatment has higher expenditure, its five-year survival probability is better than other treatments in this research.
Conclusions:
This paper presents medical cost with survival probability and its associated factors for HCC patients and further estimates the medical cost per life saved for treating HCC patients. Our findings can offer the policy-maker, provider, and patient to evaluate the intervention or prevention program in the future.

目次
中文摘要 I
英文摘要 III
致謝 V
目次 VI
表目錄 IX
圖目錄 XI
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 4
第三節 研究目的 4
第二章 文獻探討 6
第一節 肝癌簡介 6
第二節 肝癌的相關臨床檢查值 6
第三節 肝癌治療方式及效果 13
第四節 肝癌存活與復發之相關因子 20
第五節 肝癌醫療費用之經濟評估 23
第三章 研究設計與方法 27
第一節 研究對象及資料來源 27
第二節 研究步驟及架構 28
第三節 研究變項 30
第四節 研究統計方法 33
第四章 研究結果 35
第一節 全國健保資料 35
第一項 研究對象基本資料描述 35
第二項 全民健保資料之費用分析 36
第三項 全民健保資料之存活率分析 37
第四項 費用與存活之成效分析 38
第二節臨床個案資料 38
第一項 研究對象基本資料描述 38
第二項 臨床個案存活率分析 39
第三項 臨床個案無病存活率分析 40
第四項 醫院臨床個案肝癌費用分析 41
第五章 討論 43
第一節 肝癌之存活與復發情形 43
第二節 肝癌之醫療費用分析 44
第三節 肝癌相關危險因子的討論 46
第四節 肝癌處置組別的討論 47
第五節 肝癌醫療費用與存活率關係 48

第六章 結論與建議 51
第一節 結論 51
第二節 建議 52
第三節 研究限制 52
參考文獻 54
中文部分 54
英文部分 55

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