Jung-DerWangNationalTaiwanUniversityCollegeofPublicHealthOpportunitiesforhealthindustryinTaiwan2004/11/81健康產(chǎn)業(yè)健康產(chǎn)業(yè)發(fā)展與國際化之契機王榮德臺大公衛(wèi)學院教授兼院長臺大醫(yī)院內(nèi)科主治醫(yī)師2004/11/82健康產(chǎn)業(yè)健康產(chǎn)業(yè)二十一世紀前半世紀臺灣最被看好最有希望發(fā)展之產(chǎn)業(yè)。凡是以增進人體健康為目標的產(chǎn)品或服務均是。除了直接醫(yī)療照護外，目前以生技業(yè)最為蓬勃。也包括老人照護、殘障科技輔具、減胖、美容等。2004/11/83健康產(chǎn)業(yè)行業(yè)別家數(shù)(家)從業(yè)員工數(shù)(人)員工勞動報酬支出(百萬元)全年各項收入(百萬元)生產(chǎn)總額(百萬元)醫(yī)療保健服務業(yè)20,102219,322172,745445,055439,205藥品製造業(yè)51524,42010,64971,41661,143食品及飲料製造業(yè)5,757112,85549,395451,801380,151資料來源:民國九十年工商及服務業(yè)普查總報告(行業(yè)別統(tǒng)計)表1部分健康相關產(chǎn)業(yè)之從業(yè)人數(shù)與生產(chǎn)總額之統(tǒng)計2004/11/85健康產(chǎn)業(yè)老人照護老年人口至2003年11月底已達208萬3千餘人，佔總人口數(shù)9.22%。行政院經(jīng)濟建設委員會推估，我國老年人口於2019年將達總人口數(shù)14%，正式邁入高齡社會。公元2027年達總人口數(shù)之20%2000年主計處調(diào)查結果得知有長期照護需求的老人計有17萬人。2004/11/86健康產(chǎn)業(yè)殘障科技輔具2002年內(nèi)政部的統(tǒng)計，目前身心障礙者人數(shù)有近84萬人。其中肢體障礙者近36萬人多重障礙者近8萬人這二者的人數(shù)就已佔了身心障礙者總人數(shù)的一半以上2004/11/87健康產(chǎn)業(yè)減胖行政院衛(wèi)生署公佈之1996年第三次國民營養(yǎng)調(diào)查顯示，國內(nèi)男性成年人口有14.6％為肥胖癥，女性人口有15.8％為肥胖癥。平均七個成年人就有一個是胖子，最近八年的趨勢更有增加，且以年青人更是明顯。2004/11/88健康產(chǎn)業(yè)肺癌1695311.4631.0白血病419717.53,707.1皮膚癌41300.9519.2乳房癌1015011.01,678.8子宮頸癌149645.81,232.9卵巢癌191011.51,846.3前列腺癌29481.6644.7膀胱癌44902.8687.5腎臟癌31726.2710.2*預估在4％醫(yī)療服務膨脹率下，以2％折現(xiàn)率之折現(xiàn)值。2004/11/810健康產(chǎn)業(yè)EmergingmarketsofhealthindustryforthenextdecadesProductsofmoderntechnologyaimtopromotehealth–biotechnologyfordiagnosisandtreatment,informatics,traditionalChinesemedicine,healthfood,devicesforphysicallychallengedpeopleProvidinghealthservicestopeoplecomingfromoverseasincludingthosewhotakeoff-shorejobsormigrantworkers2004/11/812健康產(chǎn)業(yè)GoodethicalconductisrequiredtowintrustfromourclientsEthics--Concernforcustomers’healthbenefitshouldprecedeprofitmakingforallhealthindustry人民健康權之公平正義先於利潤或績效之追求Informationimbalancebetweenproductssupplierandcustomers(peopleandhealthcareprofessionals)2004/11/814健康產(chǎn)業(yè)彼得杜拉克：醫(yī)療、教育及宗教事業(yè)之經(jīng)營目標在「改變生命」而非利潤。此點作為健康產(chǎn)業(yè)經(jīng)營者、投資者及從事此工作者之基本倫理；敬請從我們每位做起。Clients’healthisourfirstconcerninsteadofprofit2004/11/815健康產(chǎn)業(yè)EvidencebasedisnecessaryTocompetewithotherinternationalhealthserviceprovidersToestablishtrustfromclientsorcustomers--Informationimbalancebetweenproductssupplierandcustomers(peopleandhealthcareprofessionals)

Noonedarestoputtheirhealthcareresponsibilityonyourshouldersbeforetheyseesomeevidence2004/11/816健康產(chǎn)業(yè)Allproductsofhealthserviceindustrymustdemonstrate:Safety–Isitsafe?AristolochicacidinChineseherbs(?);Whatisthe1-or3-yearinjuryrateofthenewlydevelopedelectronicassistivedevice?Anyoccurrenceofgastritisaftertakingthehealthfoodornutrientsupplement?Efficacy-Isitreallyeffectiveasitclaims?Qualityassuranceisthebasicrequirementfortheabovetwo2004/11/817健康產(chǎn)業(yè)Howcanweobtainevidenceforahealthproduct?Clinicaltrials

–directlyapplyonpatientsorcustomerswithaspecifichealthproblemEpidemiologicalstudies

–systematicallyobservewhateverhappentotheusersAllmustbeapprovedbythe

IRB

(InstitutionalReviewBoard)2004/11/818健康產(chǎn)業(yè)OpportunitiesforinternationalhealthservicesCurrentcostsformosthealthservicesarelowerthanotherAsiancountriesgiventhatwehavesuchgoodqualitiesofservicesGlobalizationcreatesagrowingmarketforhealthserviceindustryinTaiwanCostfortravelisnotsohighcomparedwiththecosttobespentforhealthservices2004/11/820健康產(chǎn)業(yè)EstimatedgrowthofoffshorejobsintheU.S.2004/11/821健康產(chǎn)業(yè)EstimationoflifeyearslostandfinancialburdenofmajorcancersinTaiwan

Jung-DerWang,M.D.,Sc.D.Jing-ShiangHwang,Ph.D.Yu-YinChang,M.S.ChiunHsu,M.D.,Ph.D.NationalTaiwanUniversityCollegeofPublicHealthCenterforhealthriskassessmentandpolicy2004/11/823健康產(chǎn)業(yè)ObjectivesTodeterminethelifeexpectancyandlifeyearslostafteronecontractsaparticulartypeofcancerToestimatethefinancialburdentotheNationalHealthInsuranceforthemostfrequent10cancersforbothgenders2004/11/824健康產(chǎn)業(yè)EXTRAPOLATIONTOLIFE-LONG

DataStructure

Follow-upDataforanIndexPopulationTheestimatedsurvivalfunctionbyKaplan-Meiermethod,fort0Themeanqualityoflifefunctionusingkernelsmoothingmethod,fort02004/11/826健康產(chǎn)業(yè)HeavycensoringproblemInmanychronicdiseasescommonlyencountered,onemaydealwithsetsofsurvivaldatawithveryhighcensoringrates,say,morethan85%.Parametricextrapolationofsurvivalestimatesmaybeinaccurate.2004/11/827健康產(chǎn)業(yè)DataStructure

SimulationDataforaReferencePopulationForeachpatientintheindexpopulation,wechooseapersonwiththesameageandgender,fromthegeneralpopulationwithknownhazardfunction(e.g.LifeTable)ThesurvivaltimeoftheselectedindividualsaregeneratedaccordingtotheMonteCarlomethod.Thesurvivalcurve,denotedby2004/11/828健康產(chǎn)業(yè)ThelogitofW(t)approximatesastraightline,exceptforthetwotailends.ModelW(t)fort[Ts,Tf]

Theestimationbeyondfollow-upTf,2004/11/830健康產(chǎn)業(yè)Survivaloflivercancer(1990~2001)Follow-up12yrsLifetime(yr)Reference(yr)Survival2.45.119.8S.E.M.0.10.50.12004/11/831健康產(chǎn)業(yè)Logitoftheratioforlivercancer2004/11/832健康產(chǎn)業(yè)Survivaloflivercancerextrapolatedtolifetime2004/11/833健康產(chǎn)業(yè)

Survivalofbreastcancer

(1990~1999_f2001)Follow-up12yrsLifetime(yr)Reference(yr)Survival8.821.730.2S.E.M1.42.90.12004/11/834健康產(chǎn)業(yè)LogitoftheratioforBreastCancer2004/11/835健康產(chǎn)業(yè)Survivaloflivercancerextrapolatedtolifetime2004/11/836健康產(chǎn)業(yè)TestofValidityofthismethodinarealdataset

Comparisonbetweentheestimatedsurvivalyearsin12yearsoffollow-upandextrapolationforthecohort1990-1994forthetop10majorcancersinbothgendersofTaiwan

2004/11/837健康產(chǎn)業(yè)CancerSiteSamplesizeFollowupto2001Followupto1994(Extrapolatedto2001)Censoredrate(％)SurvivalYear(S.E.)Censoredrate(％)SurvivalYear(S.E.)OralCavity686931.75.2(0.2)61.15.6(0.5)Nasopharynx554737.16.1(0.2)69.86.0(1.0)Esophagus293613.62.5(0.3)32.22.5(0.6)Stomach1193828.14.4(0.2)48.44.3(0.5)2004/11/838健康產(chǎn)業(yè)CancerSiteSamplesizeFollowupto2001Followupto1994(Extrapolatedto2001)Censoredrate(％)SurvivalYear(S.E.)Censoredrate(％)SurvivalYear(S.E.)Colon1699341.66.3(0.1)68.76.2(0.4)Liver1692612.92.4(0.1)30.52.5(0.3)Gallbladder144920.93.5(0.4)43.44.0(0.6)Pancreas211213.42.1(0.4)24.92.1(0.8)Lung1695313.42.4(0.1)30.42.4(0.3)2004/11/839健康產(chǎn)業(yè)CancerSiteSamplesizeFollowupto2001Followupto1994(Extrapolatedto2001)Censoredrate(％)SurvivalYear(S.E.)Censoredrate(％)SurvivalYear(S.E.)Leukemia419727.24.3(0.3)50.44.5(0.7)Skin413061.18.6(0.2)84.98.8(0.7)Breast1015060.98.6(0.1)85.28.2(0.9)Cervix1496471.89.4(0.1)86.99.1(0.7)2004/11/840健康產(chǎn)業(yè)CancerSiteSamplesizeFollowupto2001Followupto1994(Extrapolatedto2001)Censoredrate(％)SurvivalYear(S.E.)Censoredrate(％)SurvivalYear(S.E.)Ovary191051.57.2(0.3)72.47.6(1.3)Prostate294834.66.2(0.3)75.16.4(1.1)UrinaryBladder449045.66.9(0.3)74.47.2(0.8)Kidney317242.26.4(0.3)68.36.6(1.1)2004/11/841健康產(chǎn)業(yè)Thecohortofpatientsdiagnosedwithacancerduring1990-1999wasestablishedandfollowedtotheendof2001Theestimatedmeansurvivaltimesin12yearsoffollow-upandlifelong,andexpectedyearslostinlifelong(nextslides)2004/11/842健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostOralCavity1905240.15.3(0.1)8.7(1.9)15.4Nasopharynx1180347.86.4(0.2)11.2(2.5)17.2Oesophagus697714.32.3(0.2)4.6(0.6)12.4stomach2683132.04.4(0.1)9.3(0.5)7.917cancers(includingtop10forbothgenders2004/11/843健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostColon4363149.06.3(0.1)12.8(0.5)5.4Liver4768216.62.4(0.1)5.1(0.3)14.7Gallbladder364421.83.2(0.3)6.3(1.1)9.9Pancreas550611.21.8(0.2)4.0(0.5)12.5Lung4190113.22.2(0.1)4.1(0.3)11.417cancers(cont.)2004/11/844健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostLeukemia954830.14.2(0.2)14.6(2.6)17.5Skin1090672.08.8(0.2)18.2(6.7)0.9Breast2725172.48.9(0.1)19.6(4.2)11.0Cervix3999080.79.8(0.1)23.8(4.0)5.817cancers(cont.)2004/11/845健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostOvary469356.57.2(0.3)20.4(5.7)11.5Prostate944753.36.5(0.2)8.7(0.4)1.6Bladder1108255.27.0(0.1)12.7(1.4)2.8Kidney848550.56.4(0.2)12.5(2.6)6.217cancers(cont.)2004/11/846健康產(chǎn)業(yè)Theestimatedmeansurvivaltimesin12yearsoffollow-upandforlifelong,andexpectedyearslostinlifelong

(classifiedinto4subcohortsbyageintervals,20-44,45-54,55-64and65+years)2004/11/847健康產(chǎn)業(yè)Yearsoflifelostofcancerpatientssincediagnosisamong20-44yearsoldinTaiwan.2004/11/848健康產(chǎn)業(yè)Yearsoflifelostofcancerpatientssincediagnosisamong45-54yearsoldinTaiwan.2004/11/849健康產(chǎn)業(yè)Yearsoflifelostofcancerpatientssincediagnosisamong55-64yearsoldinTaiwan.2004/11/850健康產(chǎn)業(yè)Yearsoflifelostofcancerpatientssincediagnosisamong65+yearsoldinTaiwan.2004/11/851健康產(chǎn)業(yè)Amoregeneralmodel:xi:determinant(s)ofS(survival)andU(utility)functions

e.g.headinjury,stroke,…..,etc.Qualityadjustedsurvival

Qol(t|xi):qualityoflifefunction2004/11/852健康產(chǎn)業(yè)Expectedwagesleftover=Expectedlifelongmedicalcost=Expectedutilityleftover=Costofdiseasexi=

+2004/11/853健康產(chǎn)業(yè)NHIcostin2001ofthe17cancers

(adjustedwithdiscountrateandinflationrateofmedicalservices)2004/11/854健康產(chǎn)業(yè)cancerNumber

AveragecostBreast34,92954,086±104,892Stomach13,31081,090±146,076Kidney7,35348,171±103,147Lung22,304110,771±168,382Skin4,36821,921±58,088UrinaryBladder9,74847,198±92,0812004/11/855健康產(chǎn)業(yè)cancerNumber

AveragecostColon40,90263,733±126,193Liver31,36869,000±108,383OralCavity15,67795,042±171,251Esophagus6,05593,039±193,372Nasopharynx13,90852,776±111,887Prostate10,34864,606±87,5152004/11/856健康產(chǎn)業(yè)cancerNumber

AveragecostPancreas

3,23193,690±156,606Leukemia

5,236207,028±431,980Cervix22,22540,868±96,107Gallbladder

2,35989,615±155,744Ovary

5,36672,131±159,8492004/11/857健康產(chǎn)業(yè)AnnualchangeratesofGeneralconsumerpriceindex(Discount),Medicinesandmedicalcare(inTaiwan)2004/11/858健康產(chǎn)業(yè)EstimatedmeanhealthcareexpenditurespentbyNHIfordifferenttypesofcancers:(adjustedforannualdiscountratesandmedicalserviceinflationratesof2%and4%)2004/11/859健康產(chǎn)業(yè)InflationrateInflationrateformedicalserviceLiverLung0%0%352,413466,6672%492,201635,2454%735,158919,6002%0%269,722364,1442%352,413466,6674%488,676631,0494%0%218,866299,5822%270,975365,7174%352,413466,6672004/11/860健康產(chǎn)業(yè)InflationrateInflationrateformedicalserviceBreastCervix0%0%1,172,747893,2822%1,691,8471,241,5004%2,586,8241,814,7772%0%864,005676,5612%1,172,747893,2824%1,678,7991,232,9274%0%673,649537,2852%868,688679,9244%1,172,747893,2822004/11/861健康產(chǎn)業(yè)InflationrateInflationrateformedicalservicestomachcolon0%0%716,333787,8052%984,1701,067,4894%1,434,8601,528,1152%0%552,451613,0732%716,333787,8054%977,5161,060,6074%0%448,321499,9532%554,976615,7934%716,333787,8052004/11/862健康產(chǎn)業(yè)InflationrateInflationrateforMedicalserviceSkinLeukemia0%0%381,3232,407,0462%522,6903,742,0964%759,2466,278,1452%0%294,0231,684,5882%381,3232,407,0464%519,1893,707,0684%0%237,9081,275,5182%295,3761,695,0384%381,3232,407,0462004/11/863健康產(chǎn)業(yè)InflationrateInflationrateformedicalserviceOralCavityNasopharynx0%0%691,147534,3232%823,959668,7934%1,004,655868,3132%0%592,883441,9432%691,147534,3234%820,955665,6334%0%519,508377,0382%594,538443,4484%691,147534,3232004/11/864健康產(chǎn)業(yè)InflationrateInflationrateformedicalserviceEsophagusGallbladder0%0%431,757551,6452%587,092741,9854%845,6931,054,1502%0%336,404432,7222%431,757551,6454%583,247737,3074%0%276,026355,9862%337,872434,5714%431,757551,6452004/11/865健康產(chǎn)業(yè)InflationrateInflationrateformedicalservicePancreasProstate0%0%356,292549,9242%498,892646,8444%743,695776,3752%0%271,075476,9492%356,292549,9244%495,315644,6704%0%218,299421,5682%272,371478,1894%356,292549,9242004/11/866健康產(chǎn)業(yè)InflationrateInflationrateformedicalserviceUrinaryBladderOvary0%0%530,1281,275,1372%691,3781,861,1494%945,1022,895,9472%0%424,842933,5352%530,1281,275,1374%687,4911,846,2704%0%353,905726,1332%426,518938,6704%530,1281,275,1372004/11/867健康產(chǎn)業(yè)InflationrateInflationrateformedicalserviceKidney0%0%543,8892%714,3744%987,8072%0%434,1882%543,8894%710,2324%0%361,0202%435,9244%543,8892004/11/868健康產(chǎn)業(yè)HwangJS,TsauoJY,WangJD.(theory)

StatisticsinMedicine1996;15:93-102HwangJS,WangJD.(extrapolationtolifetime)

StatisticsinMedicine1999;18:1627HwangJS,WangJD.(extendedtohealthprofile)QualityofLifeResearch2004;13:1-10WangJD.Basicprinciplesandpracticalapplicationsinepidemiologicalresearch.Singapore:WorldScientific,20022004/11/869健康產(chǎn)業(yè)THANKYOUFORYOURATTENTION

2004/11/870健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL1905240.15.3(0.1)8.7(1.9)15.420-44511844.25.7(0.2)9.7(3.4)26.845-54525242.05.4(0.3)9.5(3.6)17.255-64467539.85.2(0.3)7.1(1.7)11.765+393331.84.3(0.3)5.5(1.2)5.1OralCavity(ICD-140)2004/11/871健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL1180347.86.4(0.2)11.2(2.5)17.220-44468655.97.3(0.3)15.3(6.0)23.545-54282650.46.7(0.4)10.2(4.2)17.255-64250339.85.5(0.3)6.7(1.2)12.665+160129.54.3(0.4)5.7(0.8)5.6Nasopharynx

(ICD-147)2004/11/872健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL697714.32.3(0.2)4.6(0.6)12.420-4458514.52.2(0.6)2.9(4.2)31.845-54109213.02.2(0.4)4.3(1.1)21.855-64199714.82.5(0.3)4.0(0.8)14.265+328414.02.3(0.2)3.2(0.3)6.7Oesophagus(ICD-150)2004/11/873健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL2683132.04.4(0.1)9.3(0.5)7.920-44293939.55.3(0.3)13.1(4.6)26.745-54291140.95.4(0.4)11.4(2.9)16.255-64589035.04.8(0.2)8.3(0.9)10.565+1496727.23.8(0.2)5.2(0.3)4.6Stomach(ICD-151)2004/11/874健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL4363149.06.3(0.1)12.8(0.5)5.420-44492851.96.7(0.2)20.4(3.1)19.445-54556857.17.3(0.3)15.2(2.9)12.655-641089852.46.8(0.2)11.7(1.1)7.565+2201144.45.7(0.1)7.5(0.2)2.6Colon(ICD-153)2004/11/875健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL4768216.62.4(0.1)5.1(0.3)14.720-44666718.12.6(0.2)6.4(1.7)31.245-54825617.22.5(0.2)4.8(0.6)21.855-641389716.62.4(0.1)3.8(0.5)15.165+1841214.92.2(0.1)3.1(0.2)7.4Liver(ICD-155)2004/11/876健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL364421.83.2(0.3)6.3(1.1)9.920-4422535.64.8(1.6)14.5(5.7)23.645-5443327.73.9(0.7)5.9(4.9)21.855-6486526.03.7(0.6)6.3(2.2)12.965+210917.12.6(0.4)3.7(0.6)6.5Gallbladder(ICD-156)2004/11/877健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL550611.21.8(0.2)4.0(0.5)12.520-4439626.33.6(0.9)10.5(3.4)27.345-5467114.02.1(0.6)4.5(2.5)22.855-6413289.71.7(0.3)2.8(0.7)16.165+30788.71.4(0.2)2.1(0.3)8.0Pancreas(ICD-157)2004/11/878健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL4190113.22.2(0.1)4.1(0.3)11.420-44237518.32.8(0.3)6.6(2.4)31.845-54423415.12.5(0.2)4.9(1.2)22.555-641009913.62.3(0.1)3.4(0.4)15.265+2503811.91.9(0.1)2.7(0.1)7.3Lung(ICD-162)2004/11/879健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL954830.14.2(0.2)14.6(2.6)17.520-44215131.14.4(0.3)12.2(4.3)30.845-54100726.73.7(0.5)6.9(3.2)20.855-64151620.33.1(0.4)5.0(1.0)14.365+281215.72.5(0.3)3.4(0.5)6.8Leukemia(ICD-169)2004/11/880健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurvival(S.E.)

LifeYearSurvival(S.E.)

YearsofLifeLostALL1090672.08.8(0.2)18.2(6.7)0.920-44151785.210.3(0.4)29.1(22.1)12.245-54120979.69.7(0.4)20.4(11.6)7.355-64230473.89.1(0.3)13.5(4.1)5.765+564165.57.9(0.4)9.8(0.5)0.0Skin(ICD-173)2004/11/881健康產(chǎn)業(yè)CohortCohortSizeCensoredRate(%)12yearSurviva