目標：本研究探討與高雄縣結核病例改診斷問題有關的因素，並就改診斷問題進行相關的成本效益分析。方法：以高雄縣2001年1月1日至2001年8月31日確診登記個案725人為研究對象，追蹤管理至2002年5月31日止，分析其最終管理結果，並依建保局費用組給付標準及官方制定結核病管理辦法計算改診斷病例之成本效益比。另以存活方法分析與改診斷問題有關的因素。結果：1.改診斷率達8.1%(59/725)。2.驗痰結果陰性者改診斷之機會是驗痰結果陽性者的3.942倍，95%信賴區間為1.488～10.444。3.改診斷之成本效益比值為5.24-5.97倍，平均每位改診斷病例節省醫療管理費用達新台幣11,263～12,829元。結論：建議新制度登記辦法對於疑似結核病例宜建立一個確定診斷的討論機制，以減少不必要的醫療和管理開支。

Objectives: The purpose of this study was to investigate factors associated with tuberculosis (TB) mis-diagnosis for those TB cases already recorded in the TB registration. The cost-benefit for the detection of tuberculosis mis-diagnosis was also estimated. Methods: A total of 725 consecutive TB cases were collected from the TB registration records between January 1 and August 31,2001 in Kaohsiung County, Taiwan. They had been followed up for 17 months until May 31,2002. Survival analyses were used to investigate factors associated with mis-diagnosis of TB. In addition, a cost-benefit analysis was conducted to assess the impact of the early detection of TB mis-diagnosis on medical expenditure. Results: Major findings included: 1. Fifty-nine patients (8.1%) of 725 cases initially diagnosed as TB were found to have been mis0diagnosed during the later follow-up period; 2. Sputum smear negative for acid-fast bacilli was associated with a higher rate of initial mis-diagnosis of TB (RR: 3.942, 95% CI: 1.488~10.444); and 3. A cost-benefit ratio for the early detection of mis-diagnosis of TB was calculated as 5.24-5.97. On the average, it corresponded to a medical expense saving of NT$ 11,263~12,829 for each misdiagnosed TB case detected. Conclusions: A well-organized evaluation procedure should be established to ensure appropriate tuberculosis diagnosis and to save unnecessary case management and medical expenditure.

結核病；改診斷；成本效益分析

tuberculosis; early detection of mis-diagnosis of TB; cost-benefit analysis