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หากในใจตน เห็นไดดวยใจ แตใจมืดมาร ใชตาจนเคย

พญ.กัลยา ตีระวัฒนานนท 28/5/2553

โครงการประเมินเทคโนโลยีและนโยบายด้านสุขภาพ ชั้น 6 อาคาร 6 กรมอนามัย กระทรวงสาธารณสุข ถ.ติวานนท์ อ.เมือง จ.นนทบุรี 11000 โทร : 02-590-4549, 02-290-4374-5 โทรสาร : 02-590-4369 www.hitap.net

รายงานการวิจัย ความคุ้มค่าของการผ่าตัดต้อกระจกโดยใส่เลนส์แก้วตาเทียมชนิดนิ่มเปรียบเทียบกับชนิดแข็งในบริบทของประเทศไทย

ดวงตามืดมัวหมองหมน ยังคงสวางสุกใส โลกกวางใหญนี้ทั้งใบ ชางงดงามเหลือประมาณ ดวงตาสวางใสตระการ มิอาจเปนสุขไดเลย เปดใจกวางอยานิ่งเฉย ละเลยคุณคาของใจ

รายงานการวิจัย ความคุ้มค่าของการผ่าตัดต้อกระจก โดยใส่เลนส์แก้วตาเทียมชนิดนิ่มเปรียบเทียบกับ ชนิดแข็งในบริบทของประเทศไทย Cost-effectiveness Analysis of Cataract Surgery Using a Foldable and a Rigid Intraocular Lens in Thailand

โครงการนี้ไดรับทุนสนับสนุนจาก สำนักงานวิจัยเพื่อการพัฒนาหลักประกันสุขภาพไทย (สวปก.)


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Abstract

This study aims to evaluate the accessibility of cataract surgery as well as the factors associated with accessibility, paying particular attention to the comparison between two health insurance coverage schemes i.e. the Civil Servant Medical Benefit scheme (CSMBS) and the Universal Coverage scheme (UC). Data was obtained from the Central Office for Healthcare Information (CHI) and the National Health Security Office (NHSO). Moreover, this study also assessed the value for money of foldable intraocular lens insertion in cataract surgery compared to rigid intraocular lens insertion under the Thai context. The model-based economic evaluation was conducted using a healthcare provider’s perspective. Regarding the accessibility of cataract surgery, there was an increasing number of cataract surgeries performed each year over the last 5 years, especially among those under the UC. Most UC patients (95%) undertook the surgery in the same provinces where they were eligible for the treatment. It was found that larger provinces had a higher cataract surgery rate per population. One ophthalmologist would significantly increase the rate of cataract surgery (52 times). Furthermore, patients under the CSMBS were 22 times more likely to undergo cataract surgery using foldable intraocular lens compared to those under the UC scheme. The patients with rigid intraocular lens insertion had significantly more surgical complications than those with foldable intraocular lens. It was also noted that those patients undergoing cataract surgery at teaching hospitals or private hospitals had a significantly higher rate of surgical complications than those receiving treatment at provincial hospitals. The cost-effectiveness analysis of cataract surgery indicated that foldable intraocular lens insertion was not cost-effective given the willingness to pay threshold (ceiling threshold) at 200,000 Baht per quality adjusted life year (QALY). The Subcommittee for Development of Health Benefit Package and Service Delivery of the

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Health Intervention and Technology Assessment Program

vi ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ NHSO concurred with this judgment. Results of this study are in accordance with the current NHSO policy which supports the use of a rigid intraocular lens. 

In addition, this study shows that the current rate for reimbursement of both rigid and foldable intraocular lens are much higher than the current market prices obtained from the price survey conducted by the research team. It was estimated that the UC scheme would save 238 million baht and the CSMBS would save 55 million baht per year if they set the new reimbursement rate for the lens. Moreover, If the reimbursement rate was set equally (using the rate of rigid intraocular lens) to support the use of rigid intraocular lens as indicated in the cost-effectiveness analysis, both the UC scheme and CSMBS would save the healthcare budget 378 million Baht annually.

 

 

 


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šœÎµ 懘o°„¦³‹„ Áž}œ£µª³š¸ÉÁ¨œ­r„oª˜µ (Crystalline lens) ¤¸‡ªµ¤…»nœ¤´ª ¨³Áž}œ­µÁ®˜» ­Îµ‡´…°Š£µª³˜µ°—Ĝ脨³Äœž¦³Áš«Åš¥(1) ­µÁ®˜»…°Šž¦³µ„¦˜µ°—š´ÉªÃ¨„Äœ ¡.«. 2545 Á„·—‹µ„懘o°„¦³‹„ ‹Îµœªœ 17.6 ¨oµœ‡œ ‡·—Áž}œ¦o°¥¨³ 47.83 ‹µ„„µ¦­Îµ¦ª‹£µª³˜µ °—®nŠµ˜· ¡.«. 2537 ˜o°„¦³‹„Áž}œ­µÁ®˜»˜µ°—™¹Š¦o°¥¨³ 74.6 ¨³„µ¦­Îµ¦ª‹­£µª³˜µ °—¨³Ã¦‡˜µš¸ÉÁž}œž{®µ­µ›µ¦–­»…Äœž¦³Áš«Åš¥ ¦³®ªnµŠ ¡.«.2549 – 2550 ¡ªnµ ˜o° „¦³‹„¥´ŠÁž}œ­µÁ®˜»˜µ°—š¸É¡¤µ„š¸É­»—(2) ­µÁ®˜»…°ŠÃ¦‡˜o°„¦³‹„­nªœÄ®nÁ„·—‹µ„ Á¨œ­r „oª˜µÁ­ºÉ°¤˜µ¤ª´¥ Ž¹ÉŠ¡Äœª´¥­¼Š°µ¥» ž{‹‹»´œŸ¼o­¼Š°µ¥»¤¸‹Îµœªœ¤µ„…¹Êœ šÎµÄ®o¤¸Ÿ¼ožiª¥˜o° „¦³‹„Á¡·É¤…¹Êœ°¥nµŠ¦ª—Á¦Èª °Š‡r„µ¦°œµ¤´¥Ã¨„‡µ—ªnµÃ¦‡˜o°„¦³‹„œ·—°— (Blinding cataract) ‹³¡Å—o ž¦³¤µ– 100 ‡œ˜n°¡¨Á¤º°Š 100,000 ‡œ(2) Ĝž¦³Áš«Åš¥‹µ„„µ¦­Îµ¦ª‹£µª³˜µ°—®nŠµ˜· ¡.«. 2537 ¡‡ªµ¤»„…°ŠŸ¼ožiª¥˜o°„¦³‹„œ·—°—­¼Š­»—š¸É¦·Áª–£µ‡Á®œº° ˜µ¤—oª¥£µ‡Ä˜o £µ‡„¨µŠ ¨³£µ‡˜³ª´œ°°„ÁŒ¸¥ŠÁ®œº° ¡Áž}œ 5.77, 3.50, 3.16 ¨³ 1.69 ˜n°Ÿ¼ožiª¥˜o° „¦³‹„ 1,000 ‡œ ˜µ¤¨Îµ—´ ×¥¡ÄœŸ¼ožiª¥°µ¥»¤µ„„ªnµ®¦º°Ášnµ„´ 60 že™¹Š¦o°¥¨³ 94.34(3) ‹µ„„µ¦­Îµ¦ª‹­£µª³˜µ°—¨³Ã¦‡˜µš¸ÉÁž}œž{®µ­µ›µ¦–­»…Äœž¦³Áš«Åš¥ ¦³®ªnµŠ¡.«. 2549 - 2550 ¡ªnµ‹ÎµœªœŸ¼ožiª¥˜o°„¦³‹„˜„‡oµŠ (Cataract backlog) ŗo¨—¨ŠÁž}œ¨Îµ—´ ÁœºÉ°Š‹µ„ÂœªÃœo¤…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœž¦³Áš«Åš¥­¼Š…¹Êœ Ÿ¼ožiª¥¤¸‡ªµ¤­œÄ‹Â¨³Á…oµ™¹Š ¦·„µ¦¤µ„…¹Êœ (4,5) ˜n„È¡ªnµµŠ¡ºÊœš¸É¤¸Ÿ¼ožiª¥¦°‡·ªŸnµ˜´—Áž}œ‹Îµœªœ¤µ„ Ĝ…–³š¸ÉµŠ¡ºÊœš¸É Ťn˜o°Š¦°‡·ªœµœ ­—Š™¹Šª·›¸¦·®µ¦‹´—„µ¦ „µ¦‡´—„¦°ŠŸ¼ožiª¥ ¨³„µ¦Á…oµ™¹Š¦·„µ¦š¸É˜„˜nµŠ „´œ œ°„‹µ„œ¸ÊŸ¼ožiª¥š¸Éŗo¦´„µ¦Ÿnµ˜´—°µ‹‹³Áž}œŸ¼ožiª¥š¸ÉÁ ž}œ˜o°„¦³‹„Ťn¤µ„ ˜n­µ¤µ¦™ Á…oµ™¹Š¦·„µ¦Å—o—¸„ªnµ Ĝ…–³š¸ÉŸ¼ožiª ¥š¸É‹ÎµÁž}œ˜o°ŠŸnµ˜´— Ánœ Ÿ¼ožiª ¥š¸É°¥¼nĜÁ„–”rÁ ž}œ˜o° „¦³‹„œ·—°—°µ‹‹³¥´ŠÅ¤nŗo¦´„µ¦Ÿnµ˜´— „µ¦¦´„¬µÃ¦‡˜o°„¦³‹„×¥„µ¦Äo¥µ¥´ŠÅ¤n¤¸…o°¤¼¨¥ºœ¥´œÂœnœ°œªnµÄoŗoŸ¨—¸Äœ„µ¦ žj°Š„´œÂ¨³¦´„¬µ ž{‹‹»´œ„µ¦Ÿnµ˜´—Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ÄœÃ¦‡˜o°„¦³‹„š¸É¤¸…o°nŠ¸ÊÁž}œ„µ¦ ¦´„¬µš¸ÉŗoŸ¨—¸ Á¨œ­r„oª˜µÁš¸¥¤‹³nª¥Ä®oŸ¼ožiª¥¤°ŠÁ®ÈœÂ¨³Äo­µ¥˜µÅ—oĄ¨oÁ‡¸¥Š­µ¥˜µž„˜· ¤µ„…¹Êœ „µ¦Ÿnµ˜´—˜o°„¦³‹„Áž}œ„µ¦Ÿnµ˜´—š¸ÉšÎµ¤µ„š¸É­»—Äœ¦³¥³ 10 žeš¸ÉŸnµœ¤µ ¨³„µ¦Ä­n Á¨œ­r„oª˜µÁš¸¥¤„ÈÁž}œ„µ¦Ä­n°ª´¥ª³Áš¸¥¤š¸É¤µ„š¸É­»—Äœž{‹‹»´œ ¨³Áž}œ„µ¦¨Šš»œš¸É‡»o¤‡nµ¤µ„ (6-9) ­Îµ®¦´ž¦³Áš«Åš¥Á¨œ­r„oª˜µÁš¸¥¤Å—o¦´„µ¦Âœ³œÎµÄ®očoĜŸ¼ožiª¥Ÿnµ˜´—懘o°„¦³‹„š»„

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Health Intervention and Technology Assessment Program ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

‡œš¸É¤¸…o°nŠ¸ÊšµŠ„µ¦Â¡š¥r¤µ˜´ÊŠÂ˜nže ¡.«. 2537 (10) Á¨œ­r  „o ª ˜µÁš¸ ¥ ¤š¸É ¤¸ ‹Î µ ®œn µ ¥Äœ ž¦³Áš«Åš¥Äœ¦³¥³Â¦„œ´ÊœÁž}œÂÁ¨œ­r…Ȋ¡´Å¤nŗo (Rigid non-foldable lens) ¤¸¦µ‡µ˜´ÊŠÂ˜n 700 – 4,000 µš (11) Ž¹ÉŠ¤¸„µ¦«¹„¬µ‡»–£µ¡¸ª·˜…°ŠŸ¼ožiª¥š¸ÉčoÁ¨œ­r„oª˜µÁš¸¥¤š¸É¤¸¦µ‡µ ˜„˜nµŠ„´œÄœ„µ¦Ÿnµ˜´—˜o°„¦³‹„ ¡ªnµ¦µ‡µš¸É˜„˜nµŠ„´œ…°ŠÁ¨œ­r„oª˜µÁš¸¥¤Å¤nŗošÎµÄ®o ‡»–£µ¡¸ª·˜Â¨³„µ¦¤°ŠÁ®Èœ®¨´ŠŸnµ˜´—…°ŠŸ¼ožiª¥Â˜„˜nµŠ„´œ (12) Ĝ¦³¥³®¨´Š„µ¦Ÿnµ˜´—˜o°„¦³‹„¡´•œµ…¹Êœ¤µ„ ¤¸„µ¦­¨µ¥˜o°„¦³‹„ץčo‡¨ºÉœÁ­¸¥Š ‡ªµ¤™¸É­¼Š (Phacoemulsification) Ž¹ÉŠÂŸ¨Ÿnµ˜´—‹³¤¸…œµ—Á¨È„ž¦³¤µ– 3 - 4 ¤¤.(13) ‹¹Š¤¸„µ¦ ‡·—‡oœÁ¨œ­rœ·É¤¡´Å—o (Foldable lens) Ž¹ÉŠÅ¤n˜o°Š…¥µ¥ÂŸ¨šÎµÄ®oŸ¨Ÿnµ˜´—¤¸…œµ—Á¨È„„ªnµÁ—·¤ ­nŠŸ¨Ä®o¦³¥³Áª¨µ¡´„¢gœ®¨´ŠŸnµ˜´—œo°¥„ªnµ „µ¦¤°ŠÁ®Èœ—¸„ªnµÃ—¥ÁŒ¡µ³¦³¥³Â¦„®¨´Š„µ¦ Ÿnµ˜´— ˜n¦µ‡µ…°ŠÁ¨œ­rœ·É¤„È¡Š„ªnµ (¦µ‡µž¦³¤µ– 6,000 µš) ¨³¥´ŠÅ¤n¤¸®¨´„“µœ¥ºœ¥´œ ªnµÁ¨œ­r œ·É¤—¸„ªn µÁ¨œ­r Â…È ŠÄœÂŠn …°Š¦³—´ „µ¦¤°ŠÁ®Èœ…°ŠŸ¼oži ª ¥®¨´ ŠŸn µ˜´ —˜o °„¦³‹„ Án œ „µ¦«¹„¬µ…°Š «»£¨´„¬–r¨³‡–³ ¡ªnµ„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—¡´Å¤nŗo‹³¤°ŠÁ®Èœ —¸ „ ªn µ „µ¦Ä­n Á ¨œ­r „o ª ˜µÁš¸ ¥ ¤œ· — ¡´  ŗo Ä œš» „ „¨»n ¤ °µ¥» ˜n Å ¤n ¤¸ ‡ ªµ¤Â˜„˜n µ Š„´ œ °¥n µ Š¤¸ œ´¥­Îµ‡´šµŠ­™·˜·ÄœŸ¼ožiª¥„¨»n¤°µ¥» 40-59 že ­nªœÄœŸ¼ožiª¥°µ¥»œo°¥„ªnµ 40 že ¨³°µ¥»¤µ„„ªnµ 59 že ¡ªn µ „µ¦Ä­n Á ¨œ­r  „o ª ˜µÁš¸ ¥ ¤œ· — ¡´  Ťn Å —o šÎ µ Ä®o Ÿ¼o ži ª ¥¤°ŠÁ®È œ ŗo —¸ „ ªn µ °¥n µ Š¤¸ œ´¥­Îµ‡´šµŠ­™·˜· °µ‹ÁœºÉ°Š¤µ‹µ„Á¤ºÉ°Ä­nÁ¨œ­r¡´ Ÿ¼ožiª¥Å¤n˜o°ŠÁ¥ÈÂŸ¨®¨´Š„µ¦Ÿnµ˜´— —´Šœ´Êœ ‹¹Š°µ‹šÎµÄ®oÁ„·—­µ¥˜µÁ°¸¥ŠÅ—o °¥nµŠÅ¦„È—¸ ¡ªnµ‹´„¬»Â¡š¥r¡°Ä‹Â¨³œ·¥¤„µ¦Ä­nÁ¨œ­r¡´ ¤µ„„ªnµÁ¡¦µ³ÂŸ¨Ÿnµ˜´—Á¨È„„ªnµ Ťn˜o°ŠŒ¸—¥µµ¦³®ªnµŠŸnµ˜´— ¨³Å¤n˜o°ŠÁ¥ÈÂŸ¨®¨´ŠŸnµ˜´— (14) Ĝž{‹‹»´œÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤¡´Å—o¤¸„µ¦¡´•œµ˜n°ÁœºÉ°Š Ánœ Á¨œ­r„oª˜µÁš¸¥¤ ¤¸Ã¢„´­®¨µ¥¦³¥³ (Multifocal intraocular lens) Ž¹ÉŠnª¥Ä®o¤°ŠÄ„¨oŗo°¥nµŠ´—Á‹œÃ—¥Å¤n ˜o°ŠÄoªnœ°nµœ®œ´Š­º° (15) œ°„‹µ„œ¸Ê¥´Š¤¸Á¨œ­r„oª˜µÁš¸¥¤°¸„¤µ„¤µ¥®¨µ¥œ·—š¸É°°„ ¤µÁ¡ºÉ°Â„oŅ…o°„¡¦n°Š…°ŠÁ¨œ­r„oª˜µÁš¸¥¤Á—·¤ Á¡ºÉ°Ä®oŗoÁ¨œ­r„oª˜µÁš¸¥¤š¸ÉÁ®¤µ³­¤„´ ¨´ „ ¬–³…°ŠÃ¦‡Â¨³» ‡ ¨· „ £µ¡…°ŠŸ¼o ži ª ¥ Ĝž¦³Áš«Åš¥…–³œ¸Ê Ÿ¼o ži ª ¥š¸É Å —o ¦´  „µ¦Ÿn µ ˜´ — ˜o°„¦³‹„‹³Å—o¦´„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤š´ÊŠœ·—…Ȋ¨³œ·É¤ ˜µ¤ª·›¸„µ¦Ÿnµ˜´—¨³­·š›·Äœ„µ¦ ¦´„¬µ…°ŠŸ¼ožiª¥ ­Îµœ´„Šµœ®¨´„ž¦³„´œ­»…£µ¡Â®nŠµ˜·Ä®ošµŠÃ¦Š¡¥µµ¨Á·„‹nµ¥‡nµÁ¨œ­r „o ª˜µÁš¸¥¤Å—o ˜µ¤‹¦· ŠÂ˜nÅ ¤nÁ „· œ 4,000 µš ™o µŸ¼o žiª ¥˜o °Š„µ¦Ä­n Á¨œ­rœ·É¤˜o °Š¦´ Ÿ· —° ‹nµ¥ÁŠ·œÁ¡·É¤Ä®o„nšµŠÃ¦Š¡¥µµ¨ž¦³¤µ– 2,000 µš ­Îµ®¦´Ÿ¼ožiª¥Á·„Å—o˜µ¤­·š›· …oµ¦µ„µ¦ šµŠ„¦¤´¸„¨µŠ°œ»¤´˜·Ä®oÁ·„Å—o 6,000 µš Ášnµ„´¦µ‡µÁ¨œ­rœ·É¤ —´Šœ´Êœ­·š›· ž¦³„´œ­»…£µ¡…°ŠŸ¼ožiª¥‹¹Š­nŠŸ¨˜n°„µ¦Á¨º°„čoÁ¨œ­r„oª˜µÁš¸¥¤¦³®ªnµŠœ·—œ·É¤Â¨³Â…ÈŠ


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‹µ„„µ¦ššªœª¦¦–„¦¦¤ Á¤ºÉ°Áž¦¸¥Áš¸¥‡ªµ¤‡»o¤‡nµšµŠ„µ¦Â¡š¥r¦³®ªnµŠÁ¨œ­r …Ȋ„´Á¨œ­rœ·É¤ÄœŸ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„Äœž¦³Áš«­„°˜Â¨œ—r ¡ªnµÅ¤n¤¸‡ªµ¤Â˜„˜nµŠ…°Š £µª³Âš¦„Žo°œ…°Š„µ¦Ä­nÁ¨œ­rš´ÊŠ­°Š„¨»n¤Äœ¦³¥³Áª¨µ 2 že®¨´Š„µ¦Ÿnµ˜´— ¨³˜oœš»œ…°Š„µ¦ ¦´„¬µ˜´ÊŠÂ˜n„µ¦Ÿnµ˜´—‹œ™¹Š„µ¦˜·—˜µ¤®¨´Š„µ¦Ÿnµ˜´—Ťn¡‡ªµ¤Â˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´ šµŠ­™· ˜· (16) œ°„‹µ„œ¸Ê ¥´ Š ¤¸ „ µ¦«¹ „ ¬µ‡ªµ¤‡»o ¤ ‡n µ …°Š„µ¦Ä­n Á ¨œ­r  œ· — ℴ ­ ¦³¥³Á—¸ ¥ ª (Monofocal) Áž¦¸¥Áš¸¥„´Á¨œ­rš¸É¤¸Ã¢„´­®¨µ¥¦³¥³ (Multifocal) Ĝž¦³Áš«ÁœÁ›°¦r¨œ—r ¡ªnµ‡»–£µ¡¸ª·˜…°Šš´ÊŠ­°Š„¨»n¤Å¤n¤¸‡ªµ¤Â˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· ¤oªnµ˜oœš»œ Ĝ„µ¦Ÿn µ ˜´ — Ä­n Á ¨œ­r  œ· — ℴ ­ ®¨µ¥¦³¥³‹³­¼ Š „ªn µ ˜n Ÿ¼o ži ª ¥š¸É Ä ­n Á ¨œ­r à ¢„´ ­ ¦³¥³Á—¸ ¥ ª¤¸ ‡nµÄo‹nµ¥­Îµ®¦´„µ¦Ä­nªnœ˜µ¤µ„„ªnµ ÁœºÉ°Š‹µ„Ÿ¼ožiª¥¤´„˜´—ªnœš¸ÉčoÁ¨œ­r¦µ‡µÂ¡ŠšÎµÄ®o ‡nµÄo‹nµ¥Ã—¥¦ª¤…°ŠŸ¼oš¸ÉÄ­nÁ¨œ­rℴ­¦³¥³Á—¸¥ª­¼Š„ªnµÁ¨È„œo°¥ (17) °¥nµŠÅ¦„Șµ¤ Ĝž¦³Áš« Ś¥¥´ŠÅ¤nÁ‡¥¤¸„µ¦«¹„¬µ—oµœ‡ªµ¤‡»o¤‡nµšµŠ„µ¦Â¡š¥r…°Š„µ¦Ä­nÁ¨œ­r…ȊÁž¦¸¥Áš¸¥„´ Á¨œ­rœ·É¤Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„ —´Šœ´Êœ ‹µ„„µ¦ž¦³»¤Ÿ¼oÁ¸É¥ªµÁ¡ºÉ°‡´—Á¨º°„®´ª…o°Šµœª·‹´¥ …°Š­Îµœ´„Šµœª·‹´¥Á¡ºÉ°„µ¦¡´•œµ®¨´„ž¦³„´œ­»…£µ¡Åš¥ (­ªž„.) ž¦³‹Îµže ¡.«. 2551 ¤¸¤˜·Ä®o š¸¤œ´„ª·‹´¥Ã‡¦Š„µ¦ž¦³Á¤·œÁš‡ÃœÃ¨¥¸Â¨³œÃ¥µ¥—oµœ­»…£µ¡—εÁœ·œŠµœª·‹´¥Á¡ºÉ°ž¦³Á¤·œ ‡ªµ¤‡»o¤‡nµ…°Š„µ¦Ä­nÁ¨œ­rœ·É¤Á¤ºÉ°Áž¦¸¥Áš¸¥„´Á¨œ­r…ȊĜ„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœ¦·š…°Š ž¦³Áš«Åš¥ ÁœºÉ°Š‹µ„Äœž{‹‹»´œ„µ¦«¹„¬µÄœ®´ª…o°—´Š„¨nµª¥´Š‡Š¤¸°¥¼nœo°¥¤µ„ œ°„‹µ„œ¸Ê‹³ šÎµ„µ¦«¹„¬µ„µ¦Á…oµ™¹Š¦·„µ¦…°ŠŸ¼ožiª¥˜o°„¦³‹„ Á¡ºÉ°Áž}œ…o°¤¼¨­Îµ‡´Äœ„µ¦Ÿ¨´„—´œœÃ¥µ¥ Ĝ„µ¦ž¦´ž¦»Š¦³„µ¦‹nµ¥ÁŠ·œ­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥š¸É¤¸­·š›·ž¦³„´œ­»…£µ¡ ˜nµŠÇ £µ¥Ä˜o¦³ž¦³„´œ­»…£µ¡Äœž¦³Áš«Åš¥ ª´˜™»ž¦³­Š‡r 1.1 Á¡ºÉ°«¹„¬µ„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦Â¨³­·š›· ž¦³„´œ­»…£µ¡™oªœ®œoµ 1.2 Á¡ºÉ°«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥­·š›·­ª´­—·„µ¦ …oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ 1.3 Á¡ºÉ°ª·Á‡¦µ³®r˜oœš»œž¦³­·š›·Ÿ¨…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rœ·É¤Áž¦¸¥Áš¸¥„´Á¨œ­r …Ȋ…°ŠŸ¼ožiª¥Äœž¦³Áš«Åš¥ ­Îµ®¦´¦µ¥Šµœ„µ¦ª·‹´¥Œ´œ¸Ê‹³ÂnŠ„µ¦«¹„¬µ°°„Áž}œ 2 ­nªœ ­nªœš¸É 1. ¦µ¥ŠµœŸ¨„µ¦ª·‹´¥˜µ¤ª´˜™»ž¦³­Š‡r…o°š¸É 1.1 ¨³ 1.2 ­nªœš¸É 2. ¦µ¥ŠµœŸ¨„µ¦ª·‹´¥˜µ¤ª´˜™»ž¦³­Š‡r…o°š¸É 1.3


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Health Intervention and Technology Assessment Program ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

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1.2 ¦³Á¸¥ª·›¸ª·‹¥´ 1.2.1 „µ¦‹´—„µ¦“µœ…o°¤¼¨…°ŠŸ¼ožiª¥Ã¦‡˜o°„¦³‹„ „µ¦«¹„¬µœ¸Êŗo¦ª¦ª¤“µœ…o°¤¼¨„µ¦Ÿnµ˜´—˜o°„¦³‹„‹µ„ 2 ®¨nŠ“µœ…o°¤¼¨ Á¡ºÉ°Ä®o ‡¦°‡¨»¤Ÿ¼ožiª¥˜o°„¦³‹„š´Éªž¦³Áš« ŗo„n (1) “µœ…o°¤¼¨‹µ„­Îµœ´„Šµœ„¨µŠ­µ¦­œÁš«¦·„µ¦­»…£µ¡ (­„­.) Ž¹ÉŠž¦³„°—oª¥ …o° ¤¼ ¨ Ÿ¼oži ª ¥Äœš¸É ¤¸ ­· š ›· ­ ª´ ­ —·„ µ¦…o µ ¦µ„µ¦Â¨³­· š ›· ž ¦³„´ œ ­»… £µ¡™oª œ®œoµ ˜´Ê Š ˜nª´ œ š¸É 1 ¤„¦µ‡¤ ¡.«. 2546 – 31 ›´œªµ‡¤ ¡.«. 2550 ˜µ¤¦µ¥„µ¦Ã¦‡Â¨³®´˜™„µ¦š¸ÉÁ„¸É¥ª…o°Š„´„µ¦ Ÿnµ˜´—˜o°„¦³‹„ Ž¹ÉŠÁž}œ“µœ…o°¤¼¨Äœ¦³„¨»n¤ª·œ·‹Œ´¥Ã¦‡¦nª¤ (Diagnosis related group; DRGs)* Ášnµœ´Êœ (—´Š˜µ¦µŠš¸É 30 ¨³ 31 ץǦŠ­¦oµŠ…o°¤¼¨Ÿ¼ožiª¥ÄœÅ—o­—ŠÅªoĜ˜µ¦µŠš¸É 32 Ĝ£µ‡Ÿœª„) (2) “µœ…o°¤¼¨Äœ®œnª¥¦·„µ¦Á·Š¦»„…°Š„µ¦¦·®µ¦‹´—„µ¦Ã‡¦Š„µ¦—¼Â¨¦´„¬µŸ¼o¤¸ž{®µ —oµœ­µ¥˜µ°´œÁœºÉ°Š‹µ„Á¨œ­r˜µ®¦º°Ã‡¦Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ Ĝ¦³®¨´„ž¦³„´œ­»…£µ¡ ®nŠµ˜· ­Îµœ´„¦·®µ¦‹´—„µ¦Ã¦‡ÁŒ¡µ³ ­Îµœ´„Šµœ®¨´„ž¦³„´œ­»…£µ¡Â®nŠµ˜·† ǦŠ„µ¦œ¸Ê¤¸ ª´˜ ™» ž ¦³­Š‡r Á ¡ºÉ ° Á¡·É ¤ „µ¦Á…o µ ™¹ Š ¦· „ µ¦ ¨—„µ¦¦°‡· ª ¨³Á¡·É ¤ ‡» – £µ¡„µ¦¦´ „ ¬µš¸É ™¼ „ ˜o ° Š ¦ª¤š´ÊŠ¡´•œµ¦³„µ¦¦·„µ¦Â„nŸ¼ožiª¥š¸É¤¸ž{®µ—oµœ­µ¥˜µÄ®o‡¦°‡¨»¤š»„¡ºÊœš¸É ŗo¤µ˜¦“µœ ˜´ÊŠÂ˜n„µ¦‡oœ®µŸ¼ožiª¥ „µ¦—¼Â¨¦´„¬µÄœ®œnª¥¦·„µ¦Â¨³°°„®œnª¥Á‡¨ºÉ°œš¸É „µ¦¢gœ¢¼—¼Â¨ ˜n°ÁœºÉ°Š®¨´Š„µ¦¦´„¬µÁ¡ºÉ°žj°Š„´œ„µ¦˜µ°—ÁœºÉ°Š‹µ„„µ¦¦´„¬µš¸ÉŤnš´œšnªŠš¸ ǦŠ„µ¦² —´Š„¨nµªœ¸ÊÁ¦·É¤—εÁœ·œ„µ¦˜´ÊŠÂ˜n 1 ˜»¨µ‡¤ ¡.«.2549 Áž}œ˜oœ¤µ (18) Ž¹ÉŠ“µœ…o°¤¼¨—´Š„¨nµª‡¸¥r …o°¤¼¨ÄœÃž¦Â„¦¤ DMIS Ž¹ÉŠ¤¸Ã‡¦Š­¦oµŠ…o°¤¼¨—´Š˜µ¦µŠš¸É 33 Ĝ£µ‡Ÿœª„

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Health Intervention and Technology Assessment Program ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

1.2.2 „µ¦ª·Á‡¦µ³®r…o°¤¼¨„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦ ¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ 1.2.2.1 ‡ªµ¤»„…°ŠŸ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„ ‹Î µ œªœŸ¼o ži ª ¥š¸É Ÿn µ ˜´ — ˜o ° „¦³‹„ÄœŸ¼o ži ª ¥­· š ›· ­ ª´ ­ —· „ µ¦…o µ ¦µ„µ¦Â¨³­· š ›· ž ¦³„´ œ ­»…£µ¡™oªœ®œoµ˜´ÊŠÂ˜n ¡.«. 2548 – 2550 ŗo‹µ„„µ¦—¹Š…o°¤¼¨‹ÎµœªœŸ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„ ‹µ„¦®´­®´˜™„µ¦„µ¦Ÿnµ˜´—˜o°„¦³‹„š´ÊŠ®¤— (—´Š˜µ¦µŠš¸É 31 Ĝ£µ‡Ÿœª„) ĜǦŠ­¦oµŠ…o°¤¼¨ Ÿ¼ožiª¥Äœ ¦®´­®´˜™„µ¦˜´ªš¸É 1 ™¹Š 20 ®¨´Š‹µ„œ´ÊœÁºÉ°¤Ã¥Š…o°¤¼¨‹´Š®ª´—š¸ÉŸ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„ °µ«´¥°¥¼nץčo¦®´­Ã¦Š¡¥µµ¨š¸É¤¸­·š›·Äœ„µ¦¦´„¬µ…°ŠŸ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„„´“µœ…o°¤¼¨ ºÉ°Â¨³š¸É˜´Ê Š…°ŠÃ¦Š¡¥µµ¨…°Š«¼œ¥r¤µ˜¦“µœ¦®´­Â¨³…o °¤¼¨ ­»…£µ¡Â®nŠµ˜· ‹¹ ŠÅ—o …o°¤¼ ¨ ‹ÎµœªœŸ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„‹ÎµÂœ„˜µ¤‹´Š®ª´—š¸É°¥¼n°µ«´¥Á¡ºÉ°œÎµ¤µÂ­—Š‡ªµ¤»„…°ŠŸ¼ožiª¥ Ÿn µ ˜´ — ˜o ° „¦³‹„˜n ¨ ³‹´ Š ®ª´ — ‹µ„œ´Ê œ œÎ µ…o °¤¼ ¨ —´ Š „¨n µ ª¤µž¦´  “µœ˜µ¤Ã‡¦Š­¦o µ Š°µ¥» … °Š ž¦³µ„¦¦µ¥‹´Š®ª´—‡ Á¡ºÉ°¨—‡ªµ¤Ãœo¤Á°¸¥Š (bias) …°ŠÃ‡¦Š­¦oµŠ°µ¥»…°Šž¦³µ„¦Â˜n¨³ ‹´Š®ª´—š¸É˜„˜nµŠ„´œ —´Š­¼˜¦˜n°Åžœ¸Ê °´˜¦µ‡ªµ¤»„Ÿ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„ž¦´“µœÃ—¥˜¦Š = [(ťPsi * Ci) / Ps] * K Psi = ž¦³µ„¦¤µ˜¦“µœÄœ„¨»n¤°µ¥» i Ps = ž¦³µ„¦¤µ˜¦“µœ¦ª¤ Ci = °´˜¦µŸ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„Äœ„¨»¤n °µ¥» i …°ŠÂ˜n¨³‹´Š®ª´— K = ‡nµ‡Šš¸É 1,000 (˜n°ž¦³µ„¦ 1,000 ‡œ) ®¨´Š‹µ„š¸Éŗo°´˜¦µ‡ªµ¤»„Ÿ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„‹ÎµÂœ„˜µ¤‹´Š®ª´—˜´ÊŠÂ˜n ¡.«.2548 – 2550 œÎµ¤µÂ­—Š‡ªµ¤»„œÂŸœš¸Éž¦³Áš«Åš¥ ץčoަ„¦¤ ArcView GIS š´ÊŠœ¸Ê«¹„¬µ ÁŒ¡µ³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ÁœºÉ°Š‹µ„ 1. …o°¤¼¨¦³®ªnµŠ ¡.«.2548 - 2550 ¤¸…o°¤¼¨š¸É­¤¼¦–r 2. …o°¤¼¨¦®´­Ã¦Š¡¥µµ¨š¸É¤¸­·š›·„µ¦¦´„¬µÁ¦·É¤¤¸´œš¹„˜´ÊŠÂ˜n ¡.«.2548-2550 Ĝ­·š›· ž¦³„´œ­»…£µ¡™oªœ®œoµÁšnµœ´Êœ 3. …o°¤¼¨¦®´­Ã¦Š¡¥µµ¨š¸É¤¸­·š›·…°Š­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦œ´ÊœÅ¤n¤¸„µ¦´œš¹„…o°¤¼¨ 

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Health Intervention and Technology Assessment Program ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

1.2.2.2 „µ¦„¦³‹µ¥…°Š‹´„¬»Â¡š¥r …o°¤¼¨‹Îµœªœ‹´„¬»Â¡š¥r¦µ¥‹´Š®ª´— ¡.«.2548 – 2550 ŗo¤µ‹µ„¦µ¥Šµœš¦´¡¥µ„¦ ­µ›µ¦–­»… ¡.«.2548 – 2550 (19) „¦³š¦ªŠ­µ›µ¦–­»… œÎµ‹Îµœªœ‹´„¬»Â¡š¥r¦µ¥‹´Š®ª´—ž¦´ Ä®oÁž}œ°´˜¦µ‹´„¬»Â¡š¥r˜n°ž¦³µ„¦°¥nµŠ®¥µÄœÂ˜n¨³‹´Š®ª´— —´Š­¼˜¦˜n°Åžœ¸Ê °´˜¦µ‹´„¬»Â¡š¥r˜n°ž¦³µ„¦¦µ¥‹´Š®ª´—°¥nµŠ®¥µ = (No_oph / Pp) * K No_oph = ‹Îµœªœ‹´„¬»Â¡š¥r¦µ¥‹´Š®ª´— = ‹Îµœªœž¦³µ„¦¦ª¤Â˜n¨³‹´Š®ª´— Pp K = ‡nµ‡Šš¸É 100,000 (˜n°ž¦³µ„¦ 100,000 ‡œ) ®¨´ Š ‹µ„œ´Ê œ œÎ µ °´ ˜ ¦µš¸É Å —o Å žÂ­—Š„µ¦„¦³‹µ¥…°Š‹´ „ ¬»  ¡š¥r  ˜n ¨ ³‹´ Š ®ª´ — ץčo ަ„¦¤ÂŸœš¸É ArcView GIS ȱ

1.2.3 „µ¦ª·Á‡¦µ³®rž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ 1.2.3.1 Áž¦¸¥Áš¸¥¦³®ªnµŠŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦„´Ÿ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡ ™oªœ®œoµ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ¦³®ªnµŠŸ¼ožiª¥­·š›· ­ª´­—·„µ¦…oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµšÎµÅ—o×¥—¹Š…o°¤¼¨Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o° „¦³‹„š¸É¤¸®´˜™„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ ¦³®ªnµŠª´œš¸É 1 ¤„¦µ‡¤ ¡.«. 2549 - ª´œš¸É 31 ›´œªµ‡¤ ¡.«. 2549 Ž¹ÉŠÁž}œžeš¸É¤¸‹ÎµœªœŸnµ˜´—­¼ŠÂ¨³¤¸…o°¤¼¨­¤¼¦–rš¸É­»— ­™·˜·š¸ÉčoĜ„µ¦ ª·Á‡¦µ³®r ‡º° Chi - square ץčoަ„¦¤­ÎµÁ¦È‹¦¼žÄœ„µ¦ª·Á‡¦µ³®r ¨³˜´ªÂž¦š¸ÉčoĜ„µ¦ ª·Á‡¦µ³®r ŗo„n ­·š›·„µ¦¦´„¬µ (UC=­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ; CSMBS=­·š›·­ª´­—·„µ¦ …oµ¦µ„µ¦) Á¡« (0=µ¥; 1=®·Š) nªŠ°µ¥» œ·—…°ŠÁ¨œ­r (2006=Á¨œ­rœ·—œ·É¤; 2007=Á¨œ­r œ·—Â…ÈŠ)


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9

1.2.3.2 Áž¦¸¥Áš¸¥¦³®ªnµŠŸ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµš¸ÉŸnµ˜´—Äœ‹´Š®ª´—š¸É¤¸„µ¦ Ÿnµ˜´—˜o°„¦³‹„¤µ„„´‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ…°ŠŸ¼ožiª¥­·š›· ž¦³„´œ­»…£µ¡™oªœ®œoµ Ĝ¡.«. 2549 ¦³®ªnµŠ‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„ (7 ‡œ ˜n°ž¦³µ„¦ 1,000 ‡œ) ž¦³„°—oª¥ ‹´Š®ª´—œ‡¦¡œ¤ ­¤»š¦­µ‡¦ ¨³£¼Á„Ș ‹´Š®ª´—š¸É¤¸„µ¦ Ÿnµ˜´—˜o°„¦³‹„œo°¥ (1 ‡œ˜n°ž¦³µ„¦ 1,000 ‡œ) ž¦³„°—oª¥ ‹´Š®ª´—¦o°¥Á°È— ­»¦·œš¦r ­¤»š¦ž¦µ„µ¦ ¨³ž{˜˜µœ¸ ­™·˜·š¸ÉčoĜ„µ¦ª·Á‡¦µ³®r ‡º° Chi - square ץčoަ„¦¤ ­ÎµÁ¦È‹¦¼žÄœ„µ¦ª·Á‡¦µ³®r ¨³˜´ªÂž¦š¸ÉčoĜ„µ¦ª·Á‡¦µ³®r ŗo„n Á¡« (0=µ¥; 1=®·Š) nªŠ°µ¥» œ·—…°ŠÁ¨œ­r (2006=Á¨œ­rœ·—œ·É¤; 2007=Á¨œ­rœ·—Â…ÈŠ) 1.2.3.3 Áž¦¸¥Áš¸¥¦³®ªnµŠŸ¼ožiª¥š¸ÉŸµn ˜´—˜o°„¦³‹„ץčoÁ¨œ­rœ·É¤Â¨³Á¨œ­r…Ȋ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ…°ŠŸ¼ožiª¥­·š›· ž¦³„´œ­»…£µ¡™oªœ®œoµ Ĝ¡.«. 2549 ¦³®ªnµŠŸ¼ožiª¥š¸Éŗo¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ץčoÁ¨œ­rœ·É¤ ¨³Á¨œ­r…Ȋ ­™·˜·š¸ÉčoĜ„µ¦ª·Á‡¦µ³®r ‡º° ­™·˜· Chi-square ¨³ t-test čoަ„¦¤­ÎµÁ¦È‹¦¼ž Ĝ„µ¦ª·Á‡¦µ³®r ×¥˜´ªÂž¦š¸ÉčoĜ„µ¦ª·Á‡¦µ³®rÁž}œ…o°¤¼¨¦µ¥»‡‡¨ ŗo„n Á¡« (0=µ¥; 1= ®·Š) °µ¥» (že) ­·š›·„µ¦¦´„¬µ (0=UC; 1=CSMBS) ž¦³Á£šÃ¦Š¡¥µµ¨š¸É¦´„¬µ 1.2.4ȱ „µ¦ª·Á‡¦µ³®rž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥­·š›·­ª´­—·„µ¦ …oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ „µ¦«¹„¬µÄœ‡¦´ÊŠœ¸Ê¤¸ª´˜™»ž¦³­Š‡rš¸É‹³«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š¦·„µ¦Ÿnµ˜´—˜o° „¦³‹„ ŗo  „n ž{ ‹ ‹´ ¥ š¸É ¤¸ Ÿ ¨˜n ° ‹Î µ œªœ„µ¦Ÿn µ ˜´ — Ĝ‹´ Š ®ª´ — š¸É ¤¸ „ µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„¤µ„Á¤ºÉ ° Áž¦¸¥Áš¸¥„´‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ ž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸É čo­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ ¨³ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á„·—£µª³Âš¦„Žo°œ (Complication) …°Š „µ¦Ÿnµ˜´—˜o°„¦³‹„ 1.2.4.1 ž{ ‹ ‹´ ¥ š¸É ¤¸ Ÿ ¨˜n ° ‹Î µ œªœ„µ¦Ÿn µ ˜´ — Ĝ‹´ Š ®ª´ — š¸É ¤¸ „ µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„¤µ„Á¤ºÉ ° Áž¦¸¥Áš¸¥ „´‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ „µ¦ª·Á‡¦µ³®rž{‹‹´¥š¸É¤¸Ÿ¨˜n°‹Îµœªœ„µ¦Ÿnµ˜´—Äœ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„Á¤ºÉ° Áž¦¸ ¥ Áš¸ ¥ „´  ‹´ Š ®ª´ — š¸É ¤¸ „ µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„œo ° ¥Ã—¥šÎ µ „µ¦«¹ „ ¬µÄœŸ¼o ži ª ¥­· š ›· ž ¦³„´ œ ­»…£µ¡™oªœ®œoµ že ¡.«. 2549 ×¥—¹Š…o°¤¼¨‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„š¸É­»— 20 ‹´Š®ª´— ¨³‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥š¸É­»— 20 ‹´Š®ª´— (—´Š˜µ¦µŠš¸É 1) ªnµ¤¸ž{‹‹´¥


Health Intervention and Technology Assessment Program

10 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ėoµŠš¸É¤¸Ÿ¨˜n°‹Îµœªœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ĝ˜n¨³‹´Š®ª´— ×¥šÎµ„µ¦ª·Á‡¦µ³®r—oª¥­¤„µ¦ ™—™°¥ Logistic regression ª·›¸ Forward Stepwise ×¥˜´ªÂž¦š¸ÉœÎµ¤µ«¹„¬µÁž}œ…o°¤¼¨¦µ¥ ‹´Š®ª´— ŗo„n 1. 2. 3. 4.

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˜µ¦µŠš¸É 1 ‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœ­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ (UC) že ¡.«. 2549 ‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´— UC ž¦´˜µ¤Ã‡¦Š­¦oµŠ ˜o°„¦³‹„¤µ„š¸É­»— ž„. ¦µ¥‹´Š®ª´— (map)(Y=1) 1,000 ‡œ œ‡¦¡œ¤ 6.609 ­¤»š¦­µ‡¦ 6.540 £¼Á„Ș 6.296 ­¦³»¦¸ 5.453 ¨ÎµžµŠ 5.055 „ε¡ŠÁ¡¦ 4.826 ˜µ„ 4.580 „µ‹œ»¦¸ 4.563 œ‡¦œµ¥„ 4.390 ¦µ»¦¸ 4.262 ¡¦n 4.143 ®œ°Š‡µ¥ 4.082 žš»¤›µœ¸ 4.036 ­·Š®r»¦¸ 3.910 œ‡¦¦µ­¸¤µ 3.825 ­»¡¦¦–»¦¸ 3.805 ¦³œ°Š 3.690 ¡¦³œ‡¦«¦¸°¥»›¥µ 3.547 Á¡¦¼¦–r 3.502 Á¨¥ 3.406

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1.2.4.2 ž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸Éčo­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸Éčo­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„čo …o°¤¼¨„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœže ¡.«. 2549 ץčo…o°¤¼¨¦®´­®´˜™„µ¦ (ICD9) š¸É¤¸„µ¦¦³»ªnµ¤¸ „µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ ­™·˜·š¸ÉčoĜ„µ¦«¹„¬µ ‡º° ­¤„µ¦™—™°¥ Logistic regression ª·›¸ Forward Stepwise ×¥˜´ªÂž¦Ž¹ÉŠÁž}œ…o°¤¼¨¦µ¥»‡‡¨š¸ÉœÎµ¤µ«¹„¬µÅ—o„n 1. 2. 3. 4.

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1.2.4.3 ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á„·—£µª³Âš¦„Žo°œ…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á„·—£µª³Âš¦„Žo°œ…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„×¥—¹Š…o°¤¼¨ Ÿ¼ožiª ¥ ¦³®ªnµŠ¡.«. 2549 – 2550 Ž¹ÉŠ¤¸¦®´­®´˜™„µ¦Ä­nÁ¨œ­r ¨³…o°¤¼¨£µª³Âš¦„Žo°œš¸É Á„·—…¹Êœ®¨´Š„µ¦Ÿnµ˜´—Äœ¦³¥³˜oœ (Early complications) ŗo„n 1. £µª³˜·—ÁºÊ°Äœ¨¼„˜µ (Purulent endophthalmitis) 2. £µª³Á¨º°—°°„Äœ´ÊœÄ˜o‹°ž¦³­µš˜µ (Choroidal hemorrhage and rupture) 3. £µª³Á¨º°—°°„n°Š®œoµ¤nµœ˜µ (Hyphema) 4. £µª³„¦³‹„˜µª¤ (Other corneal edema) 5. £µª³Âš¦„Žo°œ°ºÉœ…°Š„µ¦Ÿnµ˜´— (Complication of procedures) 6. £µª³Á¨œ­rÁ‡¨ºÉ°œ®¦º°®¨»—‹µ„˜ÎµÂ®œnŠ (Mechanical complication of intraocular lens)  **

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Health Intervention and Technology Assessment Program

12 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ­™· ˜· š¸ÉÄ o Ĝ„µ¦ª· Á‡¦µ³®r ‡º ° „µ¦ª· Á‡¦µ³®r ­¤„µ¦™—™°¥Â¨°‹·­ ˜· „­r (Logistic regression) ª·›¸ Forward Stepwise ץčoަ„¦¤­ÎµÁ¦È‹¦¼žÂ¨³˜´ªÂž¦Ž¹ÉŠÁž}œ…o°¤¼¨ ¦µ¥»‡‡¨š¸ÉœÎµ¤µ«¹„¬µÅ—o„n 1. Á¡« (0=µ¥; 1=®·Š) 2. °µ¥» (že) 3. ­·š›·„µ¦¦´„¬µ (0=UC; 1=CSMBS) 4. œ·—…°ŠÁ¨œ­r (0=Non-Foldable; 1=Foldable) 5. ž¦³Á£šÃ¦Š¡¥µµ¨š¸É¦´„¬µ ‹ÎµÂœ„Áž}œ 6 ž¦³Á£š ŗo„n - 抡¥µµ¨š´ªÉ Ş (抡¥µµ¨ž¦³‹Îµ‹´Š®ª´—) (0) - 抡¥µµ¨»¤œ (抡¥µµ¨ž¦³‹Îµ°ÎµÁ£°) (1) - 抡¥µµ¨«¼œ¥r (2) - 抡¥µµ¨­´Š„´—¤®µª·š¥µ¨´¥ (3) - 抡¥µµ¨Á°„œ (4) - 抡¥µµ¨°ºÉœÇ (5) š´ÊŠœ¸Êŗo­—Š¦µ¥¨³Á°¸¥—˜´ªÂž¦Â¨³­™·˜·š¸ÉčoĜ˜n¨³ž¦³Á—Èœ —´Š˜µ¦µŠš¸É 2


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Chi - square

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­™·˜· Logistic regression

Logistic regression

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˜µ¦µŠš¸É 2 (˜n°) ˜´ªÂž¦˜µ¤: ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„ (1) ¨³‹´Š®ª´—š¸É¤¸ „µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ (0) ( 20 °´œ—´Â¦„) ˜´ªÂž¦°·­¦³: 1. ¦µ¥Å—o…°Š‡¦´ªÁ¦º°œ/ Á—º°œ 2. ­´—­nªœ‹Îµœªœ‹´„¬»Â¡š¥r 3. ¦³¥³®nµŠÁŒ¨¸É¥¦³®ªnµŠ°ÎµÁ£°˜nµŠÇ ™¹Š°ÎµÁ£°Á¤º°Š 4. £µ‡ ˜´ªÂž¦˜µ¤: œ·—…°ŠÁ¨œ­r (0=Non-Foldable; 1=Foldable) ˜´ªÂž¦°·­¦³: 1. Á¡« (0=µ¥; 1=®·Š) 2. °µ¥» (že) 3. ­·š›·„µ¦¦´„¬µ (0=UC; 1=CSMBS) 4. ž¦³Á£šÃ¦Š¡¥µµ¨š¸É¦´„¬µ (0=抡¥µµ¨š´ÉªÅž; 1=抡¥µµ¨»¤œ; 2=抡¥µµ¨«¼œ¥r; 3=抡¥µµ¨¤®µª·š¥µ¨´¥; 4=抡¥µµ¨Á°„œ; 5=抡¥µµ¨°ºÉœÇ)

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14 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

Health Intervention and Technology Assessment Program


­™·˜· Chi - square ¨³ logistic regression

„µ¦ª·Á‡¦µ³®r

ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á„·—£µª³Âš¦„Žo°œ (complication) …°Š„µ¦ Ÿnµ˜´—˜o°„¦³‹„

˜µ¦µŠš¸É 2 (˜n°)

˜´ªÂž¦°·­¦³: 1. Á¡« (0=µ¥; 1=®·Š) 2. °µ¥» (že) 3. ­·š›·„µ¦¦´„¬µ (0=UC; 1=CSMBS) 4. œ·—…°ŠÁ¨œ­r (0=Non-Foldable; 1=Foldable) 5. ž¦³Á£šÃ¦Š¡¥µµ¨š¸É¦´„¬µ (0=抡¥µµ¨š´ÉªÅž; 1=抡¥µµ¨»¤œ; 2=抡¥µµ¨«¼œ¥r; 3=抡¥µµ¨¤®µª·š¥µ¨´¥; 4=抡¥µµ¨Á°„œ; 5=抡¥µµ¨°ºÉœÇ)

6. Mechanical complication of intraocular lens

˜´ªÂž¦˜µ¤: 1. Purulent endophthalmitis 2. Choroidal hemorrhage and rupture 3. Hyphema 4. Other corneal edema 5. Complication of procedures

˜´ªÂž¦

√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 15


Health Intervention and Technology Assessment Program

16 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3 Ÿ¨„µ¦«¹„¬µ Ÿ¨„µ¦«¹„¬µÂnŠ°°„Áž}œ 3 ­nªœ ŗo„n Ÿ¨„µ¦«¹„¬µ„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœ Ÿ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ Ÿ¨„µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n° „µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ ¨³Ÿ¨„µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦ Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥š¸É­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ 1.3.1 „µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ ­»…£µ¡™oªœ®œoµ Ÿ¨„µ¦«¹„¬µÄœ­nªœœ¸Ê‹³ž¦³„°—oª¥°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„nŠ˜µ¤ž¦³Á£š…°Š Ÿ¼ožiª¥ ŗo„n nªŠ°µ¥» Á¡« ­·š›·Äœ„µ¦¦´„¬µ ¨³ž¦³Á£š…°ŠÁ¨œ­r„oª˜µÁš¸¥¤ ‡ªµ¤»„…°Š „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„¨³‹´ „ ¬»  ¡š¥r Ä œÂ˜n ¨ ³‹´ Š ®ª´ — ¨³°´ ˜ ¦µ„µ¦Á„· — £µª³Âš¦„Žo ° œ (Complication) ‹µ„„µ¦Ÿnµ˜´—˜o°„¦³‹„nŠ˜µ¤ž¦³Á£š…°ŠÁ¨œ­r„oª˜µÁš¸¥¤ 1.3.1.1 °´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„nŠ˜µ¤ž¦³Á£š…°ŠŸ¼ožiª¥ ŗo„n nªŠ°µ¥» Á¡« ­·š›· Ĝ„µ¦¦´„¬µ ¨³ž¦³Á£š…°ŠÁ¨œ­r„oª˜µÁš¸¥¤ Ÿ¨„µ¦«¹ „ ¬µÁ¡ºÉ ° ž¦³Á¤· œ „µ¦Á…o µ ™¹ Š „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„ÄœŸ¼o ži ª ¥­· š ›· ­ ª´ ­ —· „ µ¦ …oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ª·Á‡¦µ³®r…o°¤¼¨Ÿ¼ožiª¥˜o°„¦³‹„ ¦³®ªnµŠª´œš¸É 1 ¤„¦µ‡¤ ¡.«.2546 – 31 ›´œªµ‡¤ ¡.«.2550 ¡ªnµ ¤¸Ÿ¼ožiª¥˜o°„¦³‹„Å—o¦´„µ¦Ÿnµ˜´—˜o° „¦³‹„‹Îµœªœš´ÊŠ­·Êœ 456,692 ¦µ¥ Á¤ºÉ °‹Î µÂœ„˜µ¤n ªŠ°µ¥» ¡ªn µ Ÿ¼o ži ª ¥Ÿn µ˜´ —˜o °„¦³‹„‹Î µ œªœ 4 Ĝ 10 ¦µ¥ ¤¸ °µ¥» ¦³®ªnµŠ 65 – 74 že (¦o°¥¨³ 42.6) Á¤ºÉ°‹ÎµÂœ„˜µ¤­·š›·„µ¦¦´„¬µ¡ªnµ ­°—‡¨o°Š„´£µ¡¦ª¤ „¨nµª‡º° Ÿ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„‹Îµœªœ 4 Ĝ 10 ¦µ¥‹µ„Ÿ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµÂ¨³ ­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦¤¸°µ¥»¦³®ªnµŠ 65 – 74 že (¦o°¥¨³ 41.4 ¨³ 45.3) ¦µ¥¨³Á°¸¥——´Š¦¼žš¸É 2 ¨³˜µ¦µŠš¸É 35 Ĝ£µ‡Ÿœª„


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 17

¦¼žš¸É 2 ‹ÎµœªœŸ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„‹ÎµÂœ„˜µ¤°µ¥»Â¨³­·š›·„µ¦¦´„¬µ ¦³®ªnµŠ ¡.«. 2546 2550 Á¤ºÉ°‹ÎµÂœ„˜µ¤Á¡« ¡ªnµ Ÿ¼ožiª¥Á¡«®·Š¤µ„„ªnµÁ¡«µ¥ (‹Îµœªœ 256,517 ¦µ¥ (¦o ° ¥¨³ 57.3) ¨³ 191,175 ¦µ¥ (¦o ° ¥¨³ 42.7) ) Á¤ºÉ ° ‹Î µ œ„˜µ¤­· š ›· „ µ¦¦´ „ ¬µ¡ªn µ ­°—‡¨o°Š„´Ÿ¨„µ¦«¹„¬µÃ—¥¦ª¤ „¨nµª‡º°Á¡«®·ŠÅ—o¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„„ªnµÁ¡«µ¥ Ĝš»„­·š›·„µ¦¦´„¬µÂ¨³š»„žeš¸ÉšÎµ„µ¦«¹„¬µ (—´Š¦¼žš¸É 3)

¦¼žš¸É 3 ‹ÎµœªœŸ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„‹ÎµÂœ„˜µ¤Á¡«Â¨³­·š›·„µ¦¦´„¬µ ¦³®ªnµŠ ¡.«.2546 2550


Health Intervention and Technology Assessment Program

18 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ Á¤ºÉ°‹ÎµÂœ„˜µ¤­·š›·ž¦³„´œ­»…£µ¡ ¡ªnµ¤¸Ÿ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦ (CSMBS) ‹Îµœªœ 151,379 ¦µ¥ (¦o°¥¨³ 33.2) ¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ (UC) ‹Îµœªœ 305,313 ¦µ¥ (¦o°¥¨³ 66.8) ×¥Ÿ¼ožiª¥š¸Éčo­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ¤¸‹Îµœªœ¤µ„„ªnµŸ¼ožiª¥š¸Éčo­·š›· ­ª´­—·„µ¦…oµ¦µ„µ¦ž¦³¤µ– 1 Ášnµ ¨³Ÿ¼ožiª¥˜o°„¦³‹„¤¸ÂœªÃœo¤Å—o¦´„µ¦Ÿnµ˜´—Á¡·É¤¤µ„…¹Êœ š»„žeš´ÊŠ 2 ­·š›· ×¥Ÿ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ŗo¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„š¸É­»—Äœže ¡.«. 2549 (‹Îµœªœ 84,862 ¦µ¥) (—´Š¦¼žš¸É 4)

¦¼žš¸É 4 ‹ÎµœªœŸ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„‹ÎµÂœ„˜µ¤­·š›·„µ¦¦´„¬µ ¦³®ªnµŠ ¡.«. 2546 – 2550 ‹µ„…o°¤¼¨„µ¦Ÿnµ˜´—˜o°„¦³‹„¦³®ªnµŠ¡.«. 2548 - 2550 Á¤ºÉ°‹ÎµÂœ„˜µ¤œ·—…°ŠÁ¨œ­r ¡ªnµ Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É¤¸„µ¦šÎµ®´˜™„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤¤¸‹Îµœªœš´ÊŠ®¤— 207,614 ˜µ ×¥‹ÎµÂœ„Áž}œ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ ‹Îµœªœ 86,798 ˜µ (¦o°¥¨³ 41.8) ¨³Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ¡´Å¤nŗo ‹Îµœªœ 120,816 ˜µ (¦o°¥¨³ 58.2) ‹ÎµÂœ„˜µ¤­·š›·„µ¦¦´„¬µ¡ªnµ Ÿnµ˜´—Ä­nÁ¨œ­r„oª˜µÁš¸¥¤Ã—¥Äo­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ‹Îµœªœ 130,820 ˜µ ×¥­nªœÄ®nÄ­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ¡´Å¤nŗo ‹Îµœªœ 106,480 ˜µ (¦o°¥¨³ 81.4) ­nªœš¸ÉÁ®¨º°‹Îµœªœ 24,340 ˜µ Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ (¦o°¥¨³ 18.6) ĜšµŠ„¨´„´œ ­nªœŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦ ¤¸„µ¦Ÿnµ˜´—Ä­nÁ¨œ­r„oª˜µÁš¸¥¤‹Îµœªœ 76,794 ˜µ ­nªœÄ®nÄ­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ ‹Îµœªœ 62,458 ˜µ (¦o°¥¨³ 81.3) ­nªœš¸É Á®¨º°‹Îµœªœ 14,336 ˜µ Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ¡´Å¤nŗo (¦o°¥¨³ 18.7) ¦µ¥¨³Á°¸¥——´Š ˜µ¦µŠš¸É 3


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 19

¦¼žš¸É 5 ‹ÎµœªœŸ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„‹ÎµÂœ„˜µ¤œ·—Á¨œ­r¨³­·š›·„µ¦¦´„¬µ ¦³®ªnµŠ ¡.«. 2548 - 2550 ˜µ¦µŠš¸É 3 ‹ÎµœªœŸ¼ožiª¥š¸Éŗo¦´„µ¦šÎµ®´˜™„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ ¦³®ªnµŠ¡.«.2548 – 2550 ȱ

œ·—Á¨œ­r

2548 UC

Foldable

non-foldable ¦ª¤

2549 CS

UC

¦ª¤

2550

¦ª¤

CS

UC

CS

UC

CS

2,356 14,558 10,169

21,769

11,815

26,131

24,340

62,458

86,798

(18.2) (78.3)

(16.8)

(81.8)

(20.5)

(82.7)

(18.6)

(81.3)

(41.8)

10,577 4,029

50,223

4,852

45,680

5,455 10,6480

14,336 120,816

(81.8) (21.7)

(83.2)

(18.2)

(79.5)

(17.3)

(18.7)

12,933 18,587

60,392

26,621

57,495

31,586 130,820

(81.4)

(58.2)

76,794 207,614


Health Intervention and Technology Assessment Program

20 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3.1.2 ‡ªµ¤»„…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„¨³‹´„¬»Â¡š¥rĜ˜n¨³‹´Š®ª´— „µ¦«¹ „ ¬µ‡ªµ¤» „ …°Š„µ¦Ÿn µ ˜´ —˜o ° „¦³‹„¨³‹Î µ œªœ‹´ „ ¬»  ¡š¥r Ä œÂ˜n ¨ ³‹´ Š ®ª´ — ¡ªnµ °´˜¦µ‡ªµ¤»„…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„˜µ¤­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ¤¸„µ¦„¦³‹µ¥Äœ ‹´Š®ª´—˜nµŠÇ Ĝš»„£µ‡Ã—¥ÁŒ¡µ³‹´Š®ª´—Ä®n ¨³¤¸‡ªµ¤»„…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Á¡·É¤…¹Êœ š»„že ×¥¡.«. 2549 ¤¸‡ªµ¤»„…°Š„µ¦Ÿnµ˜´—„¦³‹µ¥š´Éªž¦³Áš«¤µ„š¸É­»— ×¥‹´Š®ª´—š¸É¤¸°´˜¦µ ‡ªµ¤» „ …°Š„µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„ ˜n ° ž¦³µ„¦ 1,000 ¦µ¥ ¤µ„š¸É ­» — 5 °´ œ —´  ¦„ ŗo  „n œ‡¦¡œ¤ ­¤»š¦­µ‡¦ £¼Á „Ș ­¦³»¦¸ ¨³¨Î µžµŠ (6.61 6.54 6.30 5.45 ¨³ 5.05 ¦µ¥˜n ° ž¦³µ„¦ 1,000 ¦µ¥ ˜µ¤¨Îµ—´) Ĝ…–³š¸É‹´Š®ª´—š¸É¤¸‹Îµœªœ‹´„¬»Â¡š¥r¤µ„š¸É­»— 6 °´œ—´Â¦„ ŗo„n „¦»ŠÁš¡¤®µœ‡¦ œ‡¦ž“¤ £¼Á„Ș žš»¤›µœ¸ ­Š…¨µ ¨³Á¸¥ŠÄ®¤n (3.9 2.3 2.0 1.6 1.6 ¨³ 1.6 ¦µ¥˜n°ž¦³µ„¦ 100,000 ¦µ¥ ˜µ¤¨Îµ—´) —´ŠÂ­—ŠÄœ¦¼žš¸É 6 -11

¦¼žš¸É 6 Ÿœš¸ÂÉ ­—Š‡ªµ¤»„…°ŠŸ¼ožiª¥š¸ŸÉ nµ˜´—˜o°„¦³‹„Äœž¦³Áš«Åš¥ ¡.«. 2548


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 21

¦¼žš¸É 7 Ÿœš¸ÂÉ ­—Š„µ¦„¦³‹µ¥…°Š‹´„¬»Â¡š¥rĜž¦³Áš«Åš¥ ¡.«. 2548

¦¼žš¸É 8 Ÿœš¸ÂÉ ­—Š‡ªµ¤»„…°ŠŸ¼ožiª¥š¸ŸÉ nµ˜´—˜o°„¦³‹„Äœž¦³Áš«Åš¥ ¡.«. 2549


Health Intervention and Technology Assessment Program

22 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

¦¼žš¸É 9 Ÿœš¸ÂÉ ­—Š„µ¦„¦³‹µ¥…°Š‹´„¬»Â¡š¥rĜž¦³Áš«Åš¥ ¡.«. 2549

¦¼žš¸É 10 Ÿœš¸É­—Š‡ªµ¤»„…°ŠŸ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„Äœž¦³Áš«Åš¥ ¡.«. 2550


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 23

¦¼žš¸É 11 Ÿœš¸É­—Š„µ¦„¦³‹µ¥…°Š‹´„¬»Â¡š¥rĜž¦³Áš«Åš¥ ¡.«. 2550 ‹µ„„µ¦«¹„¬µš·«šµŠ„µ¦Ÿnµ˜´—˜o°„¦³‹„…°ŠŸ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ˜´ÊŠÂ˜n ¡.«.2548 – 2550 ˜µ¤¦®´­Ã¦Š¡¥µµ¨š¸Éަ´„¬µ ¨³¦®´­Ã¦Š¡¥µµ¨š¸É¤¸­·š›·ž¦³„´œ­»…£µ¡ ¡ªnµže ¡.«.2549 Ÿ¼ožiª¥Äœ¤¸‹Îµœªœ 84,862 ¦µ¥ Áž}œŸ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµÄœ 抡¥µµ¨š¸É°¥¼nĜ„¦»ŠÁš¡¤®µœ‡¦ ‹Îµœªœ 6,480 ¦µ¥ (¦o°¥¨³ 7.6) ¨³­·š›·ÄœÃ¦Š¡¥µµ¨ ˜nµŠ‹´Š®ª´—‹Îµœªœ 73,460 ¦µ¥ (¦o°¥¨³ 86.6) Á¤ºÉ°¡·‹µ¦–µ„µ¦Á…oµ¦´„µ¦¦´„¬µ…°ŠŸ¼ožiª¥˜o° „¦³‹„š¸É¤¸­·š›·„µ¦¦´„¬µÄœÃ¦Š¡¥µµ¨˜nµŠ‹´Š®ª´— ‹Îµœªœ 73,460 ¦µ¥ ¡ªnµ Ÿ¼ožiª¥­nªœÄ®n ¦´„¬µÃ¦‡˜o°„¦³‹„Äœ‹´Š®ª´—š¸É¤¸­·š›·„µ¦¦´„¬µ (¦o°¥¨³ 95) ¤¸Á¡¸¥Š­nªœœo°¥š¸É¦´„¬µÄœ‹´Š®ª´— °ºÉ œ (¦o ° ¥¨³ 5) ץ抡¥µµ¨š¸É ¤¸ Ÿ¼o ži ª ¥‹µ„‹´ Š ®ª´ — °ºÉ œ Ç Åž¦´ „ ¬µ 3 °´ œ —´  ¦„Å—o  „n 抡¥µµ¨¤®µ¦µœ‡¦Á¸¥ŠÄ®¤n ‹Îµœªœ 599 ¦µ¥ 抡¥µµ¨Á—·¤µŠœµŠª ‹Îµœªœ 340 ¦µ¥ 抡¥µµ¨oµœÂ¡oª ‹Îµœªœ 323 ¦µ¥ ¨³š¸ÉÁ®¨º°‹Îµœªœ 1,233 ¦µ¥ Á…oµ¦´„µ¦¦´„¬µÃ¦‡ ˜o ° „¦³‹„Äœ„¦» Š Áš¡¤®µœ‡¦ (¦o ° ¥¨³ 1.7) ŗo  „n 抡¥µµ¨¦µª· ™¸ ‹Î µ œªœ 452 ¦µ¥ 抡¥µµ¨«·¦·¦µ ‹Îµœªœ 201 ¦µ¥ 抡¥µµ¨­Š‰r ‹Îµœªœ 161 ¦µ¥ Áž}œ˜oœ (—´ŠÂ­—ŠÄœ£µ‡Ÿœª„ ¦¼žš¸É 16-18)


Health Intervention and Technology Assessment Program

24 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3.1.3 °´˜¦µ„µ¦Á„·—£µª³Âš¦„Žo°œ (Complication) ‹µ„„µ¦Ÿnµ˜´—˜o°„¦³‹„nŠ˜µ¤ ž¦³Á£š…°ŠÁ¨œ­r„oª˜µÁš¸¥¤ ‹µ„„µ¦«¹„¬µ£µª³Âš¦„Žo°œš¸ÉÁ„·—…¹Êœ‹µ„„µ¦Ÿnµ˜´—˜o°„¦³‹„ ‹ÎµÂœ„˜µ¤ž¦³Á£š …°ŠÁ¨œ­r„oª˜µÁš¸¥¤ ¡ªnµ Ÿ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµš¸É¦´„µ¦Ÿnµ˜´—Ä­nÁ¨œ­r„oª˜µ Áš¸ ¥ ¤œ· —Â…È Š¤¸ £ µª³Âš¦„Žo °œš¸É Á „· —…¹Ê œ¤µ„„ªnµ„¨»n ¤š¸É Ä ­n Á ¨œ­r „o ª ˜µÁš¸ ¥ ¤œ· —œ·É ¤ Á¤ºÉ ° ¡·‹µ¦–µ­´—­nªœ…°Š„µ¦Á„·—£µª³Âš¦„Žo°œ ¡ªnµ £µª³Âš¦„Žo°œš¸ÉÁ„·—…¹Êœ¤¸­´—­nªœœo°¥„ªnµ ¦o°¥¨³ 1 Á„º°š»„£µª³Âš¦„Žo°œ ¥„Áªoœ£µª³Âš¦„Žo°œ°ºÉœ…°Š„µ¦Ÿnµ˜´— (Complication of procedures) Ž¹ÉŠ¤¸­´—­nªœ„µ¦Á„·—‡·—Áž}œ‹Îµœªœ¦o°¥¨³ 2.25 ¨³ 1.78 …°ŠŸ¼ožiª¥š´ÊŠ®¤—š¸Éčo ­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦š¸ÉšÎµ„µ¦Ÿnµ˜´—Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠÄœže ¡.«.2549 ¨³ ¡.«. 2550 ˜µ¤¨Îµ—´ (¦¼žš¸É 12 ¨³˜µ¦µŠš¸É 36)

¦¼žš¸É 12 ‹Îµœªœ„µ¦Á„·—£µª³Âš¦„Žo°œ®¨´Š„µ¦Ÿnµ˜´—Ä­nÁ¨œ­r„oª˜µÁš¸¥¤


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 25

¦¼žš¸É 13 ­´—­nªœ…°Š„µ¦Á„·—£µª³Âš¦„Žo°œ®¨´Š„µ¦Ÿnµ˜´—Ä­nÁ¨œ­r„oª˜µÁš¸¥¤


Health Intervention and Technology Assessment Program

26 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3.2 „µ¦ª·Á‡¦µ³®rž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ Ÿ¨„µ¦«¹„¬µœ¸Ê­—ŠÄ®oÁ®Èœž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ Á¤ºÉ°Áž¦¸¥Áš¸¥¦³®ªnµŠ­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦„´­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ®¦º°Á¤ºÉ° Áž¦¸¥Áš¸¥¦³®ªnµŠ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„„´‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ Ĝže ¡.«. 2549 ĜŸ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ 1.3.2.1 ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ¦³®ªnµŠŸ¼ožiª¥­·š›· ­ª´­—·„µ¦…oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ¦³®ªnµŠŸ¼ožiª¥­·š›· ­ª´­—·„µ¦…oµ¦µ„µ¦Â¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµš¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µ Áš¸¥¤ ¡.«.2549 ‹Îµœªœ 110,622 ¦µ¥ ¡ªnµ Á¡«®·Š¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„„ªnµÁ¡«µ¥ š´ÊŠ­°Š­·š›·„µ¦¦´„¬µ (¦o°¥¨³ 59.3 ¨³ 56.8) Á¤ºÉ°‹ÎµÂœ„˜µ¤°µ¥» ¡ªnµ ¤µ„„ªnµ‡¦¹ÉŠ®œ¹ÉŠ…°Š š´ÊŠ„¨»n¤­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦ ¨³„¨»n¤­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„ Ĝ°µ¥»¦³®ªnµŠ 60 – 74 že (¦o°¥¨³ 56.3 ¨³ 56.5 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„˜µ¤®´˜™„µ¦˜µ¤œ·—…°ŠÁ¨œ­r ¡ªnµ ¤¸Ÿ¼ožiª¥‹Îµœªœ 23,657 ¦µ¥ š¸É¤¸„µ¦ Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤Â˜nŤn¤¸„µ¦Á·„‡nµÁ¨œ­r (¦o°¥¨³ 21.4) Ž¹ÉŠ¤µ‹µ„Ÿ¼ožiª¥ ­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ™¹Š 20,020 ¦µ¥ (¦o°¥¨³ 24.9) ­nªœš¸ÉÁ®¨º°‹Îµœªœ 3,637 ¦µ¥ (¦o°¥¨³ 12.0) Áž}œŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦ ¨³Ÿ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµÅ—o¦´ „µ¦Ÿnµ˜´—˜o°„¦³‹„ץčoÁ¨œ­rœ·É¤ (¦o°¥¨³ 12.6) œo°¥„ªnµŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦ (¦o°¥¨³ 72.0) °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (p-value < 0.05) Á¤ºÉ°‹ÎµÂœ„˜µ¤ž¦³Á£š…°Š 抡¥µµ¨š¸ÉšÎµ„µ¦¦´„¬µ ¡ªnµ Á„º°‡¦¹ÉŠ®œ¹ÉŠ…°ŠŸ¼ožiª¥š¸Éčo­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµšÎµ „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Ĝ抡¥µµ¨š´É ª Ş (¦o ° ¥¨³ 44.3) Ĝ…–³š¸É Ÿ¼o ži ª ¥­· š ›· ­ ª´ ­ —· „ µ¦ …oµ¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ĝ抡¥µµ¨š´ÉªÅžÂ¨³Ã¦Š¡¥µµ¨«¼œ¥r ‡·—Áž}œ‹Îµœªœ¦o°¥¨³­¼Š š¸É­»— (¦o°¥¨³ 28.4 ¨³ 25.0) œ°„‹µ„œ´Êœ¥´Š¡ªnµŸ¼ožiª¥‹Îµœªœ 1 Ĝ 4 ¦µ¥ šÎµ„µ¦¦´„¬µÃ¦‡ ˜o°„¦³‹„Ĝ抡¥µµ¨°ºÉœÇ Ĝ…–³š¸ÉŤn¡Ÿ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦Á…oµ¦´„µ¦¦´„¬µ 懘o°„¦³‹„Ĝ抡¥µµ¨Á°„œÁ¨¥ Á¤ºÉ°«¹„¬µ‡ªµ¤­´¤¡´œ›r¦³®ªnµŠž{‹‹´¥˜nµŠÇ ˜n°­·š›·„µ¦¦´„¬µ ¡ªnµ ž{‹‹´¥Á¡« °µ¥» Á¨œ­r ¨³ž¦³Á£šÃ¦Š¡¥µµ¨š¸ÉšÎµ„µ¦¦´„¬µ¤¸‡ªµ¤­´¤¡´œ›r„´­·š›·„µ¦¦´„¬µ (p-value<0.05) —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 4


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 27

˜µ¦µŠš¸É 4 ‡ªµ¤­´¤¡´œ›r¦³®ªnµŠž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°Š­·š›·„µ¦¦´„¬µ ž{‹‹´¥

­·š›·

Total

p- Value*

0.000*

­·š›·ž¦³„´œ­»…£µ¡ ™oªœ®œoµ ‹Îµœªœ (¦o°¥¨³)

­·š›·­ª´­—·„µ¦ …oµ¦µ„µ¦ ‹Îµœªœ (¦o°¥¨³)

µ¥

32,696(40.7)

13,064(43.2)

45,760(41.4)

®·Š

47,682(59.3)

17,180(56.8)

64,862(58.6)

Á¡«

°µ¥» ” 39 že 40 – 49 že

1,855(2.3)

152(0.5)

2,007(1.8)

3,576(4.4)

731(2.4)

4,307(3.9)

50 – 59 že

12,057(15.0)

2,890(9.6)

14,947(13.5)

60 – 64 že

11,588(14.4)

3,491(11.5)

15,079(13.6)

65 – 69 že

16,884(21.0)

6,014(19.9)

22,898(20.7)

70 – 74 že

16,938(21.1)

7,518(24.9)

24,456(22.1)

75 – 79 že

11,185(13.9)

5,922(19.6)

17,107(15.5)

6,295(7.8)

3,526(11.7)

9,821(8.9)

Non-Foldable

50,206(62.5)

4,845(16.0)

55,051(49.8)

Foldable

10,152(12.6)

21,762(72.0)

31,914(28.8)

ŤnÁ·„‡nµÁ¨œ­r

20,020(24.9)

3,637(12.0)

23,657(21.4)

抡¥µµ¨š´ÉªÅž

35,631(44.3)

8,598(28.4)

44,229(40.0)

抡¥µµ¨»¤œ

7,498(9.3)

1,000(3.3)

8,498(7.7)

抡¥µµ¨«¼œ¥r

26,465(32.9)

7,562(25.0)

34,027(30.8)

抡¥µµ¨¤®µª·š¥µ¨´¥

3,304(4.1)

5,180(17.1)

8,484(7.7)

抡¥µµ¨Á°„œ

2,266(2.8)

0(0.0)

2,266(2.0)

抡¥µµ¨°ºÉœÇ

5,214(6.5)

7,904(26.1)

13,118(11.9)

• 80 že ®´˜™„µ¦

0.000*

0.000*

ž¦³Á£šÃ¦Š¡¥µµ¨

* ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

0.000*


Health Intervention and Technology Assessment Program

28 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3.2.2 ž{ ‹‹´ ¥ š¸É¤¸ Ÿ ¨˜n ° „µ¦Á…o µ ™¹Š „µ¦Ÿn µ˜´ — ˜o° „¦³‹„š¸É  ˜„˜n µŠ„´ œ …°ŠŸ¼o ži ª ¥­· š ›· ž¦³„´œ­»…£µ¡™oªœ®œoµÁž¦¸¥ Áš¸¥¦³®ªnµ Š‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„„´ ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ…°ŠŸ¼ožiª¥­·š›· ž¦³„´œ­»…£µ¡™oªœ®œoµš¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„ Ĝže ¡.«. 2549 Ĝ‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´— ¤µ„ (7 ¦µ¥˜n°ž¦³µ„¦ 1,000 ¦µ¥) ŗo„n ‹´Š®ª´—œ‡¦¡œ¤ ­¤»š¦­µ‡¦ ¨³£¼Á„Ș ¨³ ‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—œo°¥ (1 ¦µ¥˜n°ž¦³µ„¦ 1,000 ¦µ¥) ŗo„n ‹´Š®ª´—­»¦·œš¦r ¦o°¥Á°È— ž{˜˜µœ¸ ¨³­¤»š¦ž¦µ„µ¦ ¦ª¤‹Îµœªœš´ÊŠ®¤— 6,142 ¦µ¥ ¤¸„µ¦šÎµ®´˜™„µ¦Ä­nÁ¨œ­r‹Îµœªœ 5,925 ¦µ¥ ¡ªnµ Á¡«®·Š¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„„ªnµÁ¡«µ¥š´ÊŠ„¦–¸š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´— ¤µ„®¦º°œo°¥ (¦o°¥¨³ 64.6 ¨³ 56.3) Á¤ºÉ°‹ÎµÂœ„˜µ¤°µ¥» ¡ªnµ ‹Îµœªœ 1 Ĝ 3 ¦µ¥ …°Šš´ÊŠ ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„¨³‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ šÎµ„µ¦Ÿnµ˜´—˜o° „¦³‹„Äœ°µ¥»¦³®ªnµŠ 70 – 74 že (¦o°¥¨³ 38.3 ¨³ 34.0 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É¤¸„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ ˜µ¤œ·—…°Š Á¨œ­r ¡ªnµ ¤¸Ÿ¼ožiª¥‹Îµœªœ 5,925 ¦µ¥ š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ Ž¹ÉŠ‹´Š®ª´— š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥­nª œÄ®n‹³Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ (¦o°¥¨³ 77.8) Ĝ…–³š¸ÉŸ¼ožiª¥š¸É°µ«´¥°¥¼nĜ‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„‹Îµœªœ¤µ„„ªnµ‡¦¹ÉŠ (¦o°¥ ¨³ 59.6) ‹³Å—o¦´„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ œ°„‹µ„œ¸Ê¡ªnµŸ¼ožiª¥š¸É¤¸„µ¦šÎµ®´˜™„µ¦Ä­n Á¨œ­r„oª˜µÁš¸¥¤‹Îµœªœ 903 ¦µ¥ Ťn¤¸„µ¦Á·„‡nµÁ¨œ­r„oª˜µÁš¸¥¤ Á¤ºÉ°«¹„¬µ‡ªµ¤­´¤¡´œ›r¦³®ªnµŠž{‹‹´¥˜nµŠÇ ˜n°°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœ‹´Š®ª´—š¸É¤¸ „µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„¨³‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ ¡ªnµ ž{‹‹´¥Á¡« °µ¥» ¨³œ·—Á¨œ­r¤¸‡ªµ¤­´¤¡´œ›r„´°´˜¦µ„µ¦Ÿnµ˜´—ÄœŸ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ (p-value <0.05) —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 5


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 29

˜µ¦µŠš¸É 5 ‡ªµ¤­´¤¡´œ›r¦³®ªnµŠ‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„„´‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦ Ÿnµ˜´—˜o°„¦³‹„œo°¥ ž{‹‹´¥

‹´Š®ª´—š¸É¤¸°´˜¦µ„µ¦Ÿnµ˜´—

Total

p- Value*

0.000*

œo°¥

¤µ„

µ¥

1,020(43.7)

1,356(35.6)

2,376(38.7)

®·Š

1,314(56.3)

2,452(64.4)

3,766(61.3)

Á¡«

°µ¥» ” 39 že 40 – 49 že

19(0.8)

4(0.1)

23(0.4)

30(1.3)

9(0.2)

39(0.6)

50 – 59 že

28(1.2)

25(0.7)

53(0.9)

60 – 64 že

70(3.0)

105(2.8)

175(2.8)

65 – 69 že

480(20.6)

656(17.2)

1,136(18.5)

70 – 74 že

794(34.0)

1,460(38.3)

2,254(36.7)

75 – 79 že

729(31.2)

1,298(34.1)

2,027(33.0)

184(7.9)

251(6.6)

435(7.1)

1,687(77.8)

968(25.8)

2,655(44.8)

Foldable

128(5.9)

2,239(59.6)

2,367(39.9)

ŤnÁ·„‡nµÁ¨œ­r

353(16.3)

550(14.6)

903(15.2)

• 80 že ®´˜™„µ¦ Non-Foldable

* ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

0.000*

0.000*


Health Intervention and Technology Assessment Program

30 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3.2.3 ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É˜„˜nµŠ„´œ…°ŠŸ¼ožiª¥š¸ÉŸnµ˜´—˜o° „¦³‹„ץčoÁ¨œ­rœ·É¤Â¨³Á¨œ­r…Ȋ ‹µ„„µ¦ª·Á‡¦µ³®rž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸Éčo­Îµ®¦´„µ¦Ÿnµ˜´—˜o° „¦³‹„ Ĝže ¡.«. 2549 ¡ªnµ¤¸Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„ ¨³¤¸¦®´­Ä­nÁ¨œ­r ‹Îµœªœ 89,289 ¦µ¥ Áž}œÁ¡«®·Š¤µ„„ªnµÁ¡«µ¥ (‹Îµœªœ 52,520 ¨³ 36,769 ¦µ¥) Á¤ºÉ°¡·‹µ¦–µ ‹ÎµÂœ„˜µ¤œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸Éčo ¡ªnµ š´ÊŠÁ¡«µ¥Â¨³Á¡«®·Š¤¸­´—­nªœ„µ¦Ä­n Á¨œ­rš´ÊŠ 2 œ·—Ä„¨oÁ‡¸¥Š„´œ ×¥Ÿ¼ožiª¥Ÿnµ˜´—˜o°„¦³‹„š´ÊŠÁ¡«µ¥Â¨³Á¡«®·Š ‹Îµœªœ 4 ¦µ¥ Ĝ 10 ¦µ¥ Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ (¦o°¥¨³ 36.2 ¨³ 36.7 ˜µ¤¨Îµ—´) ­nªœ‹Îµœªœš¸É Á®¨º°Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ Á¤ºÉ °‹Î µ œ„˜µ¤­· š ›· „ µ¦¦´ „ ¬µ ¡ªn µ Ÿ¼o ži ª ¥š¸É Ä o ­· š ›· ­ ª´ ­ —· „ µ¦…o µ ¦µ„µ¦Ä­n Á ¨œ­r „oª˜µÁš¸¥¤œ·—œ·É¤ (¦o°¥¨³ 81.4) ¤µ„„ªnµœ·—Â…ÈŠ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 18.6) Ĝ…–³š¸ÉŸ¼ožiª¥š¸Éčo­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµÄ­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤œo°¥„ªnµœ·—Â…ÈŠ °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 16.9 ¨³ 83.1 ˜µ¤¨Îµ—´) Á¤ºÉ ° ‹Î µ œ„˜µ¤ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªn µ Ÿ¼o ži ª ¥š¸É ¦´  „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Äœ 抡¥µµ¨ÄoÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ¤µ„„ªnµœ·—œ·É¤Á„º°š»„ž¦³Á£šÃ¦Š¡¥µµ¨ ¥„Áªoœ Ÿ¼ožiª¥š¸ÉšÎµ„µ¦¦´„¬µÄœÃ¦Š¡¥µµ¨¤®µª·š¥µ¨´¥Â¨³Ã¦Š¡¥µµ¨°ºÉœÇ Ž¹ÉŠÄoÁ¨œ­r„oª˜µÁš¸¥¤ œ·—œ·É¤¤µ„„ªnµœ·—Â…ÈŠ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 64.7 ¨³ 68.4 ˜µ¤¨Îµ—´) Ÿ¨„µ¦ª·Á‡¦µ³®r…o°¤¼¨ ¡ªnµ ž{‹‹´¥œ·—­·š›·„µ¦¦´„¬µ °µ¥» ¨³ž¦³Á£šÃ¦Š¡¥µµ¨š¸É šÎµ„µ¦¦´„¬µ¤¸‡ªµ¤­´¤¡´œ›r„´œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸ÉÄ­n (p-value<0.05) —´ŠÂ­—ŠÄœ ˜µ¦µŠš¸É 6


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 31

˜µ¦µŠš¸É 6 ‡ªµ¤­´¤¡´œ›r¦³®ªnµŠž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸ÉÄ­n œ·—Á¨œ­r Non Foldable Foldable

Total

F2

13,325 (36.2) 19,266 (36.7)

23,444 (63.8) 33,254 (63.3)

36,769 (41.2) 52,520 (58.8)

1.835

0.176

10,477 (16.9) 22,114 (81.4) 68.62

51,632 (83.1) 5,066 (18.6) 66.74

62,109 (69.6) 27,180 (30.4)

33927.809

0.000*

10,878 (31.5) 抡¥µµ¨»¤œ 1,803 (36.9) 抡¥µµ¨«¼œ¥r 5,785 (21.4) 抡¥µµ¨¤®µª·š¥µ¨´¥ 5,241 (64.7) 抡¥µµ¨Á°„œ 290 (13.0) 抡¥µµ¨°ºÉœÇ 8,594 (68.4)

23,624 (68.5) 3,087 (63.1) 21,224 (78.6) 2,857 (35.3) 1,937 (87.0) 3,969 (31.6)

34,502 (38.6) 4,890 (5.5) 27,009 (30.2) 8,098 (9.1) 2,227 (2.5) 12,563 (14.1)

ž{‹‹´¥ Á¡« µ¥ ®·Š œ·—­·š›· UC CSMBS °µ¥» ž¦³Á£šÃ¦Š¡¥µµ¨ 抡¥µµ¨š´ªÉ Ş

* ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

t-test

pValue*

40.518 0.000* 11848.836

0.000*


Health Intervention and Technology Assessment Program

32 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3.3 ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦ ¨³­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ Ÿ¨„µ¦«¹„¬µž¦³„°—oª¥ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á…oµ™¹Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ÄœŸ¼ožiª¥­·š›· ­ª´­ —·„µ¦…o µ¦µ„µ¦Â¨³­· š›·ž¦³„´œ­» …£µ¡™o ªœ®œoµ ž{‹‹´¥š¸É ¤¸Ÿ¨˜n°‹Îµœªœ„µ¦Ÿnµ˜´ —˜o ° „¦³‹„Ĝ˜n¨³‹´Š®ª´— ž{‹‹´¥š¸É¤¸Ÿ¨˜n°‹Îµœªœ„µ¦Ÿnµ˜´—Äœ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„ Á¤ºÉ°Áž¦¸¥Áš¸¥„´‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ ž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µ Áš¸¥¤š¸Éčo­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ ¨³ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á„·—£µª³Âš¦„Žo°œ…°Š„µ¦Ÿnµ˜´— ˜o°„¦³‹„ 1.3.3.1 ž{ ‹ ‹´ ¥ š¸É ¤¸Ÿ ¨˜n ° ‹Î µ œªœ„µ¦Ÿn µ˜´ — Ĝ‹´ Š ®ª´ —š¸É ¤¸„ µ¦Ÿn µ ˜´ —˜o ° „¦³‹„¤µ„Á¤ºÉ ° Áž¦¸¥Áš¸¥„´‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°‹Îµœªœ„µ¦Ÿnµ˜´—Äœ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µ„Á¤ºÉ° Áž¦¸¥Áš¸¥„´‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„œo°¥ ‹³„ε®œ—˜´ªÂž¦˜µ¤ ‡º° ‹´Š®ª´—š¸É¤¸„µ¦ Ÿn µ ˜´ — ¤µ„ ‹Î µ œªœ 20 ‹´ Š ®ª´ — ¦„ ŗo  „n œ‡¦¡œ¤ ­¤» š ¦­µ‡¦ £¼ Á „È ˜ ­¦³» ¦¸ ¨Î µ žµŠ „Î µ ¡ŠÁ¡¦ ˜µ„ „µ‹œ» ¦¸ œ‡¦œµ¥„ ¦µ» ¦¸ ¡¦n ®œ°Š‡µ¥ žš» ¤ ›µœ¸ ­· Š ®r » ¦¸ œ‡¦¦µ­¸¤µ ­»¡¦¦–»¦¸ ¦³œ°Š ¡¦³œ‡¦«¦¸°¥»›¥µ Á¡¦¼¦–r ¨³Á¨¥ ˜µ¤¨Îµ—´ (Y=1) ­nªœ ‹´Š®ª´—š¸É¤¸„µ¦Ÿnµ˜´—œo°¥ ‹Îµœªœ 20 ‹´Š®ª´—¦„ ŗo„n ­»¦·œš¦r ¦o°¥Á°È— ž{˜˜µœ¸ ­¤»š¦ž¦µ„µ¦ „µ¯­·œ›»r °nµŠš°Š œnµœ ­¤»š¦­Š‡¦µ¤ ¨¡»¦¸ ¥³¨µ ­¦³Â„oª ž¦³‹ª‡¸¦¸…´œ›r „¦³¸É ¤»„—µ®µ¦ œ¦µ›·ªµ­ œ‡¦«¦¸›¦¦¤¦µ °»š´¥›µœ¸ »¦¸¦´¤¥r ­„¨œ‡¦ ¨³Á¸¥Š¦µ¥ ˜µ¤¨Îµ—´ (Y=0) ×¥ šÎµ„µ¦«¹„¬µ—oª¥„µ¦ª·Á‡¦µ³®rž{‹‹´¥—oª¥­¤„µ¦™—™°¥ Logistic regression ª·›¸ Forward Stepwise ×¥œÎµ˜´ªÂž¦°·­¦³Ž¹ÉŠÁž}œ…o°¤¼¨¦µ¥‹´Š®ª´—Á…oµÄœ­¤„µ¦„µ¦ª·Á‡¦µ³®r 4 ˜´ª ŗo„n ¦µ¥Å—o…°Š‡¦´ªÁ¦º°œ˜n°Á—º°œ (µš) (X11) ­´—­nªœ‹Îµœªœ‹´„¬»Â¡š¥r (X12) ¦³¥³®nµŠÁŒ¨¸É¥ ¦³®ªnµŠ°ÎµÁ£°˜nµŠÇ ™¹Š°ÎµÁ£°Á¤º°Š (X13) ¨³£µ‡ (X14) Á¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¡ªnµ ¤¸‡nµ p-value = 0.772 (p-value>0.05) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸‡ªµ¤Á®¤µ³­¤ ‹µ„˜µ¦µŠš¸É 7 ¡ªnµ ž{‹‹´¥š¸É¤¸Ÿ¨˜n°‹Îµœªœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ĝ˜n¨³‹´Š®ª´— ŗo„n ¦³¥³®nµŠÁŒ¨¸É¥¦³®ªnµŠ°ÎµÁ£°˜nµŠÇ ™¹Š°ÎµÁ£°Á¤º°Š ¨³‹Îµœªœ‹´„¬»Â¡š¥r „¨nµª‡º° Á¤ºÉ°„ε®œ— ˜´ªÂž¦°ºÉœÇ ‡Šš¸É ‹´Š®ª´—š¸É¤¸¦³¥³šµŠÁŒ¨¸É¥¦³®ªnµŠ°ÎµÁ£°˜nµŠÇ ™¹Š°ÎµÁ£°Á¤º°Š¤µ„¤¸Ã°„µ­ ŗo¦´„µ¦Ÿnµ˜´—¤µ„„ªnµ 1 Ášnµ Á¤ºÉ°Áš¸¥„´‹´Š®ª´—š¸É¤¸¦³¥³®nµŠÁŒ¨¸É¥¦³®ªnµŠ°ÎµÁ£°˜nµŠÇ ™¹Š °ÎµÁ£°Á¤º°Šœo°¥ ¨³…–³Á—¸¥ª„´œ‹´Š®ª´—š¸É¤¸‹Îµœªœ‹´„¬»Â¡š¥rÁ¡·É¤…¹Êœ 1 ‡œ šÎµÄ®o¤¸°´˜¦µ„µ¦ Ÿnµ˜´—˜o°„¦³‹„¤µ„…¹Êœ 52 Ášnµ


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 33

˜µ¦µŠš¸É 7 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—oª¥­¤„µ¦™—™°¥ Logistic regression ˜´ªÂž¦

B

Exp(B)

Std.

Wald

df

Sig.

95% CI

3.979 8.122 6.753

1 1 1

.046 .004 .009

(1.001-1.098) (3.430-782.271)

Error

X13 X12 Constant

.047 3.947 -4.864

1.049 51.802 .008

.024 1.385 1.872

1.3.3.2 ž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸Éčo­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ „µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸Éčo­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ ×¥„µ¦ª·Á‡¦µ³®rž{‹‹´¥—oª¥­¤„µ¦™—™°¥ Logistic regression ª·›¸ Forward Stepwise ×¥œÎµ ˜´ªÂž¦°·­¦³Ž¹ÉŠÁž}œ…o°¤¼¨¦µ¥‹´Š®ª´—Á…oµÄœ­¤„µ¦„µ¦ª·Á‡¦µ³®r 4 ˜´ªÂž¦ ŗo„n Á¡« ­·š›·Äœ „µ¦¦´„¬µ ž¦³Á£šÃ¦Š¡¥µµ¨ ¨³°µ¥» ¡ªnµÁ¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¤¸‡nµ p-value = 0.997 (p-value>0.05) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸ ‡ªµ¤Á®¤µ³­¤ ‹µ„˜µ¦µŠš¸É 8 ¡ªnµ ž{‹‹´¥š¸É¤¸Ÿ¨˜n°œ·—…°ŠÁ¨œ­r„oª˜µÁš¸¥¤š¸Éčo­Îµ®¦´„µ¦Ÿnµ˜´— ˜o°„¦³‹„ ŗo„n ­·š›· ¨³Á¡« „¨nµª‡º° Á¤ºÉ°„ε®œ—˜´ªÂž¦°ºÉœÇ ‡Šš¸É Ÿ¼ožiª¥š¸É¤¸­·š›·­ª´­—·„µ¦ …oµ¦µ„µ¦¤¸Ã°„µ­Ä­nÁ¨œ­rœ·—œ·É¤¤µ„„ªnµ 22 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸É¤¸­·š›·ž¦³„´œ­»…£µ¡ ™oªœ®œoµ ¨³…–³Á—¸¥ª„´œÁ¡«®·Š¤¸Ã°„µ­Ä­nÁ¨œ­rœ·—œ·É¤¤µ„„ªnµ 1.152 Ášnµ Á¤ºÉ°Áš¸¥„´ Á¡«µ¥ ˜µ¦µŠš¸É 8 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—oª¥­¤„µ¦™—™°¥ Logistic regression B

Exp(B)

Std.

Wald

df

Sig.

95% CI

Error CSMBS Á¡«®·Š Constant

3.076 .142 -1.681

21.666 1.152 .186

.019 26322.479 .018 61.670 .015 11790.786

1 1 1

.000 .000 .000

(20.876-22.486) (1.112-1.194)


Health Intervention and Technology Assessment Program

34 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.3.3.3 ž{‹‹´¥š¸É¤¸Ÿ¨˜n°„µ¦Á„·—£µª³Âš¦„Žo°œ (Complication) …°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„ ‹µ„„µ¦«¹„¬µŸ¼ožiª¥š¸šÉ ε„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É¤¸„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ ¦³®ªnµŠª´œš¸É 1 ¤„¦µ‡¤ ¡.«. 2549 – ª´œš¸É 31 ›´œªµ‡¤ ¡.«. 2550 ‹Îµœªœ 221,799 ¦µ¥ ‹µ„‹ÎµœªœŸ¼ožªi ¥ š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„š´ÊŠ®¤— 232,242 ¦µ¥ ץnŠ„µ¦«¹„¬µž{‹‹´¥Äœ„µ¦Á„·—£µª³Âš¦„Žo°œ š´ÊŠ®¤— 6 £µª³ ž¦³„°—oª¥ 1. £µª³˜·—Áº°Ê Ĝ¨¼„˜µ (Purulent endophthalmitis) 2. £µª³Á¨º°—°°„Äœ´ÊœÄ˜o‹°ž¦³­µš˜µ (Choroidal hemorrhage and rupture) 3. £µª³Á¨º°—°°„n°Š®œoµ¤nµœ˜µ (Hyphema) 4. £µª³„¦³‹„˜µª¤ (Other corneal edema) 5. £µª³Âš¦„Žo°œ°ºÉœ…°Š„µ¦Ÿnµ˜´— (Complication of procedures) 6. £µª³Á¨œ­rÁ‡¨ºÉ°œ®¦º°®¨»—‹µ„˜ÎµÂ®œnŠ (Mechanical complication of intraocular lens) 1. £µª³˜·—ÁºÊ°Äœ¨¼„˜µ (Purulent endophthalmitis) ‹µ„„µ¦«¹ „ ¬µŸ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ˜´ — ˜o ° „¦³‹„š¸É ¤¸ „ µ¦Ä­n Á ¨œ­r „o ª ˜µÁš¸ ¥ ¤ ‹Î µ œªœ 221,799 ¦µ¥ ¡ªnµ ¤¸Ÿ¼ožiª¥š¸É¤¸£µª³ Purulent endophthalmitis ‹Îµœªœ 89 ¦µ¥ Á¤ºÉ°‹ÎµÂœ„ Ÿ¼o ži ª ¥˜µ¤œ· — Á¨œ­r š¸É Ä ­n ¡ªn µ Ÿ¼o ži ª ¥š¸É Ä ­n Á ¨œ­r  …È Š ¤¸ ­´ — ­n ª œ…°Š„µ¦Á„· — £µª³ Purulent endophthalmitis ¤µ„„ªnµŸ¼ožiª¥š¸ÉÄ­nÁ¨œ­rœ·É¤°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (p-value < 0.05) Á¤ºÉ °‹Î µ œ„˜µ¤Á¡«…°ŠŸ¼o ži ª ¥ ¡ªn µ Á¡«µ¥¤¸ ­´ — ­n ª œ…°Š„µ¦Á„· — £µª³ Purulent endophthalmitis ¤µ„„ªnµÁ¡«®·Š °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 0.1 ¨³ 0.0 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„˜µ¤ž¦³Á£šÃ¦Š¡¥µµ¨š¸ÉŸ¼ožiª¥¦´„¬µ ¡ªnµ Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨ ¤®µª·š¥µ¨´¥Â¨³Ã¦Š¡¥µµ¨Á°„œ ¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Purulent endophthalmitis ¤µ„„ªn µ Ÿ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ ˜´ — Ĝ抡¥µµ¨°ºÉ œ Ç °¥n µ Š¤¸ œ´ ¥ ­Î µ ‡´  šµŠ­™· ˜· (¦o ° ¥¨³ 0.1 Ášnµ„´œ) —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 9


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 35

˜µ¦µŠš¸É 9 £µª³ Purulent endophthalmitis (H440) ‹ÎµÂœ„˜µ¤ž{‹‹´¥ H440 ž{‹‹´¥ œ·—Á¨œ­r Non-foldable Foldable œ·—­·š›· UC CSMBS Á¡« µ¥ ®·Š ž¦³Á£šÃ¦Š¡¥µµ¨ 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ * ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

Total

p-Value*

No complications

Purulent endophthalmitis

106,101(100.0) 115,609(100.0)

53(0.0) 36(0.0)

106,154(47.9) 115,645(52.1)

0.027*

156,245(100.0) 65,465(100.0)

69(0.0) 20(0.0)

156,314(70.5) 65,485(29.5)

0.145

92,134(99.9) 129,576(100.0)

53(0.1) 36(0.0)

92,187(41.6) 129,612(58.4)

0.001*

85,875(100.0) 15,518(100.0) 70,641(100.0) 18,277(99.9) 4,575(99.9) 26,824(100.0)

35(0.0) 2(0.0) 20(0.0) 17(0.1) 6(0.1) 9(0.0)

85,910(38.7) 15,520(7.0) 70,661(31.9) 18,294(8.2) 4,581(2.1) 26,833(12.1)

0.000*

„µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°£µª³Âš¦„Žo°œ —oª¥„µ¦ª·Á‡¦µ³®rž{‹‹´¥—oª¥ Logistic regression ×¥œÎµÁ…oµ˜´ªÂž¦°·­¦³ 5 ˜´ªÂž¦ ŗo„n Á¡« °µ¥» œ·—Á¨œ­r ­·š›·„µ¦¦´„¬µ ¨³ ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Á¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦ ™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¤¸‡nµ p-value = 0.696 (p-value>0.05) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸‡ªµ¤Á®¤µ³­¤ ‹µ„­¤„µ¦ ™—™°¥­µ¤µ¦™­¦»žŸ¨„µ¦«¹„¬µÅ—o—´Šœ¸Ê 1. Á¡«®·Š¤¸Ã°„µ­Á„·—£µª³ Purulent endophthalmitis œo°¥„ªnµÁ¡«µ¥¦o°¥¨³ 44 2. Ÿ¼o ži ª ¥ š¸É Ÿn µ ˜´ — ˜o ° „ ¦ ³ ‹ „ š¸É ¤¸ ° µ ¥» ¤ µ „ …¹Ê œ ¤¸ à ° „ µ ­ Á „· — £ µ ª ³ Purulent endophthalmitis œo°¥„ªnµ¦o°¥¨³ 4 Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸É¤¸°µ¥»œo°¥ 3. Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rĜ抡¥µµ¨Á°„œ¤¸Ã°„µ­Á„·—£µª³ Purulent endophthalmitis Áž}œ 3 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Äœ 抡¥µµ¨š´ÉªÅž


Health Intervention and Technology Assessment Program

36 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 10 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—ªo ¥­¤„µ¦™—™°¥ Logistic regression ž{‹‹´¥ Á¡«®·Š °µ¥» 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ Constant

B

Exp(B)

-.589 -.044

.555 .957

Std. Error .219 .006

-1.050 -.389 .574 1.191 -.215 -4.669

.350 .678 1.776 3.289 .807 .009

.727 .281 .303 .442 .374 .384

Wald 7.242 58.196 19.195 2.083 1.918 3.589 7.242 .331 147.595

df

Sig. 1 1 5 1 1 1 1 1 1

.007 .000 .002 .149 .166 .058 .007 .565 .000

95% CI (0.361-0.852) (0.946-0.968) (0.084-1.456) (0.391-1.175) (0.980-3.217) (1.382-7.829) (0.387-1.679)

2. £µª³Á¨º°—°°„Äœ´ÊœÄ˜o‹°ž¦³­µš˜µ (Choroidal hemorrhage and rupture) ‹µ„„µ¦«¹ „ ¬µŸ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ˜´ — ˜o ° „¦³‹„š¸É ¤¸ „ µ¦Ä­n Á ¨œ­r „o ª ˜µÁš¸ ¥ ¤ ‹Î µ œªœ 221,799 ¦µ¥ ¡ªnµ ¤¸Ÿ¼ožiª¥š¸É¤¸£µª³ Choroidal hemorrhage and rupture ‹Îµœªœ 15 ¦µ¥ Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤œ·—Á¨œ­rš¸ÉÄ­n ¡ªnµ Ÿ¼ožiª¥š¸ÉÄ­nÁ¨œ­r…Ȋ¨³Á¨œ­rœ·É¤¤¸­´—­nªœ…°Š„µ¦ Á„·—£µª³Á¨º°—°°„Äœ´ÊœÄ˜o‹°ž¦³­µš˜µÅ¤n˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (p-value > 0.05) „¨nµª‡º° ‹Îµœªœ 7 ¨³ 8 ¦µ¥ ˜µ¤¨Îµ—´ —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 11


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 37

˜µ¦µŠš¸É 11 £µª³ Choroidal hemorrhage and rupture (H313) ‹ÎµÂœ„˜µ¤ž{‹‹´¥ H313 ž{‹‹´¥

œ·—Á¨œ­r non-foldable Foldable œ·—­·š›· UC CSMBS Á¡« µ¥ ®·Š ž¦³Á£šÃ¦Š¡¥µµ¨ 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ

Total

p-Value*

No complications

Choroidal hemorrhage and rupture

106,147(100.0) 115,637(100.0)

7(0.0) 8(0.0)

106,154(47.9) 115,645(52.1)

0.926

156,306(100.0) 65,478(100.0)

8(0.0) 7(0.0)

156,314(70.5) 65,485(29.5)

0.146

92,181(100.0) 129,603(100.0)

6(0.0) 9(0.0)

92,187(41.6) 129,612(58.4)

0.902

85,909(100.0) 15,520(100.0) 70,657(100.0) 18,285(99.9) 4,581(100.0) 26,832(100.0)

1(0.0) 0(0.0) 4(0.0) 9(0.1) 0(0.0) 1(0.0)

85,910(38.7) 15,520(7.0) 70,661(31.9) 18,294(8.2) 4,581(2.1) 26,833(12.1)

* ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

„µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°£µª³Âš¦„Žo°œ —oª¥„µ¦ª·Á‡¦µ³®rž{‹‹´¥—oª¥ Logistic regression ×¥œÎµÁ…oµ˜´ªÂž¦°·­¦³ 5 ˜´ªÂž¦ ŗo„n Á¡« °µ¥» œ·—Á¨œ­r ­·š›·„µ¦¦´„¬µ ¨³ ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Á¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦ ™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¤¸‡nµ p-value = 0.619 (pvalue>0.05) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸‡ªµ¤Á®¤µ³­¤ ‹µ„­¤„µ¦™—™°¥ ¡ªnµ Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ĝ抡¥µµ¨¤®µª·š¥µ¨´¥¤¸Ã°„µ­Á„·—£µª³ Choroidal hemorrhage and rupture Áž}œ 42 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž


Health Intervention and Technology Assessment Program

38 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 12 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—ªo ¥­¤„µ¦™—™°¥ Logistic regression ž{‹‹´¥

B

抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ -9.842 抡¥µµ¨«¼œ¥r 1.582 抡¥µµ¨¤®µª·š¥µ¨´¥ 3.744 抡¥µµ¨Á°„œ -9.842 抡¥µµ¨°ºÉœÇ 1.164 Constant -11.361

Exp(B)

.000 4.863 42.285 .000 3.202 .000

Std. Error 322.631 1.118 1.054 593.842 1.414 1.000

Wald 24.435 .001 2.001 12.618 .000 .677 129.072

df

Sig. 5 1 1 1 1 1 1

95% CI

.000 .976 (0.000-2.2E+270) .157 (0.544-43.514) .000 (5.357-333.778) .987 (0.000-0) .411 (0.200-51.190) .000

3. £µª³Á¨º°—°°„n°Š®œoµ¤nµœ˜µ (Hyphema) ‹µ„„µ¦«¹ „ ¬µŸ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ˜´ — ˜o ° „¦³‹„š¸É ¤¸ „ µ¦Ä­n Á ¨œ­r „o ª ˜µÁš¸ ¥ ¤ ‹Î µ œªœ 221,799 ¦µ¥ ¡ªnµ ¤¸Ÿ¼ožiª¥š¸É¤¸£µª³ Hyphema (H210) ‹Îµœªœ 131 ¦µ¥ Ž¹ÉŠ‡·—Áž}œ‹Îµœªœ ¦o°¥¨³ 0.1 …°ŠŸ¼ožiª¥š´ÊŠ®¤— Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤œ·—Á¨œ­rš¸ÉÄ­n ¡ªnµ Ÿ¼ožiª¥š¸ÉÄ­nÁ¨œ­r…Ȋ¤¸ ­´—­nªœ…°Š„µ¦Á„·—£µª³ Hyphema ¤µ„„ªnµ‡œš¸ÉÄ­nÁ¨œ­rœ·É¤°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (pvalue < 0.05) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤­·š›· ¡ªnµ Ÿ¼ožiª¥š¸É¤¸­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ¤¸ ­´ — ­n ª œ…°Š„µ¦Á„· — £µª³ Hyphema ¤µ„„ªn µ Ÿ¼o ži ª ¥š¸É Ä o ­· š ›· ­ ª´ ­ —· „ µ¦…o µ ¦µ„µ¦ ˜n Å ¤n ˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (p-value > 0.05) (¦o°¥¨³ 0.1 ¨³ 0.0 ˜µ¤¨Îµ—´) Á¤ºÉ° ‹Î µ œ„Ÿ¼o ži ª ¥˜µ¤Á¡« ¡ªn µ Á¡«µ¥Â¨³Á¡«®· Š¤¸ ­´ — ­n ª œ…°Š„µ¦Á„· — £µª³ Hyphema Ášnµ„´œ (¦o°¥¨³ 0.1 Ášnµ„´œ) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Ÿ¼ožiª¥š¸É¦´„µ¦ Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨Á°„œ¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Hyphema ¤µ„„ªnµŸ¼ožiª¥š¸É¦´ „µ¦Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨°ºÉœÇ °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (p-value < 0.05) (¦o°¥¨³ 0.2) —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 13


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 39

˜µ¦µŠš¸É 13 £µª³ Hyphema (H210) ‹ÎµÂœ„˜µ¤ž{‹‹´¥ ž{‹‹´¥ œ·—Á¨œ­r non-foldable foldable œ·—­·š›· UC CSMBS Á¡« µ¥ ®·Š ž¦³Á£šÃ¦Š¡¥µµ¨ 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ * ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

H210 No complications Hyphema

Total

p-Value*

106,073(99.9) 115,595(100.0)

81(0.1) 50(0.0)

106,154(47.9) 115,645(52.1)

0.001*

156,212(99.9) 65,456(100.0)

102(0.1) 29(0.0)

156,314(70.5) 65,485(29.5)

0.064

92,133(99.9) 129,535(99.9)

54(0.1) 77(0.1)

92,187(41.6) 129,612(58.4)

0.937

85,853(99.9) 15,500(99.9) 70,637(100.0) 18,282(99.9) 4,571(99.8) 26,8251(100.0)

57(0.1) 20(0.1) 24(0.0) 12(0.1) 10(0.2) 8(0.0)

85,910(38.7) 15,520(7.0) 70,661(31.9) 18,294(8.2) 4,581(2.1) 26,833(12.1)

0.000*

„µ¦«¹ „ ¬µž{ ‹ ‹´ ¥ š¸É ¤¸ Ÿ ¨˜n ° £µª³Âš¦„Žo ° œ —o ª ¥„µ¦ª· Á ‡¦µ³®r ž{ ‹ ‹´ ¥ —o ª ¥ Logistic regression ×¥œÎµÁ…oµ˜´ªÂž¦°·­¦³ 5 ˜´ªÂž¦ ŗo„n Á¡« °µ¥» œ·—Á¨œ­r ­·š›·„µ¦¦´„¬µ ¨³ ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Á¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦ ™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¤¸‡nµ p-value = 0.987 (p-value>0.05) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸‡ªµ¤Á®¤µ³­¤ ‹µ„­¤„µ¦ ™—™°¥ ­µ¤µ¦™­¦»žŸ¨„µ¦«¹„¬µÅ—o—´Šœ¸Ê 1. Ÿ¼ožiª¥š¸ÉÄ­nÁ¨œ­rœ·É¤¤¸Ã°„µ­Á„·—£µª³ Hyphema œo°¥„ªnµŸ¼ožiª¥š¸ÉÄ­nÁ¨œ­r…Ȋ ¦o°¥¨³ 45 2. Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ĝ抡¥µµ¨»¤œ¤¸Ã°„µ­Á„·—£µª³ Hyphema Áž}œ 2 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨š´ÉªÅž 3. Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rĜ抡¥µµ¨Á°„œ¤¸Ã°„µ­Á„·—£µª³ Hyphema Áž}œ 2.8 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž 4. Ÿ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Ä­n Á ¨œ­r Ä œÃ¦Š¡¥µµ¨«¼ œ ¥r ¤¸ à °„µ­Á„· — £µª³ Hyphema œo°¥„ªnµŸ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž¦o°¥¨³ 51


Health Intervention and Technology Assessment Program

40 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 14 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—ªo ¥­¤„µ¦™—™°¥ Logistic regression B Foldable Lens 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ Constant

Exp(B)

-.605

.546

Std. Error .186

.767 -.723 .095 1.029 -.674 -7.056

2.153 .485 1.099 2.797 .510 .001

.262 .244 .319 .346 .380 .148

Wald 10.589 38.459 8.568 8.795 .088 8.840 3.155 2259.218

df

Sig. 1 5 1 1 1 1 1 1

.001 .000 .003 .003 .767 .003 .076 .000

95% CI (0.379-0.786) (1.288-3.597) (0.301-0.783) (0.588-2.056) (1.420-5.512) (0.242-1.072)

4. £µª³„¦³‹„˜µª¤ (Other corneal edema) ‹µ„„µ¦«¹ „ ¬µŸ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ˜´ — ˜o ° „¦³‹„š¸É ¤¸ „ µ¦Ä­n Á ¨œ­r „o ª ˜µÁš¸ ¥ ¤ ‹Î µ œªœ 221,799 ¦µ¥ ¡ªnµ ¤¸Ÿ¼ožiª¥š¸É¤¸£µª³ Other corneal edema ‹Îµœªœ 115 ¦µ¥ Ž¹ÉŠ‡·—Áž}œ ‹Îµœªœ¦o°¥¨³ 0.1 …°ŠŸ¼ožiª¥š´ÊŠ®¤— Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤œ·—Á¨œ­rš¸ÉÄ­n ¡ªnµ Ÿ¼ožiª¥š¸ÉÄ­n Á¨œ­rœ·É¤¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Other corneal edema ¤µ„„ªnµ‡œš¸ÉÄ­nÁ¨œ­r…Ȋ ˜nŤn ˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 0.1 ¨³ 0.0 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤ ­·š›· ¡ªnµ Ÿ¼ožiª¥¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Other corneal edema Ášnµ„´œš´ÊŠ 2 ­·š›· (¦o°¥¨³ 0.1 Ášnµ„´œ) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤Á¡« ¡ªnµ Á¡«®·Š¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Other corneal edema ¤µ„„ªnµÁ¡«µ¥ ˜nŤn˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 0.1 ¨³ 0.0 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Ÿ¼ožiª¥š¸É¦´„µ¦Ÿnµ˜´—Ä­nÁ¨œ­r Ĝ抡¥µµ¨»¤œ¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Other corneal edema ¤µ„„ªnµŸ¼ožiª¥š¸É¦´„µ¦ Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨°ºÉœÇ °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (p-value < 0.05) (¦o°¥¨³ 0.2) —´Š ­—ŠÄœ˜µ¦µŠš¸É 15


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 41

˜µ¦µŠš¸É 15 £µª³ Other corneal edema (H182) ‹ÎµÂœ„˜µ¤ž{‹‹´¥ ž{‹‹´¥ œ·—Á¨œ­r non-foldable foldable œ·—­·š›· UC CSMBS Á¡« µ¥ ®·Š ž¦³Á£šÃ¦Š¡¥µµ¨ 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ * ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

H182 No complications Other corneal edema

Total

p-Value*

106,109(100.0) 115,575(99.9)

45(0.0) 70(0.1)

106,154(47.9) 115,645(52.1)

0.061

156,233(99.9) 65,451(99.9)

81(0.1) 34(0.1)

156,314(70.5) 65,485(29.5)

0.992

92,145(100.0) 129,539(99.9)

42(0.0) 73(0.1)

92,187(41.6) 129,612(58.4)

0.273

85,872(100.0) 15,486(99.8) 70,638(100.0) 18,289(100.0) 4,580(100.0) 26,819(99.9)

38(0.0) 34(0.2) 23(0.0) 5(0.0) 1(0.0) 14(0.1)

85,910(38.7) 15,520(7.0) 70,661(31.9) 18,294(8.2) 4,581(2.1) 26,833(12.1)

0.000*

„µ¦«¹ „ ¬µž{ ‹ ‹´ ¥ š¸É ¤¸ Ÿ ¨˜n ° £µª³Âš¦„Žo ° œ —o ª ¥„µ¦ª· Á ‡¦µ³®r ž{ ‹ ‹´ ¥ —o ª ¥ Logistic regression ×¥œÎµÁ…oµ˜´ªÂž¦°·­¦³ 5 ˜´ªÂž¦ ŗo„n Á¡« °µ¥» œ·—Á¨œ­r ­·š›·„µ¦¦´„¬µ ¨³ ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Á¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦ ™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¤¸‡nµ p-value = 0.798 (pvalue>0.05) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸‡ªµ¤Á®¤µ³­¤ ‹µ„­¤„µ¦™—™°¥ ­µ¤µ¦™­¦»ž„µ¦«¹„¬µÅ—o—´Šœ¸Ê 1. Ÿ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Á¤ºÉ ° °µ¥» ¤ µ„…¹Ê œ 1 že ¤¸ à °„µ­Á„· — £µª³ Other corneal edema Áž}œ 1 Ášnµ 2. Ÿ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Ĝ抡¥µµ¨» ¤ œ¤¸ à °„µ­Á„· — £µª³ Other corneal edema Áž}œ 4.8 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœ 抡¥µµ¨š´ÉªÅž


Health Intervention and Technology Assessment Program

42 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 16 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—ªo ¥­¤„µ¦™—™°¥ Logistic regression B °µ¥» 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ Constant

Exp(B) .035

1.035

Std. Error .010

1.579 -.306 -.460 -.670 .155 -10.128

4.852 .736 .631 .512 1.168 .000

.236 .264 .476 1.013 .313 .751

Wald 11.275 70.378 44.686 1.342 .934 .437 .245 182.064

df

Sig. 1 5 1 1 1 1 1 1

.001 .000 .000 .247 .334 .509 .620 .000

95% CI (1.015-1.057) (3.054-7.710) (0.439-1.236) (0.249-1.605) (0.070-3.729) (0.632-2.155)

5. £µª³Âš¦„Žo°œ°ºÉœ…°Š„µ¦Ÿnµ˜´— (Complication of procedures) ‹µ„„µ¦«¹ „ ¬µŸ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ˜´ — ˜o ° „¦³‹„š¸É ¤¸ „ µ¦Ä­n Á ¨œ­r „o ª ˜µÁš¸ ¥ ¤ ‹Î µ œªœ 221,799 ¦µ¥ ¡ªnµ ¤¸Ÿ¼ožiª¥š¸É¤¸£µª³ Complication of procedures ‹Îµœªœ 1,924 ¦µ¥ Ž¹ÉŠ‡·— Áž}œ‹Îµœªœ¦o°¥¨³ 0.9 …°ŠŸ¼ožiª¥š´ÊŠ®¤— Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤œ·—Á¨œ­rš¸ÉÄ­n ¡ªnµ Ÿ¼ožiª¥š¸ÉÄ­n Á¨œ­rœ·É¤Â¨³Á¨œ­r…Ȋ¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Complication of procedures Ášnµ„´œ (¦o°¥¨³ 0.9 Ášnµ„´œ) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤­·š›· ¡ªnµ Ÿ¼ožiª¥š¸Éčo­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦¤¸ ­´—­nªœ…°Š„µ¦Á„·—£µª³ Complication of procedures ¤µ„„ªnµŸ¼ožiª¥š¸Éčo­·š›·ž¦³„´œ­»…£µ¡ ™oªœ®œoµ °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 1.0 ¨³ 0.8 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤Á¡« ¡ªnµ Á¡«µ¥¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Complication of procedures ¤µ„„ªnµÁ¡«®·Š °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 1.0 ¨³ 0.8 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤ž¦³Á£š 抡¥µµ¨ ¡ªnµ Ÿ¼ožiª¥š¸É¦´„µ¦Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨¤®µª·š¥µ¨´¥¤¸­´—­nªœ…°Š„µ¦ Á„·—£µª³ Complication of procedures ¤µ„„ªnµŸ¼ožiª¥š¸É¦´„µ¦Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨ °ºÉœÇ °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 3.3) —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 17


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 43

˜µ¦µŠš¸É 17 £µª³ Complication of procedures (T81) ‹ÎµÂœ„˜µ¤ž{‹‹´¥ ž{‹‹´¥ œ·—Á¨œ­r non-foldable foldable œ·—­·š›· UC CSMBS Á¡« µ¥ ®·Š ž¦³Á£šÃ¦Š¡¥µµ¨ 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ * ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

T81 No complications Complication of procedures

Total

p-Value*

105,249(99.1) 114,626(99.1)

905(0.9) 1,019(0.9)

106,154(47.9) 115,645(52.1)

0.468

155,023(99.2) 64,852(99.0)

1,291(0.8) 633(1.0)

156,314(70.5) 65,485(29.5)

0.001*

91,305(99.0) 128,570(99.2)

882(1.0) 1,042(0.8)

92,187(41.6) 129,612(58.4)

0.000*

85,109(99.1) 15,469(99.7) 70,370(99.6) 17,695(96.7) 4,567(99.7) 26,665(99.4)

801(0.9) 51(0.3) 291(0.4) 599(3.3) 14(0.3) 168(0.6)

85,910(38.7) 15,520(7.0) 70,661(31.9) 18,294(8.2) 4,581(2.1) 26,833(12.1)

0.000*

„µ¦«¹„¬µž{‹‹´¥š¸É¤¸Ÿ¨˜n°£µª³Âš¦„Žo°œ —oª¥„µ¦ª·Á‡¦µ³®rž{‹‹´¥—oª¥ Logistic regression ×¥œÎµÁ…oµ˜´ªÂž¦°·­¦³ 5 ˜´ªÂž¦ ŗo„n Á¡« °µ¥» œ·—Á¨œ­r ­·š›·„µ¦¦´„¬µ ¨³ ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Á¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦ ™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¤¸‡nµ p-value = 0.093 (pvalue>0.05) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸‡ªµ¤Á®¤µ³­¤ ‹µ„­¤„µ¦™—™°¥ ­µ¤µ¦™­¦»ž„µ¦«¹„¬µÅ—o—´Šœ¸Ê 1. Ÿ¼ožiª¥­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦¤¸Ã°„µ­Á„·—£µª³ Complication of procedures œo°¥„ªnµŸ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ¦o°¥¨³ 28 2. Á¡«®·Š¤¸Ã°„µ­Á„·—£µª³ Complication of procedures œo°¥„ªnµÁ¡«µ¥¦o°¥¨³ 17 3. Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ä­nÁ¨œ­rÁ¤ºÉ°°µ¥»¤µ„…¹Êœ 1 že¤¸Ã°„µ­Á„·—£µª³ Complication of procedures Áž}œ‹Îµœªœ 1 Ášnµ


Health Intervention and Technology Assessment Program

44 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 4. Ÿ¼ožiª ¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ ¨œ­rĜ抡¥µµ¨»¤œ¤¸Ã°„µ­Á„·—£µª³ Complication of procedures œo°¥„ªnµŸ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž ¦o°¥¨³ 66 5. Ÿ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Ä­n Á ¨œ­r Ä œÃ¦Š¡¥µµ¨«¼ œ ¥r ¤¸ à °„µ­Á„· — £µª³ Complication of procedures œo°¥„ªnµŸ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž ¦o°¥¨³ 56 6. Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rĜ抡¥µµ¨Á°„œ¤¸Ã°„µ­Á„·—£µª³ Complication of procedures œo°¥„ªnµŸ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž ¦o°¥¨³ 69 7. Ÿ¼oži ª ¥š¸É šÎ µ „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Ä­n Á ¨œ­r Ä œÃ¦Š¡¥µµ¨°ºÉœ Ç ¤¸ à °„µ­Á„· — £µª³ Complication of procedures œo°¥„ªnµŸ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž ¦o°¥¨³ 25 8. Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rĜ抡¥µµ¨¤®µª·š¥µ¨´¥¤¸Ã°„µ­Á„·— £µª³ Complication of procedures ‹Îµœªœ 4 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸ÉšÎµ„µ¦ Ÿnµ˜´—Ĝ抡¥µµ¨š´ÉªÅž ˜µ¦µŠš¸É 18 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—ªo ¥­¤„µ¦™—™°¥ Logistic regression B CSMBS -.336 Á¡«®·Š -.184 °µ¥» .017 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ -1.076 抡¥µµ¨«¼œ¥r -.813 抡¥µµ¨¤®µª·š¥µ¨´¥ 1.434 抡¥µµ¨Á°„œ -1.162 抡¥µµ¨°ºÉœÇ -.284 Constant -5.629

Exp(B) .715 .832 1.017

Std. Error .055 .046 .002

.341 .443 4.197 .313 .753 .004

.145 .069 .059 .270 .087 .155

Wald 37.807 15.824 56.913 1201.965 55.308 140.384 589.522 18.480 10.533 1314.086

df

Sig. 1 1 1 5 1 1 1 1 1 1

.000 .000 .000 .000 .000 .000 .000 .000 .001 .000

95% CI (0.642-0.796) (0.760-0.911) (1.012-1.021) (0.257-0.453) (0.388-0.507) (3.738-4.712) (0.184-0.532) (0.634-0.894)



6. £µª³Á¨œ­rÁ‡¨ºÉ°œ®¦º°®¨»—‹µ„˜ÎµÂ®œnŠ (Mechanical complication of intraocular lens) ‹µ„„µ¦«¹ „ ¬µŸ¼oži ª ¥š¸ÉšÎ µ „µ¦Ÿn µ˜´ — ˜o° „¦³‹„š¸É¤¸ „ µ¦Ä­n Á ¨œ­r „o ª ˜µÁš¸ ¥¤ ‹Îµ œªœ 221,799 ¦µ¥ ¡ªnµ ¤¸Ÿ¼ožiª¥š¸É¤¸£µª³ Mechanical complication of intraocular lens ‹Îµœªœ


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 45

528 ¦µ¥ Ž¹ÉŠ‡·—Áž}œ‹Îµœªœ¦o°¥¨³ 0.2 …°ŠŸ¼ožiª¥š´ÊŠ®¤— Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤œ·—Á¨œ­rš¸ÉÄ­n ¡ªnµ Ÿ¼ožiª¥š¸ÉÄ­nÁ¨œ­rœ·É¤Â¨³Á¨œ­r…Ȋ¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Mechanical complication of intraocular lens Ášnµ„´œ (¦o°¥¨³ 0.2 Ášnµ„´œ) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤­·š›· ¡ªnµ Ÿ¼ožiª¥š¸Éčo ­·š›·­ª´­—·„µ¦…oµ¦µ„µ¦¤¸­´—­nªœ…°Š„µ¦Á„·—£µª³ Mechanical complication of intraocular lens ¤µ„„ªnµŸ¼ožiª¥š¸Éčo­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ˜nŤn˜„˜nµŠ°¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 0.3 ¨³ 0.2 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤Á¡« ¡ªnµ Á¡«µ¥¤¸­´—­nªœ…°Š„µ¦ Á„·—£µª³ Mechanical complication of intraocular lens ¤µ„„ªnµÁ¡«®·Š °¥nµŠ¤¸œ´¥­Îµ‡´ šµŠ­™·˜· (¦o°¥¨³ 0.3 ¨³ 0.2 ˜µ¤¨Îµ—´) Á¤ºÉ°‹ÎµÂœ„Ÿ¼ožiª¥˜µ¤ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Ÿ¼o ži ª ¥š¸É ¦´  „µ¦Ÿn µ ˜´ — Ä­n Á ¨œ­r Ä œÃ¦Š¡¥µµ¨¤®µª· š ¥µ¨´ ¥ ¤¸ ­´ — ­n ª œ…°Š„µ¦Á„· — £µª³ Mechanical complication of intraocular lens ¤µ„„ªnµŸ¼ožiª¥š¸É¦´„µ¦Ÿnµ˜´—Ä­nÁ¨œ­rĜ 抡¥µµ¨°ºÉœÇ °¥nµŠ¤¸œ´¥­Îµ‡´šµŠ­™·˜· (¦o°¥¨³ 0.7) —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 19 ˜µ¦µŠš¸É 19 £µª³ Mechanical complication of intraocular lens ‹ÎµÂœ„˜µ¤ž{‹‹´¥ ž{‹‹´¥

œ·—Á¨œ­r non-foldable foldable œ·—­·š›· UC CSMBS Á¡« µ¥ ®·Š ž¦³Á£šÃ¦Š¡¥µµ¨ 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ * ¤¸œ´¥­Îµ‡´šµŠ­™·˜·

T852 No complications Mechanical complication of intraocular lens

Total

p-Value*

105,891(99.8) 115,380(99.8)

263(0.2) 265(0.2)

106,154(47.9) 115,645(52.1)

0.369

155,957(99.8) 65,314(99.7)

357(0.2) 171(0.3)

156,314(70.5) 65,485(29.5)

0.149

91,927(99.7) 129,344(99.8)

260(0.3) 268(0.2)

92,187(41.6) 129,612(58.4)

0.000*

85,762(99.8) 15,459(99.6) 70,536(99.8) 18,159(99.3) 4,577(99.9) 26,778(99.8)

148(0.2) 61(0.4) 125(0.2) 135(0.7) 4(0.1) 55(0.2)

85,910(38.7) 15,520(7.0) 70,661(31.9) 18,294(8.2) 4,581(2.1) 26,833(12.1)

0.000*


Health Intervention and Technology Assessment Program

46 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ „µ¦«¹ „ ¬µž{ ‹ ‹´ ¥ š¸É ¤¸ Ÿ ¨˜n ° £µª³Âš¦„Žo ° œ —o ª ¥„µ¦ª· Á ‡¦µ³®r ž{ ‹ ‹´ ¥ —o ª ¥ Logistic regression ×¥œÎµÁ…oµ˜´ªÂž¦°·­¦³ 5 ˜´ªÂž¦ ŗo„n Á¡« °µ¥» œ·—Á¨œ­r ­·š›·„µ¦¦´„¬µ ¨³ ž¦³Á£šÃ¦Š¡¥µµ¨ ¡ªnµ Á¤ºÉ°šÎµ„µ¦˜¦ª‹­°‡ªµ¤Á®¤µ³­¤ (Goodness of fit) …°Š­¤„µ¦ ™—™°¥ Logistic regression —oª¥ Hosmer and Lemeshow Test ¤¸‡nµ p-value = 0.043 (pvalue>0.01) ­—Šªnµ­¤„µ¦™—™°¥ Logistic regression ¤¸‡ªµ¤Á®¤µ³­¤ ‹µ„­¤„µ¦™—™°¥ ­µ¤µ¦™­¦»ž„µ¦«¹„¬µÅ—o—´Šœ¸Ê 1. Ÿ¼o ži ª ¥š¸É šÎ µ „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„Ä­n Á ¨œ­r Á ¤ºÉ ° °µ¥» ¤ µ„…¹Ê œ 1 že ¤¸ à °„µ­Á„· — £µª³ Mechanical complication of intraocular lens ¨—¨Š¦o°¥¨³ 1 2. Ÿ¼ožiª¥š¸ÉÄ­nÁ¨œ­rœ·É¤¤¸Ã°„µ­Á„·—£µª³ Mechanical complication of intraocular lens œo°¥„ªnµŸ¼ožiª¥š¸ÉÄ­nÁ¨œ­r…Ȋ¦o°¥¨³ 23 3. Ÿ¼ožiª ¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ ¨œ­rĜ抡¥µµ¨»¤œ¤¸Ã°„µ­Á„·—£µª³ Mechanical complication of intraocular lens Áž}œ 2.4 Ášnµ Á¤ºÉ°Áš¸¥„´Ÿ¼ožiª¥š¸É šÎµ„µ¦Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨š´ÉªÅž 4. Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rĜ抡¥µµ¨¤®µª·š¥µ¨´¥¤¸Ã°„µ­Á„·— £µª³ Mechanical complication of intraocular lens Áž}œ 4.4 Ášnµ Á¤ºÉ°Áš¸¥„´ Ÿ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—Ä­nÁ¨œ­rĜ抡¥µµ¨š´ÉªÅž ˜µ¦µŠš¸É 20 ‡nµ­™·˜·‹µ„„µ¦ª·Á‡¦µ³®r—ªo ¥­¤„µ¦™—™°¥ Logistic regression B °µ¥» Foldable Lens 抡¥µµ¨š´ÉªÅž 抡¥µµ¨»¤œ 抡¥µµ¨«¼œ¥r 抡¥µµ¨¤®µª·š¥µ¨´¥ 抡¥µµ¨Á°„œ 抡¥µµ¨°ºÉœÇ Constant

Exp(B)

-.009 -.257

.991 .773

Std. Error .003 .090

.881 .002 1.486 -.761 .230 -5.622

2.413 1.002 4.419 .467 1.258 .004

.153 .122 .121 .508 .159 .244

Wald 7.116 8.134 208.728 33.042 .000 151.513 2.251 2.080 533.109

df

Sig. 1 1 5 1 1 1 1 1 1

.008 .004 .000 .000 .988 .000 .134 .149 .000

95% CI (0.984-0.998) (0.648-0.923) (1.787-3.258) (0.789-1.272) (3.488-5.599) (0.173-1.263) (0.921-1.719)


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 47

­nªœš¸É 2: „µ¦«¹„¬µ‡ªµ¤‡»o¤‡nµšµŠ„µ¦Â¡š¥r 2.1 ª´˜™»ž¦³­Š‡r Á¡ºÉ°ª·Á‡¦µ³®r˜oœš»œ°¦¦™ž¦³Ã¥œr…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ ¨³Á¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ…°ŠŸ¼ožiª¥Äœž¦³Áš«Åš¥ 2.2 ¦³Á¸¥ª·›¸ª·‹¥´ 2.2.1 „µ¦ž¦³Á¤·œ‡ªµ¤‡»¤o ‡nµšµŠÁ«¦¬“«µ­˜¦r Ĝ„µ¦ž¦³Á¤·œ‡ªµ¤‡»o¤‡nµšµŠÁ«¦¬“«µ­˜¦r…°Š„µ¦«¹„¬µœ¸Êčoª·›¸„µ¦ž¦³Á¤·œ˜oœš»œ °¦¦™ž¦³Ã¥œr (cost-utility analysis) ץčo‹Îµ¨°Š decision tree ×¥Áž¦¸¥Áš¸¥„µ¦ Ÿnµ˜´—˜o°„¦³‹„ץĭnÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠÁž¦¸¥Áš¸¥„´œ·—œ·É¤Ã—¥Äo¤»¤¤°Š…°ŠŸ¼o Ä®o¦·„µ¦ 2.2.1.1 ‹Îµ¨°ŠšµŠÁ«¦¬“«µ­˜¦r ‹Îµ¨°Š decision tree (¦¼žš¸É 14 ) ­—ŠšµŠÁ¨º°„­Îµ®¦´Ÿ¼ožiª¥š¸ÉŸnµ˜´—˜o°„¦³‹„°¥¼n ­°ŠšµŠÁ¨º ° „ šµŠÁ¨º ° „š¸É ® œ¹É Š ‡º ° „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„×¥ª· ›¸ ­ ¨µ¥˜o ° Ážd — Ÿ¨Á¨È „ (Phacoemulsification) Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ ¨³šµŠÁ¨º°„š¸É­°Š ‡º° „µ¦Ÿnµ˜´—˜o° „¦³‹„×¥ª·›¸­¨µ¥˜o°ÂÁžd—Ÿ¨Á¨È„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ ץĜ˜n¨³šµŠÁ¨º°„¤¸ ð„µ­Äœ„µ¦Ÿnµ˜´—­ÎµÁ¦È‹Â¨³Å¤n­ÎµÁ¦È‹ Ĝ„¦–¸š¸É„µ¦Ÿnµ˜´—­ÎµÁ¦È‹„È‹³¤¸Ã°„µ­š¸É¤¸®¦º°Å¤n¤¸ £µª³Âš¦„Žo°œ°¥nµŠÄ—°¥nµŠ®œ¹ÉŠ ŗo„n 1) ™»Š®»o¤Á¨œ­r…»nœ (posterior capsule opacification) 2) £µª³Á¨º°—°°„®œoµn°Š¤nµœ˜µ (hyphema) 3) £µª³Á¨œ­rÁ‡¨ºÉ°œ®¨»— (Mechanical complication of intraocular lens) Ž¹ÉŠ…o°¤¼¨£µª³Âš¦„Žo°œ—´Š„¨nµª…oµŠ˜oœÅ—o„n ™»Š®»o¤Á¨œ­r …»nœ ŗo¤µ‹µ„„µ¦ššªœª¦¦–„¦¦¤°¥nµŠÁž}œ¦³ (systematic review) ¨³„µ¦ª·Á‡¦µ³®r °£·¤µœ (meta-analysis) Ĝ­nªœ…°Š£µª³Á¨º°—°°„®œoµn°Š¤nµœ˜µ ¨³£µª³Á¨œ­rÁ‡¨ºÉ°œ®¨»— ŗo¤µ‹µ„Ÿ¨„µ¦ª·Á‡¦µ³®r…o°¤¼¨Äœ­nªœš¸É 1.3.3.3 ×¥‡´—Á¨º°„ÁŒ¡µ³£µª³Âš¦„Žo°œš¸É¤¸°´˜¦µ „µ¦Á„·—˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´¦³®ªnµŠ„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤Á¤ºÉ°Áž¦¸¥Áš¸¥ „´œ·—Â…ÈŠ Ĝ˜n¨³£µª³Âš¦„Žo°œŸ¼ožiª¥°µ‹‹³¤¸Ã°„µ­Å—o¦´„µ¦¦´„¬µ Ž¹ÉŠ„µ¦¦´„¬µ„Ȥ¸ ð„µ­š¸É°µ‹‹³­ÎµÁ¦È‹®¦º°Å¤n­ÎµÁ¦È‹ œ°„‹µ„œ¸ÊĜ„¦–¸®µ„Á„·—™»Š®»o¤Á¨œ­r…»nœ ‹³Å—o¦´„µ¦¦´„¬µ ×¥„µ¦¥·ŠÁ¨ÁŽ°¦r (Nd:YAG laser capsulotomy) ¨³°µ‹‹³¤¸Ã°„µ­Á„·—£µª³Âš¦„Žo°œ‹°ž¦³­µš˜µ®¨»—¨°„ (retinal detachment) ®¦º°Å¤nÁ„·—„Èŗo 


Health Intervention and Technology Assessment Program

48 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ successscpx Retinaldetachment successcapsulotomy nocomplications successcPCO failurecapsulotomy Rigidlens

success successchyphema failure success successcMC failure failure

Cataractsurgery successscpx Retinaldetachment successcapsulotomy nocomplications successcPCO failurecapsulotomy Foldablelens

success successchyphema failure success successcMC failure failure

¦¼žš¸É 14 ‹Îµ¨°Š decision tree ­Îµ®¦´ž¦³Á¤·œ‡ªµ¤‡»o¤‡nµ…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r œ·É¤Áž¦¸¥Áš¸¥„´Á¨œ­r…Ȋ


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 49

2.2.1.2 „µ¦‡Îµœª–šµŠÁ«¦¬“«µ­˜¦r že­»…£µª³ (Quality-Adjusted Life Years ®¦º° QALY) ‘‹Îµœªœže­»…£µª³’ Áž}œŸ¨¨´¡›ršµŠ­»…£µ¡š¸ÉÁ„·—…¹Êœ‹µ„„µ¦¦´„¬µ®¦º°ÄoÁš‡ÃœÃ¨¥¸ ®œ¹ÉŠÇ čoĜ„µ¦ª·Á‡¦µ³®r˜oœš»œ°¦¦™ž¦³Ã¥œr (cost-utility analysis) Ž¹ÉŠ­µ¤µ¦™œÎµ¤µ Áž¦¸¥Áš¸¥Äœ®œnª¥Á—¸¥ª„´œ¦³®ªnµŠšµŠÁ¨º°„„µ¦¦´„¬µ®¦º°Áš‡ÃœÃ¨¥¸˜nµŠÇ ŗo šÎµÄ®o­µ¤µ¦™ ‹´—¨Îµ—´‡ªµ¤­Îµ‡´…°Š„µ¦¦´„¬µÃ¦‡®¦º°„µ¦ÄoÁš‡ÃœÃ¨¥¸šµŠ„µ¦Â¡š¥rš¸É˜„˜nµŠ„´œÅ—o ‘‹Îµœªœže­»…£µª³’ ®µÅ—o‹µ„„µ¦‡Îµœª–×¥œÎµ‡nµžeš¸É‡µ—ªnµ‹³¤¸¸ª·˜°¥¼n (life year) ‡¼–—oª¥‡nµ °¦¦™ž¦³Ã¥œr (utility) Ž¹ÉŠ°µ‹¤¸‡nµ˜´ÊŠÂ˜n 0 ®¤µ¥™¹ŠÁ­¸¥¸ª·˜ (death) ™¹Š 1 ®¤µ¥™¹Š£µª³ ­»…£µ¡š¸É­¤¼¦–r (full health) °´˜¦µ­nªœ˜oœš»œž¦³­·š›·Ÿ¨­nªœÁ¡·É¤ (Incremental Cost-Effectiveness Ratio ®¦º° ICER) „µ¦‡Îµœª– ‘°´˜¦µ­nªœ˜oœš»œž¦³­·š›·Ÿ¨­nªœÁ¡·É¤’ Áž}œ„µ¦Áž¦¸¥Áš¸¥˜oœš»œÂ¨³ Ÿ¨¨´¡›rš¸Éŗo‹µ„„µ¦¦´„¬µ®¦º°„µ¦Á¨º°„čoÁš‡ÃœÃ¨¥¸šµŠ„µ¦Â¡š¥r˜´ÊŠÂ˜n 2 šµŠÁ¨º°„…¹ÊœÅž ×¥„µ¦‡Îµœª–œ·—œ¸Ê­µ¤µ¦™Äo„´Ÿ¨¨´¡›rš¸ÉÁž¨¸É¥œÂž¨ŠÅž…°ŠÁš‡ÃœÃ¨¥¸œ´ÊœÇ ®¨µ¥¤·˜· ˜´ÊŠÂ˜nŸ¨¨´¡›r…´Êœ„¨µŠ (intermediate outcome) Ş‹œ™¹ŠŸ¨¨´¡›r­»—šoµ¥ (final outcome) —´Šœ´Êœ„µ¦‡Îµœª–œ·—œ¸Ê‹³nª¥Äœ„µ¦˜´—­·œÄ‹‹´—­¦¦š¦´¡¥µ„¦šnµ¤„¨µŠÃ¦‡Â¨³„µ¦Á‹Èžiª¥š¸É ®¨µ„®¨µ¥ Ž¹ÉŠÄœ„µ¦«¹„¬µœ¸Ê‡º° „µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤Áž¦¸¥Áš¸¥ „´œ·—Â…ÈŠ ץčo®¨´„„µ¦ª·Á‡¦µ³®r˜oœš»œ°¦¦™ž¦³Ã¥œrš¸É­—ŠÁž}œ‹Îµœªœ˜oœš»œš¸ÉčoÁ¡ºÉ°Ä®o ŗože­»…£µª³š¸ÉÁ¡·É¤…¹Êœ 1 že—´Š­¼˜¦ °´˜¦µ­nªœ˜oœš»œž¦³­·š›·Ÿ¨­nªœÁ¡·É¤ =

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Health Intervention and Technology Assessment Program

50 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 2.2.1.3 ‡nµ˜´ªÂž¦ÄœÂ‹Îµ¨°Š ˜´ªÂž¦—oµœ‡ªµ¤¨o¤Á®¨ªÂ¨³‡ªµ¤­ÎµÁ¦È‹…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ …o ° ¤¼ ¨ …°Š˜´ ª ž¦Å—o ¤ µ‹µ„„µ¦ššªœª¦¦–„¦¦¤‹µ„“µœ…o ° ¤¼ ¨ °· Á ¨È „ š¦°œ· „ ­r Pubmed Ĝª´œš¸É 12 ¤·™»œµ¥œ ¡.«. 2552 ץčo‡Îµ­Îµ‡´Äœ„µ¦­º‡oœ ŗo„n “outcome of cataract surgery”, “senile cataract”, “intraocular lens”, “rate of success cataract surgery” ¡š‡´—¥n°š´ÊŠ®¤—‹Îµœªœ 136 Á¦ºÉ°Š Ž¹ÉŠ™¼„¡·‹µ¦–µ˜µ¤Á„–”r‡´—Á…oµÂ¨³‡´—°°„—´Šœ¸Ê Á„–”r‡´—Á…oµ 1. Áž}œŠµœª·‹´¥š¸ÉšÎµ„µ¦«¹„¬µ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ÄœŸ¼ožiª¥˜o°„¦³‹„ š¸ÉÁ„·—‹µ„‡ªµ¤Á­ºÉ°¤˜µ¤›¦¦¤µ˜· 2. Áž}œ„µ¦«¹„¬µš¸É¦µ¥ŠµœŸ¨„µ¦¤°ŠÁ®ÈœÁž¦¸¥Áš¸¥„n°œÂ¨³®¨´Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­n Á¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ®¦º°œ·É¤ Á„–”r‡´—°°„ 1. Áž}œŠµœª·‹´¥š¸É¤¸„µ¦Ÿnµ˜´—˜o°„¦³‹„¦nª¤„´„µ¦¦´„¬µ®¦º°Ÿnµ˜´—懘µ°ºÉœÇ 2. Áž}œ„µ¦«¹„¬µš¸ÉŤnŗo¦µ¥ŠµœÁž}œ£µ¬µ°´Š„§¬®¦º°Åš¥ 3. Áž}œ„µ¦«¹„¬µ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤¡·Á«¬ Ánœ Á¨œ­rž¦´´—®¨µ¥ ¦³¥³ 4. Áž}œ„µ¦«¹„¬µš¸Éčoª·›¸„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸ÉŤnÁž}œš¸É¡¦n®¨µ¥š´ÉªÅž ‹µ„Á„–”r‡´—Á…oµÂ¨³‡´—°°„—´Š„¨nµªœ´„ª·‹´¥Å—ošÎµ„µ¦‡´—Á¨º°„Á®¨º°œ·¡œ›r˜oœŒ´ 3 Á¦ºÉ°Š ¨³š‡´—¥n° 1 Á¦ºÉ°Š (23) Ž¹ÉŠ‹µ„„µ¦ššªœª¦¦–„¦¦¤œÎµ¤µšÎµ„µ¦ª·Á‡¦µ³®r°£·¤µœ (meta-analysis)  fixed-effect model ¡ªnµ‡ªµ¤œnµ‹³Áž}œš¸É„µ¦Ÿnµ˜´—˜o°„¦³‹„‹³¤¸‡ªµ¤ ¨o¤Á®¨ªÁŒ¨¸É¥Ášnµ„´ 0.09 (20,21,22)

˜´ªÂž¦—oµœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤­ÎµÁ¦È‹¦nª¤„´¤¸£µª³Âš¦„Žo°œ …o°¤¼¨—oµœ£µª³Âš¦„Žo°œÄœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Áž¦¸¥Áš¸¥¦³®ªnµŠ„µ¦Ä­nÁ¨œ­rœ·É¤ ¨³Â…ÈŠÅ—o¤µ‹µ„„µ¦ššªœª¦¦–„¦¦¤‹µ„“µœ…o°¤¼¨šµŠ°·Á¨È„š¦°œ·„­r Pubmed ¦ª¤š´ÊŠ “µœ…o°¤¼¨®o°Š­¤»—¨³ªµ¦­µ¦Äœž¦³Áš«Åš¥ ץčo‡Îµ­Îµ‡´‡º° (rigid and foldable or silicone or acrylic intraocular lens) ¨³ (PMMA and foldable or silicone or acrylic intraocular lens) ­º‡oœ…o°¤¼¨ – ª´œš¸É 20 ¤„¦µ‡¤ ¡.«. 2552 ×¥­º‡oœŠµœª·‹´¥š¸É˜¸¡·¤¡r ¥o°œ®¨´Š‹µ„ ¡.«. 2552 ޞ¦³¤µ– 10 že ¦³®ªnµŠª´œš¸É 1 ›´œªµ‡¤ ¡.«. 2541 ™¹Š 1 ¤„¦µ‡¤ ¡.«. 2552 ¨³¤¸®¨´„Á„–”r—´Šœ¸Ê


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 51

Á„–”r„µ¦‡´—Á…oµ 1. Áž}œ„µ¦«¹„¬µž¦³­·š›·£µ¡…°ŠÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠÅ—o„n rigid ¨³ PMMA intraocular lens Áž¦¸¥Áš¸¥„´Á¨œ­rœ·—œ·É¤Å—o„n foldable, silicone ®¦º° acrylic intraocular lens 2. Áž}œ„µ¦«¹„¬µš¸Éª´—Ÿ¨¨´¡›r…°ŠÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤Â¨³œ·—Â…ÈŠÄœ„µ¦¦´„¬µÃ¦‡ ˜o°„¦³‹„ Á„–”r„µ¦‡´—°°„ 1. Áž}œ„µ¦«¹„¬µÁ„¸É¥ª„´Á¨œ­r„oª˜µÁš¸¥¤š¸ÉčoĜ„µ¦¦´„¬µÃ¦‡˜µ°ºÉœÇ ®¦º°˜o°„¦³‹„¦nª¤ „´Ã¦‡˜µ°ºÉœÇ 2. Áž}œ„µ¦«¹„¬µš¸ÉÁž}œ£µ¬µ°ºÉœš¸ÉŤnčn£µ¬µ°´Š„§¬ 3. Áž}œ„µ¦«¹„¬µª´­—»Â¨³„µ¦°°„…°ŠÁ¨œ­r„oª˜µÁš¸¥¤œ·—Ä—œ·—®œ¹ÉŠ 4. Áž}œ„µ¦«¹„¬µÁ„¸É¥ª„´ª·›¸„µ¦Ÿnµ˜´—懘o°„¦³‹„ 5. Ťnčn„µ¦«¹„¬µšµŠ—oµœ‡¨·œ·„ ‹µ„„µ¦ššªœª¦¦–„¦¦¤Å—o„µ¦«¹„¬µš¸ÉÁ„¸É¥ª…o°Š 172 Á¦ºÉ°Š ¨³¡·‹µ¦–µ‹µ„Á„–”r ‡´—Á…oµÂ¨³‡´—°°„—´Š„¨nµª Á®¨º°œ·¡œ›r˜oœŒ´š¸ÉÁž}œ„µ¦«¹„¬µ—oµœ‡¨·œ·„ 30 Á¦ºÉ°Š (24-53) ¡ªnµ £µª³Âš¦„Žo°œš¸É˜„˜nµŠ„´œ°¥nµŠ´—Á‹œÄœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rœ·É¤Áš¸¥„´ Á¨œ­r…Ȋ‡º° „µ¦Á„·—™»Š®»o¤Á¨œ­r…»nœ®¨´Š„µ¦Ÿnµ˜´— (Posterior capsule opacification : PCO) ­nªœ£µª³Âš¦„Žo°œ°ºÉœÇ š¸É˜„˜nµŠ„´œ°¥nµŠ¤¸œ´¥­Îµ‡´¦³®ªnµŠ„µ¦Ä­nÁ¨œ­rœ·É¤Â¨³Â…ÈŠ ŗo‹µ„ „µ¦ª·Á‡¦µ³®r…o°¤¼¨Äœ­nªœš¸É 1 (—¼Ÿ¨„µ¦«¹„¬µ…o° 1.3.3.3) ŗo„n £µª³Á¨º°—°°„n°Š®œoµ ¤nµœ˜µ (Hyphema) ¨³£µª³Á¨œ­rÁ‡¨ºÉ°œÁ¨œ­r®¨»— (Mechanical complication of intraocular lens) £µª³™»Š®»o¤Á¨œ­r…»nœ (Posterior capsule opacification : PCO) ‹µ„„µ¦ššªœª¦¦–„¦¦¤…o µ Š˜o œ œÎ µ œ· ¡ œ›r ˜o œ Œ´  —oµ œ‡¨· œ· „ š¸É Å —o ¤ µ‡´ — ÁŒ¡µ³ „µ¦«¹„¬µš¸ÉÁ„¸É¥ª„´£µª³™»Š®»o¤Á¨œ­r…»nœ®¨´Š„µ¦Ÿnµ˜´—Áž¦¸¥Áš¸¥¦³®ªnµŠ„µ¦Ä­nÁ¨œ­rœ·É¤ (Acrylic) ¨³Â…ÈŠ (PMMA) Ž¹ÉŠ¤¸„µ¦¦µ¥Šµœ‹ÎµœªœŸ¼ožiª¥ °´˜¦µ„µ¦Á„·—™»Š®»o¤Á¨œ­r…»nœ‹µ„„µ¦ Ÿnµ˜´—ץĭnÁ¨œ­rœ·É¤Â¨³Â…ÈŠ ¨³Áž}œ£µª³™»Š®»o¤Á¨œ­r…»nœ°¥nµŠ¤¸œ´¥­Îµ‡´‹œ˜o°Š¤¸„µ¦¦´„¬µ ŗoŠµœª·‹´¥š¸É‡´—Á¨º°„Á…oµ¤µ 7 Á¦ºÉ°Š ˜´—„µ¦«¹„¬µš¸ÉŸnµ«¡Ÿ¼oš¸ÉŸnµœ„µ¦Ÿnµ˜´—˜o°„¦³‹„¤µÂ¨oª—¼ªnµ ¤¸„µ¦¦´„¬µ™»Š®»o¤Á¨œ­r…»nœ®¦º°Å¤n ÁœºÉ°Š‹µ„„µ¦«¹„¬µœ¸Ê¤¸‹ÎµœªœŸ¼oš¸ÉÄ­nÁ¨œ­r…Ȋ¤µ„„ªnµÁ¨œ­r œ·É¤™¹Š 20 Ášnµ šÎµÄ®o¡„µ¦Á„·—™»Š®»o¤Á¨œ­r…»nœÄœŸ¼oš¸ÉÄ­nÁ¨œ­r…Ȋ¤µ„„ªnµÁ¨œ­rœ·É¤¤µ„ ­»—šoµ¥ Á®¨º°Šµœª·‹´¥‹Îµœªœ 6 Á¦ºÉ°Š (48-53) œÎµ¤µšÎµ„µ¦ª·Á‡¦µ³®r°£·¤µœ (meta-analysis) Ÿ¨­¦»žªnµ


Health Intervention and Technology Assessment Program

52 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ „µ¦Ä­nÁ¨œ­rœ·É¤šÎµÄ®oÁ„·—™»Š®»o¤Á¨œ­r…»nœœo°¥„ªnµÁ¨œ­r…ȊÁŒ¨¸É¥ 0.1834 Ášnµ ×¥¤¸‡nµÁ¸É¥ŠÁœ ¤µ˜¦“µœÁšnµ„´ 0.5517 £µª³™»Š®»o¤Á¨œ­r…»nœ­µ¤µ¦™¦´„¬µ—oª¥„µ¦Äo Nd:YAG laser ¥·Š™»Šš¸É…»nœœ´Êœ (capsulotomy) šÎµÄ®o„¨´¤µ¤°ŠÁ®ÈœÅ—o´—°¸„‡¦´ÊŠÁ®¤º°œ®¨´ŠŸnµ˜´—Ä®¤n ˜´ªÂž¦°´˜¦µ„µ¦¦´„¬µ £µª³™»Š®»o¤Á¨œ­r…»nœ¨o¤Á®¨ªÅ—o¤µ‹µ„„µ¦ššªœª¦¦–„¦¦¤—´Š„¨nµª…oµŠ˜oœÁnœ„´œ Ž¹ÉŠ¤¸ ‹Îµœªœ 2 Á¦ºÉ°Š (54,55) œÎµ¤µÄo‡Îµœª–Å—o‡nµÁŒ¨¸É¥…°Š‡ªµ¤¨o¤Á®¨ªÄœ„µ¦¦´„¬µ£µª³™»Š®»o¤ Á¨œ­r…»nœÁšnµ„´ 0.05 ‡nµ‡ªµ¤‡¨µ—Á‡¨ºÉ°œ¤µ˜¦“µœÁšnµ„´ 0.01 ­nªœ‡nµÁŒ¨¸É¥…°Š„µ¦Á„·— £µª³‹°ž¦³­µš˜µ®¨»—¨°„‹µ„„µ¦¦´„¬µ£µª³™»Š®»o¤Á¨œ­r…»nœ—oª¥„µ¦Äo Nd:YAG laser œ´Êœ ŗo¤µ‹µ„„µ¦­º‡oœ…o°¤¼¨Äœž¦³Áš«Åš¥¡ªnµ¤¸„µ¦šÎµª·‹´¥ª´—‡»–£µ¡¸ª·˜…°ŠŸ¼oš¸ÉŸnµ˜´—˜o° „¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤Ã—¥¼Á­„…r¨³‡–³ (56) ¤¸‡nµÁšnµ„´ 0.03 £µª³Á¨º°—°°„n°Š®œoµ¤nµœ˜µ (Hyphema) ¨³£µª³Á¨œ­rÁ‡¨ºÉ°œ®¨»— (Mechanical complication of intraocular lens) ‹µ„Ÿ¨„µ¦ª·Á ‡¦µ³®r…o°¤¼ ¨„µ¦Ÿn µ˜´—˜o° „¦³‹„Äœž¦³Áš«Åš¥Á¦ºÉ °Šž{‹‹´¥ š¸É¤¸Ÿ ¨˜n ° £µª³Âš¦„Žo°œÄœ„µ¦Ÿnµ˜´—˜o°„¦³‹„ (—¼Ÿ¨„µ¦«¹„¬µ®´ª…o° 1.3.3.3) ¡ªnµ Ÿ¼ožiª¥š¸ÉÄ­nÁ¨œ­r œ·É¤¤¸Ã°„µ­Á„·—£µª³Á¨º°—°°„®œoµn°Š¤nµœ˜µ (Hyphema) œo°¥„ªnµŸ¼ožiª¥š¸ÉÄ­nÁ¨œ­r…Ȋ¦o°¥¨³ 45 ¨³Ÿ¼ožiª¥š¸ÉÄ­nÁ¨œ­rœ·É¤¤¸Ã°„µ­Á„·—£µª³Á¨œ­rÁ‡¨ºÉ°œ®¨»— (Mechanical complication of intraocular lens) œo°¥„ªnµŸ¼ožiª¥š¸ÉÄ­nÁ¨œ­r…Ȋ¦o°¥¨³ 23 ­—Šªnµ „µ¦Ä­nÁ¨œ­rœ·É¤®¦º°Â…ÈŠÁž}œ ž{‹‹´¥®œ¹ÉŠš¸ÉšÎµÄ®oÁ„·—£µª³Âš¦„Žo°œš´ÊŠ­°Š°¥nµŠœ¸Ê ‹¹ŠœÎµÁ…oµ¤µ‡Îµœª–Ĝ‹Îµ¨°ŠšµŠ Á«¦¬“«µ­˜¦r¦nª¤—oª¥ ‹µ„„µ¦«¹„¬µŸ¼ožiª¥š¸ÉšÎµ„µ¦Ÿnµ˜´—˜o°„¦³‹„š¸É¤¸„µ¦Ä­nÁ¨œ­r„oª˜µÁš¸¥¤ ¦³®ªnµŠª´œš¸É 1 ¤„¦µ‡¤ ¡.«. 2549 – ª´œš¸É 31 ›´œªµ‡¤ ¡.«. 2550 ‹Îµœªœ 221,799 ¦µ¥ ¡ªnµÁ„·—£µª³ Á¨º°—°°„n°Š®œoµ¤nµœ˜µÄœŸ¼oš¸ÉÄ­nÁ¨œ­r…Ȋ‹Îµœªœ 81 ¦µ¥ ‹µ„š´ÊŠ®¤— 106,154 ¦µ¥ ¨³ÄœŸ¼o š¸ÉÄ­nÁ¨œ­rœ·É¤¡‹Îµœªœ 50 ¦µ¥ ‹µ„š´ÊŠ®¤— 115,645 ¦µ¥ ­nªœ£µª³Á¨œ­rÁ‡¨ºÉ°œ®¨»— ¡ÄœŸ¼o š¸ÉÄ­nÁ¨œ­r…Ȋ‹Îµœªœ 263 ¦µ¥ ‹µ„š´ÊŠ®¤— 106,154 ¦µ¥ ¨³ÄœŸ¼oš¸ÉÄ­nÁ¨œ­rœ·É¤¡‹Îµœªœ 265 ¦µ¥ ‹µ„š´ÊŠ®¤— 115,645 ¦µ¥ Á¤ºÉ°œÎµ¤µ‡Îµœª–‹³Å—o‡nµÁŒ¨¸É¥Â¨³‡ªµ¤‡¨µ—Á‡¨ºÉ°œ¤µ˜¦“µœ —´Š˜µ¦µŠš¸É 21


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 53

˜µ¦µŠš¸É 21 ‡nµÁŒ¨¸É¥„µ¦Á„·—£µª³Âš¦„Žo°œÁ¨º°—°°„n°Š®œoµ¤nµœ˜µÂ¨³£µª³Á¨œ­rÁ‡¨ºÉ°œ ®¨»— £µª³Âš¦„Žo°œ Hyphema

Mechanical complication of intraocular lens

œ·—…°ŠÁ¨œ­r Rigid

‡nµÁŒ¨¸É¥ 0.0008

‡ªµ¤‡¨µ—Á‡¨ºÉ°œ¤µ˜¦“µœ 0.0001

Foldable

0.0004

0.0001

Rigid

0.0026

0.0025

Foldable

0.0021

0.0023

˜´ªÂž¦—oµœ˜oœš»œ (Cost) ¤»¤¤°Šš¸ÉčoĜ„µ¦‡Îµœª–˜oœš»œÄœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤ ¨³Â…ÈŠÄœ„µ¦«¹„¬µœ¸Ê ‡º°¤»¤¤°Š…°ŠŸ¼oÄ®o¦·„µ¦ (provider’s perspective) Ž¹ÉŠÁž}œ˜oœš»œšµŠ „µ¦Â¡š¥rš¸ÉÁ„·—…¹ÊœÄœ­™µœ¡¥µµ¨Ášnµœ´Êœ (direct medical cost) nŠÅ—oÁž}œ ‡nµÁ¨œ­r„oª˜µÁš¸¥¤ Ĝ„µ¦«¹„¬µ‡¦´ÊŠœ¸Êš¸¤ª·‹´¥Å—ošÎµ„µ¦­Îµ¦ª‹‡nµÁ¨œ­r„oª˜µÁš¸¥¤œ·—…Ȋ¨³œ·É¤ ×¥šÎµ „µ¦­nŠ‹—®¤µ¥Åž¥´Š¦·¬´šŸ¼o‹´—‹Îµ®œnµ¥Á¨œ­r„oª˜µÁš¸¥¤Äœž¦³Áš«Åš¥‹Îµœªœ 5 ¦·¬´š ×¥ Ä®ošµŠ¦·¬´šÁ­œ°¦µ‡µÁ¨œ­rœ·—Â…ÈŠ (PMMA) ¨³œ·—œ·É¤ (Acrylic) ¡¦o°¤š´ÊŠ…o°¤¼¨‡»–­¤´˜· …°ŠÁ¨œ­rœ´ÊœÇ Ĝ¦µ‡µš¸É˜Éεš¸É­»— ™oµ®µ„ªnµ‹³¤¸„µ¦­´ÉŠŽºÊ°‹Îµœªœže¨³ž¦³¤µ– 100,000 Á¨œ­r Ž¹ÉŠ¦ª¤‡nµ…œ­nŠÅž¥´ŠÃ¦Š¡¥µµ¨˜nµŠÇ Ĝž¦³Áš«Åš¥Â¨oª Á¡ºÉ°œÎµ…o°¤¼¨¦µ‡µÁ¨œ­r¤µÄoĜ Šµœª·‹´¥Ã—¥‹³¤¸„µ¦ž„žd—ºÉ°¦·¬´š ¨³Å¤n¤¸„µ¦­´µªnµ‹³¤¸„µ¦­´ÉŠŽºÊ°Á¨œ­r‹¦·Š ¤¸¦·¬´šš¸É­nŠ ¦µ‡µ¤µ˜µ¤„ε®œ—Áª¨µš´ÊŠ®¤— 3 ¦·¬´š œÎµ¤µ‡Îµœª–®µ‡nµÁŒ¨¸É¥­Îµ®¦´Áž}œ‡nµÁ¨œ­rÁš¸¥¤ œ·—…Ȋ¨³œ·É¤š¸ÉčoĜ„µ¦«¹„¬µœ¸Ê —´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 22 ¨³ 23


Health Intervention and Technology Assessment Program

54 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 22 ¦µ‡µÁ¨œ­r„oª˜µÁš¸¥¤œ·—…Ȋ¨³œ·É¤…°ŠÂ˜n¨³¦·¬š´ ºÉ°¦·¬´š

¦®´­ Code No.

A

¦µ‡µ Non Foldable Lens Foldable Lens 1,500 1,500 3,500 590 590 1,000 4,000 4,500 1,000 5,500 1,030 4,375 166.413 426.956 590 – 1,500 3,500 – 5,500

A11 A12 A21 A13 A14 B11 B21 B22 C11 C21

B

C Mean Std.Error Minimum - Maximum

˜µ¦µŠš¸É 23 ‡nµ˜´ªÂž¦¦µ‡µÁ¨œ­r„oª˜µÁš¸¥¤ ˜´ªÂž¦ ‡nµÄo‹nµ¥ (µš)

¦¼žÂ„µ¦ „¦³‹µ¥

‡nµÁŒ¨¸É¥

‡ªµ¤‡¨µ— Á‡¨ºÉ°œ¤µ˜¦“µœ

‡nµÁ¨œ­rÁš¸¥¤œ·—Â…ÈŠ ‡nµÁ¨œ­rÁš¸¥¤œ·—œ·É¤

„¤¤µ „¤¤µ

1,030 4,375

166 427

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˜µ¦µŠš¸É 24 ‡nµ˜´ªÂž¦‡nµÄo‹nµ¥Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„ ˜´ªÂž¦‡nµÄo‹µn ¥ (µš) (Ťn¦ª¤‡nµÁ¨œ­r) ‡nµÄo‹nµ¥Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r…ȊץŤn¤¸ £µª³Âš¦„Žo°œ ‡nµÄo‹nµ¥Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rœ¤·É ץŤn¤¸ £µª³Âš¦„Žo°œ ‡nµÄo‹nµ¥Äœ„µ¦¦´„¬µ™»Š®»¤o Á¨œ­r…»nœ ‡nµÄo‹nµ¥Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r…Ȋ×¥¤¸ £µª³Á¨º°—°°„n°Š®œoµ¤nµœ˜µ¦nª¤ ‡nµÄo‹nµ¥Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rœ¤·É ×¥¤¸ £µª³Á¨º°—°°„n°Š®œoµ¤nµœ˜µ¦nª¤ ‡nµÄo‹nµ¥Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r…Ȋ×¥¤¸ £µª³Á¨œ­rÁ‡¨ºÉ°œ®¨»—¦nª¤ ‡nµÄo‹nµ¥Äœ„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rœ¤·É ×¥¤¸ £µª³Á¨œ­rÁ‡¨ºÉ°œ®¨»—¦nª¤

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Health Intervention and Technology Assessment Program

56 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 25 ˜´ªÂž¦‡nµÄo‹nµ¥Äœ„µ¦¦´„¬µ£µª³™»Š®»o¤Á¨œ­r…»nœ ˜´ªÂž¦ ‡nµÄo‹nµ¥ (µš) ‡nµÄo‹nµ¥Äœ„µ¦šÎµ Nd:YAG laser capsulotomy ‡nµÄo‹nµ¥Äœ„µ¦¦´„¬µ‹°ž¦³­µš˜µ®¨»—¨°„

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Health Intervention and Technology Assessment Program

58 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 2.3 Ÿ¨„µ¦«¹„¬µ 2.3.1 „µ¦ª·Á‡¦µ³®r‡ªµ¤‡»o¤‡nµ…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rœ·É¤Áš¸¥„´Á¨œ­r…Ȋ ˜oœš»œÃ—¥¦ª¤…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­rœ·É¤ ¤¸‡nµÁŒ¨¸É¥Ášnµ„´ 18,105 µš ‡nµ ‡ªµ¤‡¨µ—Á‡¨ºÉ°œ¤µ˜¦“µœÁšnµ„´ 421 ­nªœ˜oœš»œÃ—¥¦ª¤…°Š„µ¦Ÿnµ˜´—˜o°„¦³‹„Ä­nÁ¨œ­r „oª˜µÁš¸¥¤œ·—Â…ÈŠÄœ¤»¤¤°Š…°ŠŸ¼oÄ®o¦·„µ¦ (provider’s perspective) ˜n°„µ¦Ÿnµ˜´— 1 ‡¦´ÊŠ ŗo‡nµÁŒ¨¸É¥Ášnµ„´ 15,434 µš ‡nµ‡ªµ¤‡¨µ—Á‡¨ºÉ°œ¤µ˜¦“µœÁšnµ„´ 269 ‡nµÁŒ¨¸É¥˜oœš»œÃ—¥¦ª¤…°Š„µ¦Ÿnµ˜´—¦nª¤„´„µ¦¦´„¬µ£µª³Âš¦„Žo°œ˜nµŠÇ —´ŠÂ­—Š Ĝ˜µ¦µŠš¸É 27 ˜µ¦µŠš¸É 27 ‡nµÁŒ¨¸É¥˜oœš»œ„µ¦Ÿnµ˜´—˜o°„¦³‹„¦nª¤„´„µ¦¦´„¬µ£µª³Âš¦„Žo°œ £µª³Âš¦„Žo°œ

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Health Intervention and Technology Assessment Program

60 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 1.00 0.90

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0.70

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Health Intervention and Technology Assessment Program

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Health Intervention and Technology Assessment Program

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„¦¤´¸„¨µŠ V.1

‹Îµœªœ (˜µ) Á¨œ­r…Ȋ Á¨œ­rœ·É¤ ¦µ‡µÁ·„Å—o˜µ¤­·š›·ž{‹‹»´œ (µš) Á¨œ­r…Ȋ Á¨œ­rœ·É¤ ˜oœš»œž{‹‹»´œ (µš) Á¨œ­r…Ȋ Á¨œ­rœ·É¤ ¦ª¤ ˜oœš»œ‹µ„œÃ¥µ¥Ä®¤n* Á¨œ­r…Ȋ Á¨œ­rœ·É¤ ¦ª¤ „εŦ­»š›·

®¤µ¥Á®˜»

V.2

50,206 (1) 30,172 (2)

4,845 (1) 25,399 (2)

4,000 (3) 4,000 (3)

4,000 (3) 6,000 (4)

200,824,000 (1*3) 120,688,000 (2*3) 321,512,000 (5)

19,380,000 (1*3) 152,394,000 (2*4) 171,774,000 (5)

19,380,000 (1*3) 152,394,000 (2*4) 171,774,000 (5)

51,712,180 (1*7) 31,077,160 (2*7) 82,789,340 (6) 238,722,660 (5-6)

4,990,350 (1*7) 111,120,625 (2*8) 116,110,975 (6) 55,663,025 (5-6)

4,990,350 (1*7) 26,160,970 (2*7) 31,151,320 (6) 140,622,680 (5-6)

V.1 ‡º° Á·„‹nµ¥Å—oš´ÊŠÁ¨œ­r„oª˜µÁš¸¥¤œ·—œ·É¤Â¨³œ·—Â…ÈŠ V.2 ‡º° Á·„‹nµ¥Å—oĜ¦µ‡µÁ¨œ­r„oª˜µÁš¸¥¤œ·—Â…ÈŠ * ¦µ‡µ Non Foldable Lens Ášnµ„´ 1,030 µš (7) * ¦µ‡µ Foldable Lens Ášnµ„´ 4,375 µš (8)

‹µ„˜µ¦µŠš¸É 29 ¡ªnµÄœŸ¼ožiª¥­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ®µ„¨—°´˜¦µ„µ¦Á·„‹nµ¥ ‡nµÁ¨œ­r…Ȋ…°Š ­ž­. ‹µ„ 4,000 µš Áž}œ 1,030 µš ‹³­µ¤µ¦™¨—‡nµÄo‹nµ¥Å—o™¹Šže¨³ 149,111,820 µš ¨³®µ„‡Îµœª–‡nµÁ¨œ­rœ·É¤Ã—¥Äo‡nµÁŒ¨¸É¥…°Š¦µ‡µÁ¨œ­rœ·É¤š¸É­Îµ¦ª‹Å—o‡º° 4,375 µš‡·—¦ª¤—oª¥‹³­µ¤µ¦™¨—‡nµÄo‹nµ¥Å—ože¨³ 238,722,660 µš Ĝ­nªœ…°ŠŸ¼ožiª¥­·š›· ­ª´­—·„µ¦…oµ¦µ„µ¦ ®µ„¤¸„µ¦Á·„‹nµ¥‡nµÁ¨œ­rœ·É¤Â¨³Á¨œ­r…ȊÁšnµ„´¦µ‡µ‡nµÁŒ¨¸É¥š¸É­Îµ¦ª‹Å—o ‹³­µ¤µ¦™¨—‡nµÄo‹nµ¥Å—ože¨³ 55,663,025 µš ¨³™oµÄ®oÁ·„‹nµ¥Å—oÁšnµ¦µ‡µÁ¨œ­r…Ȋš¸É ­Îµ¦ª‹Å—oÁ®¤º°œ„´œ®¤—‹³¨—‡nµÄo‹nµ¥Å—ože¨³ 140,622,680 µš —´Šœ´Êœ®µ„®œnª¥Šµœš¸É ¦´Ÿ·—°„µ¦Á·„‹nµ¥‡nµÁ¨œ­r„oª˜µÁš¸¥¤„ε®œ—¦µ‡µÁ¨œ­rš¸É‹³Á·„Å—o°¥nµŠÁ®¤µ³­¤‹³nª¥ Ä®ož¦³®¥´—Šž¦³¤µ–ŞŗoÁž}œ‹Îµœªœ¤µ„ Ž¹ÉŠŠž¦³¤µ–—´Š„¨nµª­µ¤µ¦™œÎµÅžÄoĜŠµœ ­µ›µ¦–­»…—oµœ°ºÉœš¸É‹ÎµÁž}œÂ¨³…µ—‡¨œÅ—o¤µ„…¹Êœ—oª¥


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3.2 …o°Á­œ°Âœ³Á·ŠœÃ¥µ¥ 1. ¤¸„µ¦„¦³‹µ¥š»œ f„°¦¤Â¡š¥rÁŒ¡µ³šµŠ—oµœ‹´„¬»Ä®o„n‹´Š®ª´—š¸É¥´Š…µ—‡¨œ 2. ‡ª¦Ä®o‡ªµ¤¦¼oš¸É™¼„˜o°Š„´ž¦³µœÁ„¸É¥ª„´Á¨œ­r…Ȋ¨³Á¨œ­rœ·É¤ ÁœºÉ°Š‹µ„°µ‹‹³ ¤¸„µ¦‹¼ŠÄ‹‹µ„Ÿ¼oÄ®o¦·„µ¦Ä®o‹nµ¥ÁŠ·œÁ¡·É¤ 3. ‹µ„„µ¦­Îµ¦ª‹‡¦´ÊŠœ¸Ê¡ªnµ ¦µ‡µÁ¨œ­r™¼„„ªnµ¦µ‡µš¸É­Îµœ´„Šµœ®¨´„ž¦³„´œ­»…£µ¡ ®nŠµ˜· ¨³„¦¤´¸„¨µŠÄ®oÁ·„Ūo‡°n œ…oµŠ¤µ„ Ĝ„¦–¸Á¨œ­r…Ȋ¦µ‡µ¨—¨ŠÅ—o ™¹Š 4 Ášnµ˜´ª „¦–¸Á¨œ­rœ·É¤¦µ‡µ¨—¨ŠÅ—oÁ„º°‡¦¹ÉŠ®œ¹ÉŠ ‹¹Š‡ª¦¤¸„µ¦ššªœ¦µ‡µ Á¨œ­rš¸ÉÁ·„‹nµ¥Äœ°œµ‡˜ 3.3 …o°‹Îµ„´—…°Š„µ¦«¹„¬µ 1. …o°¤¼¨Ÿ¼ožiª¥š¸Éŗo¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„Ťnčn…o°¤¼¨š´ÊŠ®¤—…°ŠŸ¼ožiª¥š¸ÉŸnµ˜´—˜o° „¦³‹„Äœž¦³Áš«Åš¥ ˜nÁž}œ…o°¤¼¨…°ŠŸ¼ožiª¥­nªœÄ®n…°Šž¦³Áš«Åš¥‡º° Ÿ¼ožiª¥ ­· š ›· ž ¦³„´ œ ­» … £µ¡™o ª œ®œo µ ¨³­· š ›· ­ ª´ ­ —· „ µ¦…o µ ¦µ„µ¦ °¥n µ ŠÅ¦„È ˜ µ¤ Ĝ „µ¦«¹„¬µœ¸ÊŤn¤¸…o°¤¼¨…°ŠŸ¼ožiª¥­·š›·ž¦³„´œ­´Š‡¤ ¨³Ÿ¼ožiª¥š¸É‹nµ¥ÁŠ·œŸnµ˜´—Á°Š š´ÊŠ®¤—š¸É抡¥µµ¨Á°„œ 2. Ĝ­nªœ…°Š„µ¦ž¦³Á¤·œ‡ªµ¤‡»o¤‡nµ ¾ Ťnŗočo˜oœš»œ‹¦·Š (cost) Ĝ„µ¦‡·—‡nµ°´˜¦µ­nªœ˜oœš»œž¦³­·š›·Ÿ¨­nªœÁ¡·É¤ ˜nčoÁž}œ‡nµÄo‹nµ¥š¸ÉÁ¦¸¥„Á„ȝ‹µ„抡¥µµ¨Åž¥´Š ­ž­. (charge) ¾ ŤŗošÎµ„µ¦«¹„¬µ˜oœš»œÄœ¤»¤¤°ŠšµŠ­´Š‡¤ Ánœ „µ¦­¼Á­¸¥¦µ¥Å—o‹µ„„µ¦ ®¥»—Šµœ ¦µ¥Å—o…°Šµ˜·š¸É˜o°Š¡µ¤µ˜¦ª‹ ²¨² ¾ Ťnŗo«¹„¬µ‡nµÄo‹nµ¥š¸ÉÁ„¸É¥ª„´˜oœš»œ˜¦Šš¸É¤·ÄnšµŠ„µ¦Â¡š¥r Ánœ ‡nµ¦™ ‡nµ°µ®µ¦…°ŠŸ¼ožiª¥š¸É¤µ˜¦ª‹ „µ¦«¹„¬µª·‹´¥‡¦´ÊŠœ¸ÊÁž}œ…o°¤¼¨ÁºÊ°Š˜oœ­Îµ®¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„Äœž¦³Áš«Åš¥ Á¡ºÉ° ¡· ‹ µ¦–µÁºÉ ° ¤Ã¥Š„´  œÃ¥µ¥Ä®o ¤¸ „ µ¦Á…o µ ™¹ Š „µ¦Ÿn µ ˜´ — ˜o ° „¦³‹„¤µ„…¹Ê œ ¨³Äo Á Š· œ ¨³ š¦´ ¡ ¥µ„¦š¸É ‡»o ¤ ‡n µ °¥n µ ŠÅ¦„È ˜ µ¤„µ¦«¹ „ ¬µœ¸Ê ¥´ Š ¤¸ …o ° ‹Î µ „´ — ˜n µ ŠÇ —´ Š „¨n µ ª…o µ Š˜o œ ‹¹ Š ‡ª¦¤¸ „µ¦«¹„¬µÁ¡·É¤Á˜·¤Á¡ºÉ°«¹„¬µÄ®o‡¦™oªœÂ¨³¦°—oµœ¤µ„…¹ÊœÄœ°œµ‡˜


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Á°„­µ¦°oµŠ°·Š 1. ¦µª·š¥µ¨´¥‹´„¬»Â¡š¥r®nŠž¦³Áš«Åš¥. œªšµŠž’·˜´ ·Ã¦‡šµŠ‹´„¬»ªš· ¥µ­Îµ®¦´‹´„¬» ¡š¥r, ªµ¦­µ¦‹´„¬»›¦¦¤«µ­˜¦r 2549;1;1:51-57 2. ­Îµœ´„Šµœ¡´•œµœÃ¥µ¥­»…£µ¡¦³®ªnµŠž¦³Áš«. ¦nµŠ¦µ¥ŠµœÃ‡¦Š„µ¦«¹„¬µª·‹´¥ÂŸœ„µ¦ ¨Šš»œ—oµœ­»…£µ¡ÄœÂŸœ¡´•œµÁ«¦¬“„·‹Â¨³­´Š‡¤Â®nŠµ˜· Œ´š¸É 10 (¡.«.2550-2554): »—š¸É­°Š ­™µœ„µ¦–rž{‹‹»´œ…°Š¤µ˜¦„µ¦‡ª‡»¤Â¨³žj°Š„´œÃ¦‡š¸É¤¸¨Îµ—´‡ªµ¤­Îµ‡´­¼Š ¨³„µ¦¨Šš»œ£µ‡¦´“—oµœ­»…£µ¡. „¦³š¦ªŠ­µ›µ¦–­»…. 2551. £µ‡Ÿœª„š¸É 14: ®œoµ 278-297. 3. Wongwetsawat Somchai, Blinding cataract in Thailand, 1994. Thai J Ophthalmol 1996;10;2:125-134 4. Chaidaroon W, Tungpakorn N, Puranitee P. Current trends in cataract surgery in Thailand-2004 Survey J Med Assoc Thai 2005;88(supp 9):S43-50 5. «·¦·¦´˜œr Á˜ÃÁ¦º°Šª·ª´•œr Preoperative visual acuity and location of cataract patients in Maharat Nakorn Ratchsima Hospital. Thai J PBl Hlth Ophthalmol 2004;18(1):49-56 6. Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T et al. Surgical interventions for age-related cataract. Cochrane Database Syst Rev. 2007 Issue 4 Oct 18(4): CD001323 pub 2 7. Tabin G, Chen M, Espandar L. Cataract surgery for the developing world. Curr Opin Ophthalmol 2008;19(1) : 55-9 8. Baltussen R, Sylla M, and Mariotti S. “Cost-Effectiveness of Cataract Surgery; A Global and Regional Analysis.” Bulletin of the World Health Organization 2004;82(5):338-45 9. Cheng MA, Congdon NG, Baker SK, Bloem MW, Savage H, Sommer A. The surgical management of cataract: barriers, best practices and outcomes. Int Ophthalmol 2007 Aug 22 (Epub ahead of print) 10. Pongnumkul P. Intraocular lens. Thai J Publ Hlth Ophthalmol 1991;5:93-107


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11. ¡´•¡Š¬r „»¨¥µœœšr, ª´•œ¸¥r Á¥Èœ‹·˜¦, Œª¸ª¦¦– Á¥Èœ‹·˜¦, ´¥¦´˜œr Á˜ÈŠÅ˜¦¦´˜œr, ª¸¦³«´„—·Í °œ»˜¦°´Š„¼¦, ­»—µ¦´˜œr œÁ¦œš¦r¡·š´„¬r. ˜o°„¦³‹„: £µ¦³Ã¦‡š¸É­Îµ‡´…°Šž¦³Áš«Åš¥ …o°¤¼¨ ‹µ„ǦŠ„µ¦­Îµ¦ª‹­£µª³˜µ°— ­µ¥˜µÁ¨º°œ¦µŠ ¨³Ã¦‡˜µš¸ÉÁž}œž{®µ­µ›µ¦–­»…. ªµ¦­µ¦‹´„¬»­µ›µ¦–­»… 2007;21(2):136-160 12. Yenjitr C, Tangcharoensathien V, Sornpaisan C, Jenchitr W. Vision and quality of life in patients having intraocular lens for cataract surgery. Proceedings The 19th Congress of Asia-Pacific Academy of Ophthalmology 2003:247-52 13. ›œ´´¥ °˜·«¡´ šr ÁŒ¨µ š°ŠÁž¨nŠ«¦¸ ­¤´˜· «¦¸­»ª¦¦–£¦–r Clear corneal phacoemulsification with conventional and new anesthetic techniques. Thai J Ophthalmol 1993;7(2) : 167-87 14. Raiyawa S, Samaiporn S, Sirikul S, Jenchitr W, Yenjitr C, Tapunya M. Visual acuity in patients having foldable and non-foldable intraocular lens for cataract surgery. J Med Assoc Thai 2008;91 (Supp) : S 15. ¤´·¤µ ¤³„¦ª´•œ³. „µ¦Á¨º°„čoÁ¨œ­r„oª˜µÁš¸¥¤Âž¦´´—®¨µ¥¦³¥³ÄœŸ¼ožªi ¥Ÿnµ˜´— ˜o°„¦³‹„. ªµ¦­µ¦‹´„¬»›¦¦¤«µ­˜¦r 2551;3;1:53-56 16. Afsar, A.J., et al., Economic costs of cataract surgery using a rigid and a foldable intraocular lens. Ophthalmic and Physiological Optics, 2001. 21(4): p. 262-267. 17. Dolders, M.G., et al., Cost effectiveness of foldable multifocal intraocular lenses compared to foldable monofocal intraocular lenses for cataract surgery. Br J Ophthalmol, 2004. 88(9): p. 1163-8. 18. ­Îµœ´„¦·®µ¦‹´—„µ¦Ã¦‡ÁŒ¡µ³. œªšµŠ„µ¦¦·®µ¦‹´—„µ¦Ã‡¦Š„µ¦—¼Â¨¦´„¬µŸ¼¤o ¸ž{®µ —oµœ­µ¥˜µ°´œÁœºÉ°Š¤µ‹µ„Á¨œ­r˜µ (Ÿnµ˜´—˜o°„¦³‹„) Ĝ¦³®¨´„ž¦³„´œ­»…£µ¡ ®nŠµ˜·: ­Îµœ´„Šµœ®¨´„ž¦³„´œ­»…£µ¡Â®nŠµ˜·; 2549 19. „¦³š¦ªŠ­µ›µ¦–­»…. ‹ÎµœªœÂ¡š¥rÁŒ¡µ³šµŠ­µ…µ˜nµŠÇ ¦µ¥‹´Š®ª´— 2548 – 2550. 20. Dhaivadee Dulayajinda , Wirut Nukhaw, Suchada Kampanartsanyakorn, La-ongsri Atchaneeyasakul, Thammanoon Surachatkumtonekul, Kayawan Srihiran. Outcomes of Cataract Surgery in Senile Cataract Patients at Siriraj Hospital: A Prospective Observational Study:J Med Assoc Thai 2005; 88 (Suppl 9): S82-8


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68 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 21. Jens Christian Norregaard, Charlotte Hindsberger, Jordi Alonso, Lorne Bellan, Peter Bernth-Petersen, Charlyn Black, Elaine Dunn, Tavs Folmer Andersen, Mireia Espallargues, Gerard F. Anderson. Visual outcome of cataract surgery in the United states, Canada, Denmark, and Spain: Arch Ophthalmol.1998;116:1095-1100 22. Jonathan C. Javitt, M. Harvey Brenner, Barbara Curbow, Marcia W. Legro, Debra A. Street. Outcome of cataract surgery: Arch Ophthalmol.1993:111:686-691 23. Das A, Khan M, Bandhopadhyay C, Ghosh A, Agarwal PK, Banerjee AR. Evaluation of visual outcome following cataract surgery in a tertiary eye care hospital. J Indian Med Assoc. 2006 Mar;104(3):116-8, 120. 24. Raiyawa S, Samaiporn S, Sirikul S, Jenchitr W, Yenjitr C, Tapunya M: Visual acuity in patients having foldable and non-foldable intra-ocular lens for cataract surgery. J Med Assoc Thai 2008, 91 Suppl 1:S102-110. 25. Fristrom B, Lundh BL: Colour contrast sensitivity in cataract and pseudophakia. Acta Ophthalmol Scand 2000, 78:506-511. 26. Kuchle M, Lausen B, Gusek-Schneider GC: Results and complications of hydrophobic acrylic vs PMMA posterior chamber lenses in children under 17 years of age. Graefes Arch Clin Exp Ophthalmol 2003, 241:637-641. 27. Rowe NA, Biswas S, Lloyd IC: Primary IOL implantation in children: a risk analysis of foldable acrylic v PMMA lenses. Br J Ophthalmol 2004, 88:481-485. 28. Gozum N, Unal ES, Altan-Yaycioglu R, Gucukoglu A, Ozgun C: Visual performance of acrylic and PMMA intraocular lenses. Eye 2003, 17:238-242. 29. Monteiro M, Marinho A, Salgado-Borges J, Ribeiro L, Castro-Correia J: Evaluation of a new scleral fixation foldable IOL in the absence of capsule support. J Fr Ophtalmol 2007, 30:791-797. 30. Wilson ME, Elliott L, Johnson B, Peterseim MM, Rah S, Werner L, et al: AcrySof acrylic intraocular lens implantation in children: clinical indications of biocompatibility. J Aapos 2001, 5:377-380. 31. Negishi K, Ohnuma K, Hirayama N, Noda T: Effect of chromatic aberration on contrast sensitivity in pseudophakic eyes. Arch Ophthalmol 2001, 119:1154-1158.


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32. Vilarrodona L, Barrett GD, Johnson B: High-order aberrations in pseudophakia with different intraocular lenses. J Cataract Refract Surg 2004, 30:571-575. 33. Iwase T, Tanaka N, Sugiyama K: Postoperative refraction changes in phacoemulsification cataract surgery with implantation of different types of intraocular lens. Eur J Ophthalmol 2008, 18:371-376. 34. Pandey SK, Werner L, Wilson ME, Jr., Izak AM, Apple DJ: Capsulorhexis ovaling and capsular bag stretch after rigid and foldable intraocular lens implantation: experimental study in pediatric human eyes. J Cataract Refract Surg 2004, 30:21832191. 35. Kurosaka D, Kato K: Membranous proliferation of lens epithelial cells on acrylic, silicone, and poly(methyl methacrylate) lenses. J Cataract Refract Surg 2001, 27:1591-1595. 36. O'Keefe M, Mulvihill A, Yeoh PL: Visual outcome and complications of bilateral intraocular lens implantation in children. J Cataract Refract Surg 2000, 26:17581764. 37. Ram J, Brar GS, Kaushik S, Gupta A, Gupta A: Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery. J Cataract Refract Surg 2003, 29:15791584. 38. Wejde G, Kugelberg M, Zetterstrom C: Posterior capsule opacification: comparison of 3 intraocular lenses of different materials and design. J Cataract Refract Surg 2003, 29:1556-1559. 39. Zemaitiene R, Jasinskas V, Barzdziukas V, Auffarth GU: Prevention of posterior capsule opacification using different intraocular lenses (results of one-year clinical study). Medicina (Kaunas) 2004, 40:721-730. 40. Cheng JW, Wei RL, Cai JP, Xi GL, Zhu H, Li Y, et al: Efficacy of different intraocular lens materials and optic edge designs in preventing posterior capsular opacification: a meta-analysis. Am J Ophthalmol 2007, 143:428-436.


Health Intervention and Technology Assessment Program

70 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ 41. Moreno-Montanes J, Alvarez A, Bes-Rastrollo M, Garcia-Layana A: Optical coherence tomography evaluation of posterior capsule opacification related to intraocular lens design. J Cataract Refract Surg 2008, 34:643-650. 42. Shah AR, Praveen MR, Vasavada AR: Posterior capsule opacification after extra capsular cataract extraction in Indian rural population: foldable acrylic vs poly (methyl-methacrylate) intraocular lenses a randomized clinical trial. Eye 2008, 22:889-894. 43. Michael Georgopoulos, Oliver Findl, Rupert Menapace, Wolf Buehl, Matthias Wirtitsch, Georg Rainer. Influence of intraocular lens material on regeneratory posterior capsule opacification after neodymium:YAG laser capsulotomy.J Cataract Refract Surg 2003; 29:1560–1565 44. Nishi O, Nishi K, Akura J: Speed of capsular bend formation at the optic edge of acrylic, silicone, and poly(methyl methacrylate) lenses. J Cataract Refract Surg 2002, 28:431-437. 45. Kodjikian L, Beby F, Rabilloud M, Bruslea D, Halphen I, Fleury J, et al: Influence of intraocular lens material on the development of acute endophthalmitis after cataract surgery? Eye 2008, 22:184-193. 46. Li N, Chen X, Zhang J, Zhou Y, Yao X, Du L, et al: Effect of AcrySof versus silicone or polymethyl methacrylate intraocular lens on posterior capsule opacification. Ophthalmology 2008, 115:830-838. 47. Apple DJ, Peng Q, Visessook N, Werner L, Pandey SK, Escobar-Gomez M, et al: Eradication of posterior capsule opacification: documentation of a marked decrease in Nd:YAG laser posterior capsulotomy rates noted in an analysis of 5416 pseudophakic human eyes obtained postmortem. Ophthalmology 2001, 108:505518. 48. Oner FH, Gunenc U, Ferliel ST: Posterior capsule opacification after phacoemulsification: foldable acrylic versus poly(methyl methacrylate) intraocular lenses. J Cataract Refract Surg 2000, 26:722-726.


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49. Hayashi K, Hayashi H, Nakao F, Hayashi F: Changes in posterior capsule opacification after poly(methyl methacrylate), silicone, and acrylic intraocular lens implantation. J Cataract Refract Surg 2001, 27:817-824. 50. Sundelin K, Friberg-Riad Y, Ostberg A, Sjostrand J: Posterior capsule opacification with AcrySof and poly(methyl methacrylate) intraocular lenses. Comparative study with a 3-year follow-up. J Cataract Refract Surg 2001, 27:1586-1590. 51. Auffarth GU, Brezin A, Caporossi A, Lafuma A, Mendicute J, Berdeaux G, et al: Comparison of Nd : YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, or acrylic intra-ocular lenses in four European countries. Ophthalmic Epidemiol 2004, 11:319-329. 52. Emma J. Hollick, David J. Spalton, Paul G. Ursell, Milind V. Pande, Sarah A. Barman, James F. Boyce, Kate Tilling: The Effect of Polymethylmethacrylate, Silicone, and Polyacrylic Intraocular Lenses on Posterior Capsular Opacification 3 Years after Cataract Surgery. Ophthalmology 1999;106:49–55 53. Hayashi H, Hayashi K, Nakao F, Hayashi F: Quantitative comparison of posterior capsule opacification after polymethylmethacrylate, silicone, and soft acrylic intraocular lens implantation. Arch Ophthalmol. 1998 Dec; 116(12):1579-82. 54. EJAZ AHMAD JAVED, ZIA UD DIN AHMAD, MUHAMMAD SULTAN. ND: YAG LASER CAPSULOTOMY AND COMPLICATIONS. Professional Med J Dec 2007; 14(4): 616-619. 55. Keith A. Skolnick, Jay I. Perlman, Doug M. Long, Jean M. Kernan. Neodymium: YAG laser posterior capsulotomies performed by residents at a Veterans Administration hospital. J Cataract Refract Surg 2000; 26:597-601 56. ¼Á­„…r «¦Å¡«µ¨, ª´•œ¸¥r Á¥Èœ‹·˜¦, Œª¸ª¦¦– Á¥Èœ‹·˜¦, ª·Ã¦‹œr˜´ÊŠÁ‹¦·Á­™¸¥¦. ª·›ª¸ ´— ‡»–£µ¡¸ª·˜­Îµ®¦´Ÿ¼ožiª¥˜o°„¦³‹„Äœ£¼¤·£µ‡. ªµ¦­µ¦‹´„¬»­µ›µ¦–­»… 2002; 16(2): 69 -94 57. œªšµŠ„µ¦¦·®µ¦‹´—„µ¦Ã‡¦Š„µ¦¡´•œµŸ¼o¤¸ž{®µ—oµœ­µ¥˜µ°´œÁœº°Š¤µ‹µ„Á¨œ­r˜µÄœ ¦³ž¦³„´œ­»…£µ¡Â®nŠµ˜· žeŠž¦³¤µ– 2551. ­Îµœ´„Šµœ®¨´„ž¦³„´œ­»…£µ¡Â®nŠµ˜·


Health Intervention and Technology Assessment Program

72 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

£µ‡Ÿœª„ ˜µ¦µŠš¸É 30 ¦µ¥„µ¦Ã¦‡š¸ÉÁ„¸É¥ª…o°Š„´„µ¦Ÿnµ˜´—˜o°„¦³‹„ 

¨Îµ—´ æ‡ š¸É Senile cataract 1 Senile incipient cataract 2 Senile nuclear cataract 3 Senile cataract, morgagnian type 4 Other senile cataract 5 Senile cataract, unspecified Other cataract 6 Infantile, juvenile and presenile cataract 7 Traumatic cataract 8 Complicated cataract 9 Drug-induced cataract 10 Other specified cataract 11 Cataract, unspecified Cataract and other disorders of lens in diseases classified elsewhere 12 Diabetic cataract (E10-E14+ with common fourth character .3) 13 Cataract in other endocrine, nutritional and metabolic diseases 14 Cataract in other diseases classified elsewhere 15 Congenital cataract

ICD 10 H25 H25.0 H25.1 H25.2 H25.8 H25.9 H26 H26.0 H26.1 H26.2 H26.3 H26.8 H26.9 H28 H28.0 H28.1 H28.2 Q12.0


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 73

˜µ¦µŠš¸É 31 ®´˜™„µ¦š¸ÁÉ „¸É¥ª…o°Š„´„µ¦Ÿnµ˜´—˜o°„¦³‹„ ¨Îµ—´ š¸É 1 2 3 4 5 6 7 8 9 10 11 12

®´˜„µ¦

ICD 9 CM

Intracapsular extraction of lens by temporal inferior route Other intracapsular extraction of lens Extracapsular extraction of lens by linear extraction technique Extracapsular extraction of lens by simple aspiration (and irrigation) technique Phacoemulsification and aspiration of cataract Mechanical phacofragmentation and aspiration of cataract by posterior route Mechanical phacofragmentation and other aspiration of cataract Extracapsular extraction of lens by temporal inferior route Other extracapsular extraction of lens Insertion of pseudophakos, not otherwise specified Insertion of intraocular lens prosthesis at time of cataract extraction, one-stage Secondary insertion of intraocular lens prosthesis

13.11 13.19 13.2 13.3 13.41 13.42 13.43 13.51 13.59 13.70 13.71 13.72


Health Intervention and Technology Assessment Program

74 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 32 ǦŠ­¦oµŠ…o°¤¼¨Ÿ¼ožiª¥Äœ (˜o°„¦³‹„) …°Š­Îµœ´„Šµœ„¨µŠ­µ¦­œÁš«¦·„µ¦­»…£µ¡ (­„­.) ¨Îµ—´š¸É ¦®´­˜´ªÂž¦ ˜´ªÂž¦ 1 CYRDSC žež’·š·œ…°Šª´œš¸É‹Îµ®œnµ¥ 2 HMAIN ¦®´­Ã¦Š¡¥µµ¨š¸É¤¸­·š›· 3 HCODE ¦®´­Ã¦Š¡¥µµ¨š¸É¦´„¬µ 4 HN HN (Hospital Number) 5 AN AN (Admission Number) 6 CPID Á¨…š¸É ˜´ ¦ž¦³‹Îµ˜´ª/´˜¦˜nµŠ—oµª/®œ´Š­º°Á—·œšµŠ „¦–¸´˜¦ž¦³µœ (ž¨ŠÂ¨oª) 7 DOB ª´œÁ—º°œžeÁ„·— 8 SEX Á¡« 1= µ¥ 2= ®·Š 9 DATEADM ª´œ¦´Á…oµÄœ 抡¥µµ¨ 10 DATEDSC ª´œ‹Îµ®œnµ¥ 11 LEAVEDAY ‹Îµœªœª´œš¸¨É µ„¨´oµœ 12 DISCHS ­™µœ£µ¡„µ¦‹Îµ®œnµ¥ 1 = Complete recovery 2 = Improved 3 = Not improved 4 = Normal delivery 5 = Un-delivery 6 = Normal child discharge with mother 7 = Normal child discharge separately 8 = Stillbirth 9 = Dead 13 DISCHT ž¦³Á£š„µ¦‹Îµ®œnµ¥ 1 = With approval 2 = Against advice 3 = Escape 4 = By transfer 5 = Other 6 = Dead autopsy 7 = Dead no autopsy 14 DRG „¨»n¤ª·œ·‹Œ´¥Ã¦‡¦nª¤(Diagnosis Related Group)


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 75

¨Îµ—´š¸É ¦®´­˜´ªÂž¦ 15 RW 16 ADJRW 17 18

AMOUNT AMLIM

19

AMOVLIM

20 21 22 23 24 25 26 27 28

AMREIMB AMNREIMB TR1 TR2 TR3 TR4 TR5 TR6 TR7

29 30 31 32 33 34 35 36

TR8 TR9 TR10 TR11 TR12 TR13 TR14 TR15

37 38 39 40 41 42

PDX SDX1 SDX2 SDX3 SDX4 SDX5

˜´ªÂž¦ ‡nµœÎʵ®œ´„­´¤¡´š›r (Relative Weight) ‡nµœÎʵ®œ´„­´¤¡´š›rš¸Éž¦´˜µ¤‡nµª´œœ°œ‹¦·Š (Adjusted Relative Weight) ‹ÎµœªœÁŠ·œ‡nµ¦´„¬µ¡¥µµ¨¦ª¤ ‹ÎµœªœÁŠ·œ‡nµ®o°Š/°µ®µ¦Â¨³‡nµ°ª´¥ª³Áš¸¥¤² ­nªœ˜µ¤­·š›· ‹ÎµœªœÁŠ·œ‡nµ®o°Š/°µ®µ¦Â¨³‡nµ°ª´¥ª³Áš¸¥¤² ­nªœš¸ÉÁ„·œ­·š›· ‹ÎµœªœÁŠ·œ‡nµ¦´„¬µ¡¥µµ¨°ºÉœ­nªœ˜µ¤­·š›· ‹ÎµœªœÁŠ·œ‡nµ¦´„¬µ¡¥µµ¨°ºÉœ­nªœš¸ÉÁ„·œ­·š›· ‡nµ®o°ŠÂ¨³‡nµ°µ®µ¦ ‡nµ°ª´¥ª³Áš¸¥¤Â¨³°»ž„¦–rĜ„µ¦Îµ´—¦´„¬µ ‡nµ¥µÂ¨³­µ¦°µ®µ¦šµŠÁ­oœÁ¨º°— ‡nµ¥µÂ¨³­µ¦°µ®µ¦šµŠÁ­oœÁ¨º°— ‡nµÁª£´–”rš¤¸É ·Än¥µ ‡nµ¦·„µ¦Ã¨®·˜Â¨³­nªœž¦³„°…°ŠÃ¨®·˜ ‡nµ˜¦ª‹ª·œ·‹Œ´¥šµŠÁš‡œ·‡„µ¦Â¡š¥r¨³¡¥µ›· ª·š¥µ ‡nµª·œ·‹Œ´¥Â¨³¦´„¬µšµŠ¦´Š­¸ª·š¥µ ‡nµ˜¦ª‹ª·œ·‹Œ´¥Ã—¥ª·›¸¡·Á«¬°ºÉœÇ ‡nµ°»ž„¦–r…°ŠÄo¨³Á‡¦ºÉ°Š¤º°šµŠ„µ¦Â¡š¥r ‡nµšÎµ®´˜™„µ¦Â¨³ª·­´¸ ‡nµ¦·„µ¦šµŠ„µ¦¡¥µµ¨ ‡nµ¦·„µ¦šµŠš´œ˜„¦¦¤ ‡nµ¦·„µ¦šµŠ„µ¥£µ¡Îµ´—¨³Áª„¦¦¤¢gœ¢¼ ‡nµ¦·„µ¦ {ŠÁ…Ȥ¨³„µ¦Îµ´—Ÿ¼ož¦³„°Ã¦‡«·¨žm °ºÉœ Ç ¦®´­Ã¦‡®¨´„ ¦®´­Ã¦‡¦°Š(˜´ªš¸1É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸2É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸3É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸4É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸5É )


Health Intervention and Technology Assessment Program

76 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ¨Îµ—´š¸É 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74

¦®´­˜´ªÂž¦ SDX6 SDX7 SDX8 SDX9 SDX10 SDX11 SDX12 SDX13 SDX14 SDX15 SDX16 SDX17 SDX18 SDX19 SDX20 PROC1 PROC2 PROC3 PROC4 PROC5 PROC6 PROC7 PROC8 PROC9 PROC10 PROC11 PROC12 PROC13 PROC14 PROC15 PROC16 PROC17

˜´ªÂž¦ ¦®´­Ã¦‡¦°Š(˜´ªš¸6É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸7É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸8É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸9É ) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 0) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 1) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 2) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 3) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 4) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 5) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 6) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 7) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 8) ¦®´­Ã¦‡¦°Š(˜´ªš¸1É 9) ¦®´­Ã¦‡¦°Š(˜´ªš¸2É 0) ¦®´­®´˜™„µ¦(˜´ªš¸1É ) ¦®´­®´˜™„µ¦(˜´ªš¸2É ) ¦®´­®´˜™„µ¦(˜´ªš¸3É ) ¦®´­®´˜™„µ¦(˜´ªš¸4É ) ¦®´­®´˜™„µ¦(˜´ªš¸5É ) ¦®´­®´˜™„µ¦(˜´ªš¸6É ) ¦®´­®´˜™„µ¦(˜´ªš¸7É ) ¦®´­®´˜™„µ¦(˜´ªš¸8É ) ¦®´­®´˜™„µ¦(˜´ªš¸9É ) ¦®´­®´˜™„µ¦(˜´ªš¸1É 0) ¦®´­®´˜™„µ¦(˜´ªš¸1É 1) ¦®´­®´˜™„µ¦(˜´ªš¸1É 2) ¦®´­®´˜™„µ¦(˜´ªš¸1É 3) ¦®´­®´˜™„µ¦(˜´ªš¸1É 4) ¦®´­®´˜™„µ¦(˜´ªš¸1É 5) ¦®´­®´˜™„µ¦(˜´ªš¸1É 6) ¦®´­®´˜™„µ¦(˜´ªš¸1É 7)


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 77

¨Îµ—´š¸É 75 76 77 78 79 80 81 82 83 84 85

¦®´­˜´ªÂž¦ PROC18 PROC19 PROC20 C2006 C2007 TOTPAY2006 / TOTCGD2006 TOTPAY2007 / TOTCGD2007 TOTPAY / TOTGCD TOTCPY06 / TOTPAT2006 TOTCPY07 / TOTPAT2007 TOTCPY / TOTPAT

˜´ªÂž¦ ¦®´­®´˜™„µ¦(˜´ªš¸1É 8) ¦®´­®´˜™„µ¦(˜´ªš¸1É 9) ¦®´­®´˜™„µ¦(˜´ªš¸2É 0) Á¨œ­rœ·É¤ Á¨œ­r…Ȋ ¦µ‡µÁ¨œ­rœ·É¤­nªœ˜µ¤­·š›· ¦µ‡µÁ¨œ­r…Ȋ­nªœ˜µ¤­·š›· ¦µ‡µ¦ª¤Á¨œ­rœ·É¤Â¨³Á¨œ­r…Ȋ­nªœ˜µ¤­·š›· ¦µ‡µÁ¨œ­rœ·É¤­nªœÁ„·œ­·š›· ¦µ‡µÁ¨œ­r…Ȋ­nªœÁ„·œ­·š›· ¦µ‡µ¦ª¤Á¨œ­rœ·É¤Â¨³Á¨œ­r…Ȋ­nªœÁ„·œ­·š›·


Health Intervention and Technology Assessment Program

78 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ ˜µ¦µŠš¸É 33 ǦŠ­¦oµŠ…o°¤¼¨Ÿ¼ožiª¥˜o°„¦³‹„…°Š­Îµœ´„Šµœ¦·®µ¦‹´—„µ¦Ã¦‡ÁŒ¡µ³ ­Îµœ´„Šµœ ®¨´„ž¦³„´œ­»…£µ¡Â®nŠµ˜· ¦®´­˜´ªÂž¦ ˜´ªÂž¦ REG_HCODE ¦®´­Ã¦Š¡¥µµ¨š¸É¤¸­·š›· REG_HMAIN ¦®´­Ã¦Š¡¥µµ¨š¸É¦´„¬µ REG_PROVINCE ¦®´­‹´Š®ª´— REG_MAININS ­·š›· REG_SEX Á¡« 1=µ¥ 2= ®·Š REG_AGE_Y °µ¥» (že) REG_AGE_M Á—º°œ REG_AGE_D ª´œ REG_VARE VA „n°œŸnµ˜´—…oµŠ…ªµ REG_VALE VA „n°œŸnµ˜´—…oµŠŽoµ¥ REG_DATE ª´œš¸É¨Šš³Á¸¥œŸnµ˜´— OPER_AN OPER_VARE VA ®¨´ŠŸnµ˜´—…oµŠ…ªµ OPER_VALE VA ®¨´ŠŸnµ˜´—…oµŠŽoµ¥


¦ª¤

®·Š

Á¡« µ¥

11,179

4,610 (41.2) 6,569 (58.8)

UC

2546

25,432

10,817 (42.5) 14,615 (57.5)

CS

56,848

23,644 (41.6) 33,204 (58.4)

UC

2547

28,574

12,121 (42.4) 16,453 (57.6)

CS

72,981

30,125 (41.3) 42,856 (58.7)

UC

2548

29,436

12,673 (43.1) 16,763 (56.9)

CS

2549

84,862

34,819 (41.0) 50,043 (59.0)

UC

˜µ¦µŠš¸É 34 ‹ÎµœªœŸ¼ožiª¥š¸ÅÉ —o¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ ¦³®ªnµŠ ¡.«. 2546 – 2550 ‹ÎµÂœ„˜µ¤Á¡«

31,450

13,621 (43.3) 17,829 (56.7)

CS

79,443

33,048 (41.6) 46,395 (58.4)

UC

2550

36,487

15,697 (43.0) 20,790 (57.0)

CS

305,313

126,246 (41.3) 179,067 (58.7)

UC

¦ª¤

151,379

64,929 (42.9) 86,450 (57.1)

CS

√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 79


¦ª¤

80 že…¹ÊœÅž

75 - 79 že

70 - 74 že

65 - 69 že

60 - 64 že

50 - 59 že

40 - 49 že

0 - 39 že

°µ¥»

25,432

(10.7)

(8.1)

11,179

184 (0.7) 727 (2.9) 2,464 (9.7) 2,904 (11.4) 5,518 (21.7) 6,367 (25.0) 4,537 (17.8) 2,731

CS

405 (3.6) 600 (5.4) 1,655 (14.8) 1,589 (14.2) 2,357 (21.1) 2,284 (20.4) 1,384 (12.4) 905

UC

2546

56,848

(8.6)

1,905 (3.4) 2,926 (5.1) 8,371 (14.7) 8,169 (14.4) 11,823 (20.8) 11,304 (19.9) 7,464 (13.1) 4,886

UC

2547

28,574

(10.9)

192 (0.7) 790 (2.8) 2,738 (9.6) 3,188 (11.2) 6,105 (21.4) 7,194 (25.2) 5,245 (18.4) 3,122

CS

72,981

(8.1)

2,301 (3.2) 3,500 (4.8) 10,633 (14.6) 10,432 (14.3) 15,173 (20.8) 15,013 (20.6) 10,013 (13.7) 5,916

UC

2548

29,436

(11.7)

189 (0.6) 852 (2.9) 2,880 (9.8) 3,386 (11.5) 5,922 (20.1) 7,230 (24.6) 5,527 (18.8) 3,450

CS

2549

84,862

(7.8)

2,331 (2.7) 3,817 (4.5) 12,743 (15.0) 12,192 (14.4) 17,675 (20.8) 17,701 (20.9) 11,754 (13.9) 6,649

UC

˜µ¦µŠš¸É 35 ‹ÎµœªœŸ¼ožiª¥š¸ÅÉ —o¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„ ¦³®ªnµŠ ¡.«. 2546 – 2550 ‹ÎµÂœ„˜µ¤°µ¥»

31,450

(11.7)

174 (0.6) 767 (2.4) 3,029 (9.6) 3,614 (11.5) 6,221 (19.8) 7,805 (24.8) 6,155 (19.6) 3,685

CS

79,443

(7.9)

2,321 (2.9) 3,608 (4.5) 11,950 (15.0) 11,318 (14.2) 16,359 (20.6) 16,506 (20.8) 11,070 (13.9) 6,311

UC

2550

36,487

(12.0)

166 (0.5) 780 (2.1) 3,452 (9.5) 4,117 (11.3) 6,941 (19.0) 9,187 (25.2) 7,477 (20.5) 4,367

CS

305,313

(8.1)

405 (3.0) 600 (4.7) 1,655 (14.9) 1,589 (14.3) 2,357 (20.8) 2,284 (20.6) 1,384 (13.7) 905

UC

¦ª¤

151,379

(11.5)

184 (0.6) 727 (2.6) 2,464 (9.6) 2,904 (11.4) 5,518 (20.3) 6,367 (25.0) 4,537 (19.1) 2,731

CS

80 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

Health Intervention and Technology Assessment Program


°ÎµÁ£°š¸É¦´„¬µ = °ÎµÁ£°š¸É¤¸­·š›· 22,713 (36.91%)

°ÎµÁ£°š¸É¦´„¬µ °ÎµÁ£°š¸É¤¸­·š›·: 38,789(63.1%)

¦´„¬µ-‡œ¨³‹´Š®ª´—: 3,310 (5.0%) 1. Á—·¤µŠœµŠª 352 (10.6) 2. ¤®µ¦µœ‡¦Á¸¥ŠÄ®¤n 318 (9.6) 3. ¡¦³¡»š›µš 213 (6.4) 4. °·œš¦r»¦¸ 199 (6.0) 5. Á¤˜˜µž¦³µ¦´„¬r 184 (5.6)

¦´„¬µ-„¦»ŠÁš¡²: 4,799 (95.4%) 1. ˜µ„­·œ 733 (15.0) 2. ­¤Á—È‹¡¦³žd~œÁ„¨oµ 446 (9.3) 3. Á‹¦·„¦»Šž¦³µ¦´„¬r 415 (8.6) 4. ¦µª·™¸ 410 (8.5) 5. œ¡¦´˜œ¦µ›µœ¸ 356 (7.4)

¦´„¬µ-˜nµŠ‹´Š®ª´—: 234 (4.6%) 1. oµœÂ¡oª 103 (44.0) 2. Á¤˜˜µž¦³µ¦´„¬r 61 (26.1) 3. Á—·¤µŠœµŠª 12 (5.1) 4. „µ¦Â¡š¥r­¤Á—È‹¡¦³Áš¡² 10 (4.3) 5. š´ÉªÅž­¤»š¦­µ‡¦ 4 (1.7)

­·š›·„¦»ŠÁš¡¤®µœ‡¦ 5,033 (6.9%)

- NSHO - No-HMAIN: 2,143(2.9%)

°ÎµÁ£°°ºÉœ – °ÎµÁ£°Á¤º°Š: 33,278 (45.6%) Mean=46.1 SD=29.8 Median=40 Mode=45 Min.=2 Max=238

°ÎµÁ£°Á¤º°Š – °ÎµÁ£°°ºÉœ: 277 (0.4%)

°ÎµÁ£°°ºÉœ – °ÎµÁ£°°ºÉœ: 6,293 (7.4%)

¦´„¬µ-„¦»ŠÁš¡²: 1,093 (1.7%) 1. ­Š‰r 368 (33.7) 2. ¦µª·™¸ 355 (32.5) 3. «·¦·¦µ 130 (11.9) 4. ¦µ¤µ›·—¸ 77 (7.0) 5. ­™µ´œ­»…£µ¡Á—È„² 51 (4.7)

¦¼žš¸É 16 š·«šµŠ„µ¦Ÿnµ˜´—˜o°„¦³‹„˜µ¤Ã¦Š¡¥µµ¨š¸Éަ´„¬µ…°Š­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ¡.«.2548

¦´„¬µ-‹´Š®ª´—Á—¸¥ª„´œ: 61,502 (93.3%)

­·š›·˜nµŠ‹´Š®ª´— 65,905 (90.16 %)

˜o°„¦³‹„ ¡.«.2548 72,981 ‡œ

√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 81


°ÎµÁ£°š¸É¦´„¬µ = °ÎµÁ£°š¸É¤¸­·š›· 27,289 (38.3%)

°ÎµÁ£°š¸É¦´„¬µ °ÎµÁ£°š¸É¤¸­·š›·: 40,220(56.5%)

¦´„¬µ-‡œ¨³‹´Š®ª´—: 3,689 (5.0%) 1. ¤®µ¦µœ‡¦Á¸¥ŠÄ®¤n 599 (16.2) 2. Á—·¤µŠœµŠª 340 (9.2) 3. oµœÂ¡oª 323 (8.8) 4. Á¤˜˜µž¦³µ¦´„¬r 241 (6.5) 5. «¼œ¥r­¦³»¦¸ 230 (6.2)

¦´„¬µ-˜nµŠ‹´Š®ª´—: 325 (5.0%) 1. oµœÂ¡oª 171 (52.6) 2. Á¤˜˜µž¦³µ¦´„¬r 85 (26.2) 3. „µ¦Â¡š¥r­¤Á—È‹¡¦³Áš¡² 22 (6.8) 4. Á—·¤µŠœµŠª 4 (1.2) 5. «¼œ¥r¨ÎµžµŠ 4 (1.2) 6. š´ÉªÅžœ‡¦¡œ¤ 3 (0.9) 7. š´ÉªÅž¡·‹·˜¦ 3 (0.9)

°ÎµÁ£°°ºÉœ – °ÎµÁ£°Á¤º°Š: 37,221 (43.9%) Mean=46.2 SD=28.6 Median=40 Mode=45 Min.=2 Max=238

°ÎµÁ£°Á¤º°Š – °ÎµÁ£°°ºÉœ: 345 (0.4%)

- NSHO - No-HMAIN: 2,312(2.7%)

­·š›·„¦»ŠÁš¡¤®µœ‡¦ 6,480 (7.6%)

¦´„¬µ-„¦»ŠÁš¡²: 6,155 (95.0%) 1. ˜µ„­·œ 781 (12.7) 2. Á„¬¤¦µ¬‘¦rž¦³µºÉœ 586 (9.5) 3. ¦µª·™¸ 539 (8.8) 4. ­¤Á—È‹¡¦³žd~œÁ„¨oµ 508 (8.3) 5. ª·¦¡¥µµ¨ 455 (7.4)

°ÎµÁ£°°ºÉœ – °ÎµÁ£°°ºÉœ: 6,293 (7.4%)

¦´„¬µ-„¦»ŠÁš¡²: 1,233 (1.7%) 1. ¦µª·™¸ 452 (36.7) 2. «·¦·¦µ 201 (16.3) 3. ­Š‰r 161 (13.1) 4. ­£µ„µµ—Åš¥ 135 (10.9) 5. ¦µ¤µ›·—¸ 93 (7.5)

¦¼žš¸É 17 š·«šµŠ„µ¦Ÿnµ˜´—˜o°„¦³‹„˜µ¤Ã¦Š¡¥µµ¨š¸Éަ´„¬µ…°Š­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ¡.«.2549

¦´„¬µ-‹´Š®ª´—Á—¸¥ª„´œ: 71,163 (96.9%)

­·š›·˜nµŠ‹´Š®ª´— 73,460 (86.6 %)

˜o°„¦³‹„ ¡.«.2549 84,862 ‡œ

82 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

Health Intervention and Technology Assessment Program


°ÎµÁ£°š¸É¦´„¬µ = °ÎµÁ£°š¸É¤¸­·š›· 24,477 (37.8%)

°ÎµÁ£°š¸É¦´„¬µ °ÎµÁ£°š¸É¤¸­·š›·: 40,220(62.2%)

¦´„¬µ-‡œ¨³‹´Š®ª´—: 3,650 (5.2%) 1. oµœÂ¡oª 680 (9.3) 2. ¤®µ¦µœ‡¦Á¸¥ŠÄ®¤n 382 (5.2) 3. Á¤˜˜µž¦³µ¦´„¬r (ª´—Ŧn…·Š) 357 (4.9) 4. «¦¸œ‡¦·œš¦r …°œÂ„nœ 274 (3.8) 5. ­Š…¨µœ‡¦·œš¦r 240 (3.3)

188 (0.2) 2,005(2.5%) 772 (1.0%) 1 (0.0%)

¦´„¬µ-˜nµŠ‹´Š®ª´—: 221 (3.3%) 1. oµœÂ¡¦oª 107 (48.4) 2. Á¤˜˜µž¦³µ¦´„¬r (ª´—Ŧn…·Š) 65 (29.4) 3. «¼œ¥r¤®µ¦µ œ‡¦¦µ­¸¤µ 10 (4.5) 4. ¡·‹·˜¦ 5 (2.3) 5. ­¤»š¦­µ‡¦ 5 (2.3) 6. „µ¦Â¡š¥r­¤Á—È‹¡¦³Áš¡² 3 (0.9) 7. ›¦¦¤«µ­˜¦rÁŒ¨·¤¡¦³Á„¸¥¦˜· 3 (1.4)

°ÎµÁ£°°ºÉœ – °ÎµÁ£°Á¤º°Š: 39,939 (99.3%) Mean=46.9 SD=29.1 Median=40 Mode=22.0 Min.=2 Max=238

°ÎµÁ£°Á¤º°Š – °ÎµÁ£°°ºÉœ: 252 (0.6%)

- NSHO: - No-HMAIN: -21340: -11894: ­·š›·„¦»ŠÁš¡¤®µœ‡¦ 6,613 (8.3%)

¦´„¬µ-„¦»ŠÁš¡²: 6,392 (95.0%) 1. ˜µ„­·œ 766 (12.0) 2. Á„¬¤¦µ¬‘¦rž¦³µºÉœ 664 (10.4) 3. ¦µª·™¸ 490 (7.7) 4. ­¤Á—È‹¡¦³žd~œÁ„¨oµ 425 (6.6) 5. Á‹¦·„¦»Šž¦³µ¦´„¬r 424 (6.6)

°ÎµÁ£°°ºÉœ – °ÎµÁ£°°ºÉœ: 29 (0.1%)

¦´„¬µ-„¦»ŠÁš¡²: 1,517 (2.2%) 1. ¦µª·™¸ 438 (28.9) 2. ­Š‰r 349 (23.0) 3. ‹»¯µ² 225 (14.8) 4. «·¦·¦µ 166 (10.9) 5. ­™µ´œ­»…£µ¡Á—È„² 108 (7.1)

¦¼žš¸É 18 š·«šµŠ„µ¦Ÿnµ˜´—˜o°„¦³‹„˜µ¤Ã¦Š¡¥µµ¨š¸Éަ´„¬µ…°Š­·š›·ž¦³„´œ­»…£µ¡™oªœ®œoµ ¡.«.2550

¦´„¬µ-‹´Š®ª´—Á—¸¥ª„´œ: 64,697 (92.6%)

­·š›·˜nµŠ‹´Š®ª´— 69,864 (86.0 %)

˜o°„¦³‹„ ¡.«.2550 79,443 ‡œ

√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 83


‹Îµœªœ (…oµŠ) Mechanical complication Complications of procedures Astigmtism Myopia Hypermetropia Purulent endophthalmitis Vitreous haemorrhage Retinal detachment with retinal break Choroidal hemorrhage and rupture After cataract Hyphema Other corneal edema

­·š›·„µ¦¦´„¬µ nonfoldable 10,577 15(0.14) 46(0.43) 2(0.02) 22(0.21) 0 2(0.02) 19(0.18) 17(0.16) 2(0.02) 9(0.09) 6(0.06) 5(0.05)

foldable 59,000 89(0.15) 342(0.58) 13(0.02) 91(0.15) 0 13(0.02) 108(0.18) 109(0.18)

2(0.00) 27(0.05) 55(0.09) 36(0.06)

2548

0 12(0.04) 21(0.07) 31(0.10) 1(0.00) 28(0.06) 30(0.06) 17(0.03) 1(0.00) 14(0.05) 12(0.04) 15(0.05) 6(0.01) 28(0.06) 39(0.09) 18(0.04)

1(0.00) 36(0.15) 12(0.05) 14(0.06)

0 3(0.07) 5(0.12) 3(0.07)

2550 2548 nonnonnonfoldable foldable foldable foldable foldable foldable 30,172 50,206 30,270 45,666 24,398 4,019 80(0.27) 76(0.15) 93(0.31) 108(0.24) 31(0.13) 6(0.15) 287(0.95) 257(0.51) 307(1.01) 440(0.96) 118(0.48) 41(1.02) 23(0.08) 13(0.03) 21(0.07) 2(0.00) 8(0.03) 1(0.02) 43(0.14) 72(0.14) 56(0.19) 78(0.17) 59(0.24) 7(0.17) 0 1(0.00) 0 0 0 0 9(0.03) 25(0.05) 13(0.04) 22(0.05) 2(0.01) 2(0.05) 52(0.17) 104(0.21) 53(0.18) 83(0.18) 35(0.14) 11(0.27) 42(0.14) 83(0.17) 70(0.23) 110(0.24) 39(0.16) 5(0.12)

2549

UC

˜µ¦µŠš¸É 36 ‹ÎµœªœŸ¼ožiª¥š¸ÅÉ —o¦´„µ¦Ÿnµ˜´—˜o°„¦³‹„¦³®ªnµŠ ¡.«.2548 – 2550 ‹ÎµÂœ„˜µ¤®´˜™„µ¦Ä­nÁ¨œ­r¨³œ·—Á¨œ­r

3(0.01) 24(0.09) 10(0.04) 14(0.06)

foldable 25,399 40(0.16) 156(0.61) 25(0.10) 94(0.37) 3(0.01) 2(0.01) 45(0.18) 34(0.13) 0 4(0.08) 5(0.10) 3(0.06)

nonfoldable 4,845 37(0.76) 86(1.78) 0 5(0.10) 0 2(0.04) 5(0.10) 10(0.21)

2549

CSMBS

4(0.01) 24(0.08) 7(0.02) 10(0.03)

0 8(0.15) 7(0.13) 7(0.13)

nonfoldable foldable 29,804 5,429 52(0.17) 42(0.77) 269(0.90) 122(2.25) 47(0.16) 2(0.04) 90(0.30) 3(0.06) 3(0.01) 0 12(0.04) 4(0.07) 65(0.22) 12(0.22) 62(0.21) 15(0.28)

2550

84 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

Health Intervention and Technology Assessment Program


√“¬ß“π°“√«‘®—¬ §«“¡§ÿâ¡§à“¢Õß°“√ºà“µ—¥µâÕ°√–®° ‚¥¬„ à‡≈π å·°â«µ“‡∑’¬¡™π‘¥π‘Ë¡‡ª√’¬∫‡∑’’¬∫°—∫™π‘¥·¢Áß„π∫√‘∫∑¢Õߪ√–‡∑»‰∑¬ 85


Health Intervention and Technology Assessment Program

86 ‚§√ß°“√ª√–‡¡‘π‡∑§‚π‚≈¬’·≈–π‚¬∫“¬¥â“π ÿ¢¿“æ

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