국내 골관절염 및 류마티스관절염 치료를 위한 Celecoxib의 비용-효과성 연구

박다진,이연주,황성혜 한국보건의료기술평가학회 2015 보건의료기술평가 Vol.3 No.1

Objectives: The aim of this study is to analyze cost-effectiveness of celecoxib monotherapy versus diclofenac and omeprazole combination therapy for osteoarthritis or rheumatoid arthritis patients in Korea. Methods: A 6-month decision tree model was developed from the limited societal per- spective. The main efficacy probabilities were derived from the CONDOR trial which studied the efficacy and adverse event rates for rheumatoid arthritis and osteoarthritis patients with the use of non-steroidal anti-inflammatory drugs. The model was conducted on a 3-month cycle until the first event and one-month cycle thereafter. Gastrointestinal event rates were applied along with mortality and utility values to get the final results. Costs included medications, monitoring and treatment costs for adverse events. All cost information was obtained from Korea-specific data sources. Sensi- tivity analysis was conducted to reflect compliance rate, patient age and celecoxib price change ac- cording to the current drug pricing policy in Korea. Results: The final cost and quality-adjusted life year (QALY) of celecoxib was 409591 KRW with 0.43064 QALY and 426645 KRW with 0.42539 QALY for diclofenac plus omeprazole. The celecoxib total cost was less costly than diclofenanc plus omeprazole while it yielded more QALY gained, thus celcecoxib was a dominant treatment option. Sensitivity analysis results were robust and proved celecoxib was cost effective. Conclusion: Cele- coxib can be considered as a cost-effective measure compared to difclofenac plus omeprazole thera- py in patients with osteoarthritis and rheumatoid arthritis.

기정진 경학(經學)의 특징적 양상에 관한 검토 - 경전에 대한 인식과 공부를 중심으로 -

박다진 한서대학교 동양고전연구소 2022 동방학 Vol.- No.47

The purpose of this study is to identify the characteristic aspects of the Nosa Ki Jung-jin’s study on Chinese Classics. The characteristic perspectives of Ki Jung-jin’s interpretation of the Chinese Classics is to regard the original text defined as ‘teaching of Susa(洙泗之敎)’ as the source of noe-confucianism and to pursue practical understanding that directly realizes the meaning of original text. These perspectives were presented for the purpose of cautioning scholars who focus only on theoretical discussions, and the basis is that the original text of 'Four Books(四書)' realizes the truth of Neo-Confucianism in itself while its content mainly focuses on the Life-World. Ki Jung-jin criticized that scholars had a superficial understanding of the 'teaching of Susa' for the situation buried in theoretical discussions, and suggested ‘Searching reason in oneself(反求諸己)’ and ‘Reading in self-scrutiny(看得切己)’, which are the essential attitudes and methods of studying Confucian classics. Ki Jeong-jin's study on Chinese Classics is classified as 'Study of Neo-Confucian Classics', nevertheless, it has its own differentiation due to contextual conditions such as the situation of the times in which he lived. The significance of Ki Jeong-jin's study on Chinese Classics can be found in that he urged the reorientation of the intellectual community of Neo-Confucianism of the time and laid the foundation for concrete practice in the realistic situation of Joseon(朝鮮) in the 19th century. 본 연구에서는 노사(蘆沙) 기정진(奇正鎭, 1798~1879)이 제시한 경학(經學)의 특징적 양상을 확인하였다. 기정진의 경전 인식에서는 ‘수사지교(洙泗之敎)’로서의 경문을 성리설의 근본으로 규정하고, 경문에 내재한 의미를 체득하는 실천적 이해를 추구하는 것이 주요 경학적 관점으로 나타난다. 이러한 관점은 ‘사서(四書)’와 같은 경전의 원문이 인사(人事)에 절실한 내용이 주를 이루면서도 그 자체로 성리학적 진리를 실현한다는 생각을 통해 이론적 논의에만 치중하는 학인들을 경계하려는 목적성을 띤다. 기정진은 학인들이 이론적 논의에 천착하는 것을 ‘수사지교’를 피상적으로 이해한 것이라고 비판하고, 이에 대한 처방으로 경전공부에서 견지해야 본질적인 태도이자 방법인 ‘반구저기(反求諸己)’와 ‘간득절기(看得切己)’를 제시하였다. 기정진의 경학은 기본적으로 ‘주자학적 경학’에 해당하지만, 당대의 시대적 상황 등 여러 맥락적 조건을 통해 나름의 차별성을 보여준다. 기정진의 경학은 19세기 조선의 현실적 상황에서 당대 성리학 지식계의 재정향(再定向)을 촉구하고 구체적인 실천의 토대를 마련하였다는 점에서 그 의의를 찾을 수 있다.

율곡의 호발설(互發說) 비판에 대한 성호의 반비판 - 사상사적 함의에 주목하여 -

박다진 ( Park Da-jin ) 충남대학교 유학연구소 2020 儒學硏究 Vol.50 No.-

사단칠정에 대한 이해방식에서 퇴계와 율곡이 보인 입장 차이는 후대의 논의로 계승되는 과정에서 ‘비판과 반비판의 길항’을 통해 중요한 쟁점을 끊임없이 환기하였다. 그 중심에는 퇴계의 호발설(互發說)을 어떻게 이해할 것인가의 문제가 있었다. 율곡은 ‘리기지묘(理氣之妙)’를 전제로 혼륜(渾淪)의 관점을 강조하면서 퇴계의 호발설이 가진 논리적 문제점들을 강하게 비판하였다. 율곡의 호발설 비판에서 제기된 논의 방식들은 17세기 이후로 율곡학파가 퇴계학파의 사단칠정론을 논박하는 데 있어 핵심적인 논거로 활용되었다. 이는 퇴계학파에서 호발설을 옹호하기 위해서는 율곡의 비판을 극복할 수 있는 논리를 확립하는 것이 선결 과제로 주어졌음을 의미 한다. 퇴계학파의 입장에서 퇴계의 사단칠정론을 옹호했던 성호는 자신의 초기 저술인 『사칠신편(四七新編)』에서 율곡의 호발설 비판을 ‘반비판’ 하는 형식을 통해 퇴계의 호발설이 가진 논리적 문제점을 보완하고자 하였다. 성호는 사단과 칠정의 가치론적 대비 구도를 통해 그 선악적 의미의 강조하는 퇴계의 호발설을 발전적으로 계승하였으며, 이 과정에서 리의 주재성을 강조하는 ‘리발일도설(理發一途說)’을 제시하였다. 하지만 성호의 논의는 본래의 의도와는 달리 율곡이 설정한 ‘기발리승일도설(氣發理乘一途說)’의 구도에서 벗어나지 못하였으며, 또 다른 새로운 쟁점들을 만들어 내는 것으로 귀결되었다. 성호의 『사칠신편』에서 드러난 여러 가지 한계점들은 성호학파 내부에서 사단칠정에 관한 새로운 논의를 새롭게 촉발함으로써, 결과적으로 퇴계의 철학을 반성적으로 재해석하고 사단칠정에 대한 논의를 다기화(多岐化)하는 중요한 계기적 조건이 되었다. The differences in the ways of understanding Four Beginnings and Seven Feelings between Toegye and Yulgok kept raising important issues through "contention between criticism and anti-criticism" in the transmission process of the discussions to the following generations. At the center was the question about how to understand Toegye's theory of mutual issuance (互發說). Yulgok criticized strongly the logical problems of his theory by emphasizing the perspective of integration on the premise of "marvel of Li-Qi (理氣之妙)." The ways of discussion that Yulgok presented in his criticism of Toegye's theory of mutual issuance were used as essential grounds for arguments since the 17th century as the Yulgok School refuted the Toegye School's theory of Four-Seven, which means that the Toegye School's first task in their advocacy for the theory of mutual issuance was to establish logic to overcome Yulgok's criticism. Advocating Toegye's theory of Four-Seven in the position of the Toegye School, Sungho tried to supplement the logical problems of Toegye's theory of mutual issuance in the form of "anti-criticism" for Yulgok's criticism of the theory in his early work Siqixinbian (『四七新編』). Sungho inherited developmentally Toegye's theory of mutual issuance, which puts an emphasis on the meanings of Four Beginnings and Seven Feelings in good and evil through their confronting composition in value, and proposed "Lifayitu theory (理發一途說)," which stresses the governance of Li, in the process. His discussions, however, ended up creating new issues while failing to escape from the magnetic field of Yulgok's "qifalichengyitu theory (氣發理乘一途說)" contrary to his original intention. Many different limitations in Sungho's Siqixinbian raised new discussions about Four Beginnings and Seven Feelings within the Sungho School and eventually became important instrumental conditions to reinterpret Toegye's philosophy in a reflective manner and diversify the discussions about Four Beginnings and Seven Feelings.

건강보험ㆍ자동차보험ㆍ산재보험 제도의 국내외 비교

박다진(Dajin Park),고수경(Sukyoung Ko),송기민(Kimin Song) 서울대학교 보건환경연구소 2006 보건학논집 Vol.43 No.2

Multiple Criteria Decision Analysis (MCDA) in Health Technology Assessment: Review of Literature on MCDA Methodology and Decision Criteria

이용주,김영주,박다진,Danny Liew,이용주 한국보건의료기술평가학회 2017 보건의료기술평가 Vol.5 No.2

Objectives: Many studies are being conducted around the globe to assess the feasibility of multiple criteria decision analysis (MCDA) in health technology assessment (HTA). In this review, we assessed MCDA methodologies and decision criteria used in HTA. Methods: A total of 35 studies published from 2005−2015 that applied MCDA in HTA were selected and the following areas were reviewed: 1) Context of the decision making: decision making setting, level (e.g., micro, meso, macro), and the assessment target (e.g., healthcare policy, drugs, health program, medical test, medical device, treatment, or surgery), 2) MCDA methodology: type of MCDA technique, weighting method, criteria elicitation method, and the participants, 3) Decision criteria: feasibility, social/population impact, intervention related factors, patient/individual-centered values, budget impact, and quality of evidence, and 4) Transparency of the decision making process: the process was considered transparent if the study disclosed the weight of each criterion, the formula used to calculate the final score or if the weighting/calculation method was well explained to the level considered acceptable by the authors. Results: Of the studies reviewed, 63.9% used MCDA for decision making at a national level, and the type of HT being assessed was most often national/regional healthcare policy (44.1%). The most prevalent method of weighting was direct weighting using scales (40.0%). Most of the studies (80.0%) conducted group discussions for criterion selection, and among the criteria, intervention-related factors such as safety and efficacy (93.9%) were most often observed, followed by budget-impact (81.8%) and patient/individual-centered values (81.8%). Conclusion: Substantial demands for incorporation of patient-centered values into the current HTA process were observed. Additionally, MCDA may be a useful tool in incorporating such values to the HTA decision framework, but unresolved methodological issues remain. Further assessment on the application of MCDA in HTA should be conducted for Korea-specific settings.

폐경기 여성들의 혈관운동증상 관리에 대한 지불의사금액과 영향요인 분석

김은주,고수경,박다진 한국보건의료기술평가학회 2014 보건의료기술평가 Vol.2 No.2

Objectives: The aim of this study is to analyze inherent value and factors which influence willingness to pay (WTP) of vasomotor symptoms (VMS) treatment in Korea. Methods: The nationwide, cross-sectional, face to face survey was conducted on 1500 menopausal women above age of 40. Respondent provided data which included educational attainment, employment and marital status, monthly household income, and other demographic information. Among 1500 respondents, 657 (43.8%) reported experiencing VMS in the previous 6 months. The 657 respondents completed interview for their WTP for VMS treatment regarding a specific amount of money to return to patient’s pre-VMS health status through 3 times of bidding games. Starting bids were 10000 KRW, 30000 KRW, 50000 KRW, and 100000 KRW. Following bidding games, respondent was asked an open ended question directly asking them to provide maximum WTP. Predictors of open-ended maximum WTP and that of first bid acceptancy were evaluated using linear regression models and logistic regression models, respectively. Results: Average monthly WTP for a hypothetical treatment to return current state to their pre-VMS state was 43463 KRW. The factors having a significant effect of patient WTP for VMS treatment are income, amount of current expenditure for VMS management and initial starting bid. As the ability to pay increases, the patient is willing to pay more for a treatment that will return them to their pre-VMS health state. Recognition of necessity of menopausal symptom management also resulted in a increase in patient WTP. WTP was closely associated with initial starting bid (p<0.001). WTP results were higher with higher starting bids. Conclusion: Average monthly WTP was 43463 KRW. The main factors to influence to increase WTP were income, amount of current expenditure for VMS management and starting bid in bidding game.

금연 치료의 재정영향 분석

고수경,이주연,박다진 한국보건의료기술평가학회 2014 보건의료기술평가 Vol.2 No.2

Objectives: To estimate the budgetary impact of smoking cessation treatment in Korea in the first 5 years after policy change related to reimbursement of smoking cessation treatment from the healthcare perspective. Methods: In the economic impact model, target populations were adult smokers who were over 20-year old, decided to quit smoking, and took medication for smoking cessation through hospital or clinic visits. Assumed baseline rate of smoking, decision to quit, hospital/clinic visit, and prescription of smoking cessation treatment was 42.1% (male) and 6.2% (female), 55.3%, 5.4%, and 13% respectively. Annual increase rates of smoking, trial to quit smoking, hospital/clinic visits, and prescription of smoking cessation treatment were estimated as -1.8%, 5%, 5%, and 20% respectively during 5 years. Smoking cessation treatments based on three alternatives were estimated: nicotine replacement therapy, bupropion, and varenicline. All drug costs are calculated based on 12-week treatment. Sensitivity analysis was performed to evaluate the impact of varying the smoking rate. Results: Model estimates suggest that the budgetary impact of smoking cessation treatments would be 40 billion KRW in 2014. and in the fifth year after policy change, total smoking cessation programs would be 109 billion KRW in 2019. Conclusion: Reimbursement of smoking cessation treatment could result in additional national budget of 70 billion KRW annually. But we can expect a reduction in the number of smokers would offset this cost by decreasing the burden of smoking.

현행 사회보험 권리구제제도의 문제점 및 개선방안

송기민,고수경,박다진 한국사회보장학회 2006 사회보장연구 Vol.22 No.2

일부 농촌지역주민의 의료이용행태에 관한 연구

김한해,김양중,김동식,김동옥,김정희,남소영,문성은,박다진,박지현,조성준,지남주,채수미,정문호 서울대학교 보건환경연구소 2004 보건학논집 Vol.41 No.1

금연치료제의 경제성 평가

김윤희 ( Younhee Kim ),김은주 ( Eunju Kim ),박다진 ( Dajin Park ) 한국보건경제정책학회(구 한국보건경제학회) 2014 보건경제와 정책연구 Vol.20 No.3

본 연구는 금연치료제인 varenicline과 bupropion의 경제성 분석을 수행하였다. 우리나라 30세~79세 성인 남녀 중 흡연자이면서 적극적인 금연 의지를 가지고 있는 사람들을 대상으로 varenicline과 bupropion의 금연성공률을 주요 효과 지표로 하여 마콥 모형을 적용하여 분석하였다. 마콥 상태는 금연, 재흡연, 흡연 및 사망으로 구분하였고 분석기간은 30년, 분석주기는 1년으로 설정하였다. 최종 효과 지표로 LYG(Life-Year Gained)와 QALY(Quality Adjusted Life Years)를 고려하였다. 보험자 관점을 가정하여 의료비용만을 포함하였으며 구체적으로 약품비용, 약국비용, 모니터링 비용, 흡연으로 인한 추가 의료비용을 추정하였다. 분석결과 varenicline은 bupropion에 비해 30,408 QALYs를 더 얻으면서 2,255억원을 더 지출하는 것으로 나타나 bupropion에 대한 varenicline의 점증적 비용-효용비(ICUR)는 7,415,712원/QALY로 추정되었다. 우리나라 1인당 GDP 수준을 고려할 때 금연치료제로서 varenicline은 다른 대안에 비해 비용-효과적인 것으로 판단할 수 있다. 민감도 분석 결과 할인율이 높아질수록, 분석기간이 짧을수록 점증적 비용-효용비가 높아지는 것으로 나타났으며 다른 요인에는 큰 영향을 받지 않은 것으로 나타났다. This study was conducted to estimate cost-effectiveness of varenicline, a pharmacotherapy developed to support smoking cessation, versus bupropion among prescription drugs. A 30-year Markov model with health states “Smoker”, “Quitter” and “Dead” was used for a hypothetical cohort of Korean smokers who are over 30 years old and willing to quit smoking. Utility values of smokers and quitters incorporated in the model were collected from Korea National Health & Nutrition Examination Survey. Transition probabilities were from clinical trials and Korean statistic data, and cost data were obtained from Korean health insurance reimbursement price list. The model used a 5% discount rate for costs and effectiveness. Sensitivity analyses were conducted on various parameters such as the time to reach mortality rate of ex-smokers compared to that of non-smokers, time horizon and discount rate. The incremental effectiveness of varenicline versus bupropion was 30,408 QALYs. The incremental cost of varenicline versus bupropion was 225 billion KRW. The ICER of varenicline comparing to bupropion was estimated at 7.4 million KRW per QALY. Sensitivity analyses were quite robust for all parameters but it was most sensitive to time horizon. Varenicline treatment for smoking cessation can be considered as cost-effective compared with existing therapies in Korea.