BackgroundGastric cancer is one of the leading causes of cancer-related deaths in both sexes worldwide, especially in Eastern Asia. This study aimed to estimate the economic burden of advanced gastric cancer (AGC) in Taiwan.MethodsThe costs of AGC in 2013 were estimated using resource use data from a chart review study (n = 122 with AGC) and national statistics. Annual per-patient costs, where patients’ follow-up periods were adjusted for, were estimated with 82 patients who had complete resource use data. The costs were composed of direct medical costs, direct non-medical costs (healthcare travel and caregiver costs), morbidity costs, and mortality costs. Relevant unit costs were retrieved mainly from literature and national statistics, and applied to the resource use data. A broad definition of morbidity and mortality costs was employed to value the productivity loss in patients with unpaid employment, economically inactive and unemployed as well as the life years after the age of retirement. Their narrow definitions were also used in sensitivity analyses, using age- and/or sex-specific employment rates. Forgone future earnings/productivity loss were discounted at 3%. Annual per-patient costs were projected to estimate the total costs of AGC at the national level with an estimated number of patients with AGC (N = 2611) in Taiwan in 2013.ResultsThe mean age of the 82 patients was 59.3 (SD: 11.9) years, and 67.1% were male. Per-patient costs were US$26,431 for direct medical costs, US$4669 for direct non-medical costs, US$5758 for morbidity costs, and US$145,990 for mortality costs (per death). These per-patient costs were projected to incur total AGC costs of US$423 million at the national-level. Mortality costs accounted for 77.3% of the total costs, followed by direct medical costs (16.3%), morbidity costs (3.6%), and direct non-medical costs (2.9%).ConclusionAGC was found to exert a significant economic burden in Taiwan, incurring US$423 million in 2013. This represents about 0.08% of the Taiwanese economy. Mortality costs appeared to be the single greatest contributor to the burden, followed by direct medical costs. Early detection and providing effective treatments will help to reduce its burden on patients, caregivers and society as a whole.A poster of this study was presented at the 2016 American Society of Clinical Oncology (ASCO) Gastrointestinal Cancers Symposium in San Francisco, CA, USA.

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180 Background: In Taiwan, limited real-world data indicate that initial EC diagnosis tends to occur at an advanced stage with limited therapeutic options and poor prognosis. Methods: This was a retrospective ‘real world’ observational study using the Taiwan National Health Insurance Research Database (NHIRD). Patients having at least one hospital record with a primary ICD-9 or ICD-10 code of EC were selected from Jan 1st, 2013 through Dec 31st, 2018. The first date of EC diagnosis was defined as the index date. Patients were followed for a minimum ± 30 days from the index date and were stratified by staging, clinical presentation (i.e. resectable vs. non-resectable advanced) and tumor histotype (squamous cell carcinoma, adenocarcinoma, unknown). Key characteristics such as demographics, clinical parameters, medication utilization, health care resource utilization, costs incurred, and survival were tracked for the overall population, resectable and non-resectable, advanced cohorts. Results: Patients identified with non-resectable advanced EC (N = 4,340) had a mean (SD) age of 59.7 (12.3) years and the vast majority were male (n = 4,044, 93.2%). Approximately half (50.4%) had Stage 3 disease and an additional 36.2% with stage 4, with the remainder Stage 1, 2 or Unknown. The majority (91.8%) were diagnosed with squamous cell carcinoma. 71.3% of patients received first line (1L) chemotherapy, most commonly with fluorouracil + cisplatin (69.9% of 1L) or platinum monotherapy (13.8% of 1L). 36.3% of patients survived one year with mean (SD) annualized post-index EC-related costs of New Taiwan (NT) $791,827.4 (NT$ 582,663.8). Conclusions: In Taiwan, the most common 1L chemotherapeutic treatment modality for Taiwanese patients with EC were fluorouracil + cisplatin. The EC-related costs for these patients appear to be a substantial financial burden in Taiwan.

33 Background: Gastric cancer is one of the leading causes of cancer deaths in both sexes worldwide, especially in East Asia. This study aimed to estimate the economic burden of advanced gastric cancer (AGC) in Taiwan. Methods: The costs of AGC in 2013 were estimated using resource use data from a chart review study (n = 122 with AGC) and national statistics. Annual per-patient costs were estimated from 82 patients who had complete resource use data. The costs were composed of direct medical costs (inpatient, outpatients, and chemotherapy-related costs), direct non-medical costs (healthcare travel and caregiver costs), morbidity costs, and mortality costs. Relevant unit costs were retrieved mainly from literature and national statistics, and applied to the resource use data. Broad definitions of morbidity and mortality costs were employed to value the productivity loss in patients with unpaid employment, economically inactive and unemployed as well as the life years after the age of retirement. Narrow definitions were also used in sensitivity analyses, using age- and/or sex-specific employment rates. Forgone future earnings/productivity loss were discounted at 3%. Annual per-patient costs were projected to estimate the total costs of AGC at the national level with an estimated number of patients with AGC (N = 2,611) in 2013 in Taiwan. Results: The mean age of the 82 patients was 59.3 (SD: 11.9) years, and 67.1% were male. Per-patient costs were US$26,431 for direct medical costs, US$4,669 for direct non-medical costs, US$5,758 for morbidity costs, and US$145,990 for mortality costs (per death). These per-patient costs were projected to incur total AGC costs of US$423 million in 2013 in Taiwan. Mortality costs accounted for 77.3% of the total costs, followed by direct medical costs (16.3%), morbidity costs (3.6%), and direct non-medical costs (2.9%). Conclusions: The total costs of AGC in Taiwan were estimated to be about US$423million in 2013. Such high costs, despite relatively low AGC incidence/prevalence rates in Taiwan, were mainly due to high mortality rates and high mortality costs (per death). Reducing mortality rates and providing effective treatments may help to reduce its burden on patients, caregivers and society as a whole.

Objectives: The rs12611091 variant in the BR serine/threonine kinase 1 gene is one of the variants previously associated with age at natural menopause. So far, this variant has not been replicated in Taiwanese women. The purpose of this study was to determine the association between rs12611091 and age at natural menopause based on physical activity. Methods: A total of 1,758 women were eligible for analysis whose information about menopause was collected from the Taiwan Biobank. Multiple linear regression analysis was used for analysis. Results: The mean age (standard deviation) at natural menopause was 50.82 (3.59) years. Of the eligible participants, 56.94% were rs12611091 CC carriers, 36.69% were TC carriers, and 6.37% were TT carriers. Compared to CC carriers, TC and TT carriers were associated with early menopause (β = −0.42, P = 0.02 and −0.87, P = 0.01, respectively). There was a significant interaction between rs12611091 and physical activity (P for interaction = 0.02). Compared to rs12611091 CC carriers, TC and TT carriers who were physically inactive were significantly associated with earlier menopause (β = −0.88, P < 0.01 and −1.25, P = 0.02, respectively). Conclusion: We demonstrated that rs12611091 variant was associated with age at natural menopause especially among inactive women in Taiwan. That is, women with TC and TT genotypes who were physically inactive were significantly associated with earlier natural menopause compared to those with CC genotype.