Estimating the lifelong health impact and financial burdens of different types of lung cancer

Abstract

BackgroundOwing to the high mortality and rapidly growing costs related to lung cancer, it is worth examining the health benefits of prevention for major types of lung cancer. This study attempts to quantify the quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures of patients with different pathological types of lung cancer.MethodsA national cohort consisting of 66,535 patients with pathologically verified lung cancer was followed for 13 years (1998–2010) to obtain the survival function, which was further extrapolated to lifetime. Between 2011 and 2012, EuroQol 5-dimension questionnaires were used to measure the quality of life (QoL) for 1,314 consecutive, cross-sectional samples. After multiplying the lifetime survival function by the utility values of QoL, we estimated the QALE and loss-of-QALE. We also collected the monthly healthcare expenditures, which included National Health Insurance-reimbursed and out-of-pocket direct medical costs, for 2,456 patients from 2005 to 2012. These values were multiplied by the corresponding survival probabilities to calculate lifetime healthcare expenditures after adjustments with medical care inflation rates and annual discount rates.ResultsThe QALE for patients with small cell lung cancer, squamous cell carcinoma, and adenocarcinoma were 1.21, 2.37, and 3.03 quality-adjusted life year (QALY), with the corresponding loss-of-QALE of 13.69, 12.22, and 15.03 QALY, respectively. The lifetime healthcare expenditures were US$ 18,455 ± 1,137, 20,599 ± 1,787, and 36,771 ± 1,998, respectively.ConclusionsThe lifelong health impact and financial burdens in Taiwan are heavier for adenocarcinoma than for squamous cell carcinoma. The cost-effectiveness of prevention programs could be directly compared with that of treatment strategies to improve patient value. And the methodology could be applied to other chronic diseases for resources planning of healthcare services.

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

“…By using a semiparametric method explained in detail in our previous article [13], we extrapolated the survival to lifetime to estimate the life expectancy of patients receiving one of three first-line treatments. The extrapolation method has been shown to be effective via computer simulations [14], mathematical proof [15] and corroboration by examples of lung cancer cohorts [13,16,17]. The iSQoL statistical package (www.stat.sinica.…”

Cost‐effectiveness of chemotherapy combined with thoracic radiotherapy versus chemotherapy alone for limited stage small cell lung cancer: A population‐based propensity‐score matched analysis

“…We searched PubMed in January 2014 using the following keywords, as modified from our previous studies, to realize which cost issue(s) of SCLC had been reported in the literature: ([small cell lung cancer] NOT [non‐small cell lung]) AND ([“costs and cost analysis”{MeSH}] OR costs[Title/Abstract] OR cost effective*[Title/Abstract]) OR (cost*[Title/Abstract] OR “costs and cost analysis”[MeSH:noexp] OR cost benefit analysis*[Title/Abstract] OR cost‐benefit analysis[MeSH] OR health care costs MeSH: noexp) . We found that various issues, including work‐up modality, chemotherapy intensity, prophylactic cranial irradiation, granulocyte colony‐stimulating factor, prophylactic antibiotics, second line treatment, new drugs, and overall cost, had been reported since 2000 . However, the cost‐effectiveness of C‐TRT in LS‐SCLC had never been reported.…”

“…We searched PubMed in January 2014 using the following keywords, as modified from our previous studies, to realize which cost issue(s) of SCLC had been reported in the literature: ( 35 We found that various issues, including work-up modality, chemotherapy intensity, prophylactic cranial irradiation, granulocyte colony-stimulating factor, prophylactic antibiotics, second line treatment, new drugs, and overall cost, had been reported since 2000. [36][37][38][39][40][41][42][43][44][45][46][47] However, the costeffectiveness of C-TRT in LS-SCLC had never been reported. Our result did, however, reflect similar results in the literature that C-TRT versus C/T is associated with improved overall survival.…”

Comparison of expected health impacts for major cancers: Integration of incidence rate and loss of quality-adjusted life expectancy

“…Although estimates of standardized mortality rates can still provide useful information on the impacts of diseases or technologies, which can then aid health policy decision, such comparisons for different illnesses have become less efficient, especially because for most cancers patients usually survive for more than 5-10 years, and thus one must wait for a long period of time for mortality to occur [1][2][3][4][5][6]. The current coding of one underlying cause of death might also underestimate the impact of other causes, including cancer.…”

“…Recently, the authors of this study have developed estimates of the expected years of life lost and loss-of-QALE that quantify the consequences of illness with life-year and QALY, respectively, which make possible direct comparisons of prevention with clinical care [1][2][3][4]15] if incidence rates can also be incorporated together [16]. It may thus be possible to quantify both incidence rates and how much utility is lost from developing a specific illness, rather than simply making policy decisions based on mortality rates.…”