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.
Highlights
Owing 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
Based on data from the National Cancer Registry, National Health Insurance (NHI) reimbursements, and National Cheng Kung University Hospital (NCKUH), this study is aimed at quantifying the quality-adjusted life expectancy (QALE), loss-of-QALE and lifetime healthcare expenditures that occur in patients with different subtypes of lung cancer that would be regained through successful prevention initiatives
By using the same method, patients with Non-small cell lung cancer (NSCLC) in the NCKUH cohort were found to have longer life expectancy and greater NHI-reimbursed lifetime healthcare expenditures than those in the national cohort, which can be partially explained by the advancement of NSCLC treatment in the past five years and different frequency distributions of pathological subtypes in the two groups
Summary
Owing 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. Both survival and quality of life (QoL) should be taken into consideration, and quality-adjusted life expectancy (QALE) using qualityadjusted life year (QALY) as the unit may be more suitable than estimating survival alone for the purpose of comparison of various types of healthcare services [4,5,6]. Almost all cancer-specific medical costs are reimbursed by the National Health Insurance (NHI) available in Taiwan, there are out-of-pocket medical costs that must be estimated to obtain the lifetime healthcare expenditures attributable to lung cancer. Transportation costs, payments to caregivers, home adaptation due to illness and human capital loss were not taken into consideration in this analysis
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