Abstract
BackgroundIt is essential to have information on the disease burden of lung cancer at an individual level throughout the life; however, few such results have been reported. Thus, this study aimed to assess the lifetime disease burden in patients with lung cancer by assessing various factors, such as survival, years of life lost (YLL) and medical expenditure in South Korea based on real-world data and extrapolation.MethodsNewly diagnosed lung cancer patients (n = 2919) in 2004–2010 were selected and observed until the end of 2015 using nationwide reimbursement claim database. The patients were categorised into the Surgery group, Chemo and/or Radiotherapy group (CTx/RTx), and Surgery+CTx/RTx according to their treatment modality. Age- and sex-matched control subjects were selected from among general population using the life table. The survival and cost data after diagnosis were analysed by a semi-parametric method, the Kaplan–Meier analysis for the first 100 months and rolling extrapolation algorithm for 101–300 months. YLL were derived from the difference in survival between patients and controls.ResultsLifetime estimates (standard error) were 4.5 (0.2) years for patients and 14.5 (0.1) years for controls and the derived YLL duration was 10.0 (0.2) years. Lifetime survival years showed the following trend: Surgery (14.2 years) > Surgery+CTx/RTx (8.5 years) > CTx/RTx group (3.0 years), and YLL were increased as lifetime survival years decreased (2.3, 8.7, 12.2 years, respectively). The mean lifetime medical cost was estimated at 30,857 USD/patient. Patients in the Surgery group paid higher treatment cost in first year after diagnosis, but the overall mean cost per year was lower at 4359 USD compared with 7075USD of Surgery+CTx/RTx or 7626USD of CTx/RTx group.ConclusionsLung cancer has resulted in about 10 years of life lost in overall patients. The losses were associated with treatment modality, and the results indicated that diagnosing lung cancer in patients with low stage disease eligible for surgery is beneficial for reducing disease burden in terms of survival and treatment cost per year throughout the life.
Highlights
It is essential to have information on the disease burden of lung cancer at an individual level throughout the life; few such results have been reported
The survival rate of lung cancer patients has improved over the years with newer treatments; the average five-year survival rate of lung cancer remains < 20% considering all stages, which is substantially low compared to other major cancers and is the leading cause of cancer deaths
Patient subgroups were defined as follows according to the treatment modality in the first year after diagnosis instead of disease stage: Surgery-only group (n = 426), chemo and/or radiotherapy group (CTx/RTx, n = 1405) without surgery, best supportive care (BSC, n = 792) and Surgery and chemo and/or radiotherapy group (Surgery + Chemo and/or radiotherapy (CTx/RTx), n = 296), which included patients who underwent pre-operative adjuvant chemo and/or radiotherapy (n = 213) and post-operative adjuvant chemo and/or radiotherapy (n = 83) (Supplement Figure A.1)
Summary
It is essential to have information on the disease burden of lung cancer at an individual level throughout the life; few such results have been reported. The increasing rate of incidence is dependent on the region, smoking habits, gender and socio-environmental status, and considering the trend of lung cancer prevalence, this rate was predicted to continue to increase in years [3]. With this high mortality rate and increasing incidence, lung cancer is a worldwide public health problem, and information on the burden of lung cancer will be critical to the development of new drugs and framing of health policies in the future. Such information would be instrumental in assessing treatment efficiency and prioritising budget allocation for target patient group
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