Loss Of Quality-adjusted Life Expectancy Research Articles

Survival-weighted quality of life profiles in patients treated for laryngeal and hypopharyngeal cancers.

Objectives: This study assessed functional outcomes and quality of life (QoL) in the long term in individuals treated for laryngohypopharyngeal cancer (LHC) by estimating their life expectancy (LE), survival-weighted psychometric scores (SWPSs), and quality-adjusted LE (QALE). Materials and methods: To estimate survival outcomes, we retrospectively reviewed the data of 1576 patients treated for primary LHC between January 2010 and December 2018 and followed them until death or December 2020. We also prospectively collected QoL and functional data between October 2013 and November 2022 from 232 patients by administering the Taiwanese Chinese versions of the QoL Questionnaire Core 30, Head and Neck 35, and EQ-5D-3L. To estimate LE, we employed linear extrapolation of a logit-transformed curve. We calculated QALE and SWPSs by combining the QoL data with the LE results. Results: We estimated the LE of the patients with LHC to be 7.8 years and their loss of LE to be 15.7 years. The estimated QALE was 7.0 QALYs, with a loss of QALE of 16.5 QALYs. Lifetime impairment durations were estimated for cognitive (4.9 years), physical (4.2 years), emotional (3.4 years), social (3.4 years), and role functions (2.7 years). We estimated the durations of problems related to swallowing, speech, and teeth to be 6.2, 5.6, and 4.8 years, respectively. The patients were expected to be dependent on feeding tubes for 1.2 years. Conclusions: Patients with LHC experience significant reductions in both LE and QALE. SWPSs may constitute a valuable tool for obtaining subjective information regarding how LHC affects multifaceted QoL outcomes.

Survival-Weighted Health Profiles in Patients Treated for Advanced Oral Cavity Squamous Cell Carcinoma

ObjectivesFor patients with oral cavity squamous cell carcinoma (OSCC), particularly for those with advanced disease, quality of life (QoL) is a key outcome measure. Therefore, we estimated survival-weighted psychometric scores (SWPS), life expectancy (LE), and quality-adjusted LE (QALE) in patients with advanced OSCC.Methods and MaterialsFor estimation of survival function, we enrolled 2313 patients with advanced OSCC diagnosed between January 1, 2007, and December 31, 2013. The patients were followed until death or December 31, 2014. To acquire the QoL data, data from 194 patients were collected by employing the Taiwan Chinese versions of the Quality of Life Questionnaire Core 30 and Quality of Life Questionnaire Head and Neck 35 developed by the European Organisation for Research and Treatment of Cancer and the EQ-5D-3L between October 1, 2013, and December 31, 2017. The LE of the patients with OSCC were estimated through linear extrapolation of a logit-transformed curve. SWPS and QALE were determined by integrating the LE and corresponding QoL outcomes.ResultsFor the patients with advanced OSCC, the estimated LE and QALE were 8.7 years and 7.7 quality-adjusted life years (QALYs), respectively. The loss of LE and QALE was 19.0 years and 20.0 QALYs, respectively. The estimated lifetime impairments of swallowing, speech, cognitive functioning, physical functioning, social functioning, and emotional functioning were 8.3, 6.5, 6.5, 6.1, 5.7, and 5.4 years, respectively. The estimated lifetime problems regarding mouth opening, teeth, social eating, and social contact were 6.6, 6.1, 7.5, and 6.1 years, respectively. The duration of feeding tube dependency was estimated to be 1.6 years.ConclusionsPatients with advanced OSCC had an estimated LE of 8.7 years and QALE of 7.7 QALYs. SWPS provided useful information regarding how advanced OSCC affects the subjective assessment of QoL. Our study results may serve as a reference for the allocation of cancer treatment resources.

Optimal Intervals of Ultrasonography Screening for Early Diagnosis of Hepatocellular Carcinoma in Taiwan

There are different clinical practices regarding ultrasonography screening intervals for hepatocellular carcinoma (HCC) despite recommendations from international guidelines. To evaluate whether ultrasonography screening using intervals suggested by international guidelines is associated with cancer stage shifting, reductions in mortality, and improved quality of life (QoL) for patients with HCC. This nationwide comparative effectiveness research study estimated lifetime survival functions using interlinkages of 3 databases from Taiwan-the Taiwan National Health Insurance, Taiwan National Cancer Registry, and National Mortality Registry-combined with QoL measurements obtained from National Cheng Kung University Hospital. In total, 114 022 patients listed as having newly diagnosed HCC from 2002 through 2015 in the Taiwan National Cancer Registry were followed up until 2017. The QoL values of 1059 patients with HCC who visited National Cheng Kung University Hospital were prospectively measured with the European QoL-5 dimensions questionnaire from 2011 through 2019. Patients were categorized based on the time between their last ultrasonography screening and the index date (90 days prior to HCC diagnosis) as 1 of 5 subcohorts: 6 months (0-6 months), 12 months (7-12 months), 24 months (13-24 months), 36 months (25-36 months), and longer than 36 months (no screening in the previous 3 years). Data were analyzed from April 2020 to April 2021. Life expectancy, quality-adjusted life expectancy, and loss of life expectancy or loss of quality-adjusted life expectancy compared with age-, sex-, and calendar year-matched cohorts. There were 59 194 patients with Barcelona Clinic Liver Cancer staging information, including 42 081 men (mean [SD] age, 62.2 [12.6] years) and 17 113 women (mean [SD] age, 69.0 [11.2] years). There was a consistent trend showing that the longer the interval between ultrasonography examinations, the higher the loss of life expectancy and loss of quality-adjusted life expectancy for both sexes. Loss of quality-adjusted life expectancy values for male subcohorts were 10.0 (95% CI, 9.1-10.9) quality-adjusted life-years (QALYs) for ultrasonography screening intervals of 6 months, 11.1 (95% CI, 10.4-11.8) QALYs for 12 months, 12.1 (95% CI, 11.5-12.7) QALYs for 24 months, 13.1 (95% CI, 12.6-13.6) QALYs for 36 months, and 14.6 (95% CI, 14.2-15.0) QALYs for longer than 36 months. Loss of quality-adjusted life expectancy values for female subcohorts were 9.0 (95% CI, 8.3-9.6) QALYs for 6 months, 9.7 (95% CI, 9.2-10.2) QALYs for 12 months, 10.3 (95% CI, 9.8-10.7) QALYs for 24 months, 10.7 (95% CI, 10.2-11.1) QALYs for 36 months, and 11.4 (95% CI, 11.0-11.8) QALYs for longer than 36 months. Patients with underlying hepatitis B virus infection or cirrhosis had the greatest improvement in life expectancy with shorter screening intervals. Regular ultrasonography screening with intervals less than 6 to 12 months may be associated with early detection of HCC, save lives, and improve the quality of life for patients with HCC from a lifetime perspective.

Estimation of losses of quality-adjusted life expectancy attributed to the combination of cognitive impairment and multimorbidity among Chinese adults aged 45 years and older

ObjectivesThis study aims to estimate the losses of quality-adjusted life expectancy (QALE) due to the joint effects of cognitive impairment and multimorbidity, and to further confirm additional losses attributable to this interaction among middle-aged and elderly Chinese people.MethodsThe National Cause of Death Monitoring Data were linked with the China Health and Retirement Longitudinal Study (CHARLS). A mapping and assignment method was used to estimate health utility values, which were further used to calculate QALE. Losses of QALE were measured by comparing the differences between subgroups. All the losses of QALE were displayed at two levels: the individual and population levels.ResultsAt age 45, the individual-level and population-level losses of QALE attributed to the combination of cognitive impairment and multimorbidity were 7.61 (95% CI: 5.68, 9.57) years and 4.30 (95% CI: 3.43, 5.20) years, respectively. The losses for cognitive impairment alone were 3.10 (95% CI: 2.29, 3.95) years and 1.71 (95% CI: 1.32, 2.13) years at the two levels. Similarly, the losses for multimorbidity alone were 3.53 (95% CI: 2.53, 4.56) years and 1.91 (95% CI: 1.24, 2.63) years at the two levels. Additional losses due to the interaction of cognitive impairment and multimorbidity were indicated by the 0.98 years of the individual-level gap and 0.67 years of the population-level gap.ConclusionAmong middle-aged and elderly Chinese people, cognitive impairment and multimorbidity resulted in substantial losses of QALE, and additional QALE losses were seen due to their interaction at both individual and population levels.

Impact of adverse childhood experiences on quality-adjusted life expectancy in the U.S. population

BackgroundAdverse childhood experiences (ACEs) adversely impact morbidity and mortality. ObjectiveTo quantify burden of disease associated with ACEs among U.S. adults by estimating quality-adjusted life expectancy (QALE) according to number of ACEs reported. Participants and settingData from respondents’ adverse experiences occurring before age 18 were collected in nine states through the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS). MethodsWe estimated health-related quality of life (HRQOL) scores from BRFSS data. We constructed life tables from the Compressed Mortality Files to calculate QALE, a generalization of life expectancy that weights expected years of life lived with the HRQOL score, according to number of ACEs. ResultsThe QALE for an 18-year-old person reporting 0, 1–2, and 3+ ACEs was 55.1, 53.4, and 45.6 years, respectively. Reporting 3+ ACEs was associated with a 9.5-year decrease (17%) in QALE. The adverse impact of ACEs are present according to age, gender, and race/ethnicity subgroups. The impact of 3+ ACEs on QALE was nearly 3-fold greater for women than men (13.2 vs. 4.7-year decrease). By contrast, an 18-year-old reporting 1–2 ACEs experienced a small decrease in QALE (1.7 years). ConclusionsReporting 3+ ACEs led to a significant burden of disease, as assessed by QALE loss, to a similar degree as many other well-established behavioral risk factors and chronic conditions. Providers and policymakers should focus on efforts to prevent ACEs, initiate early detection of and interventions to minimize the impact of an ACE, and reduce the likelihood of engaging in maladaptive risky behaviors.

Estimation of Quality-Adjusted Life Expectancy of Patients With Oral Cancer: Integration of Lifetime Survival With Repeated Quality-of-Life Measurements

BackgroundQuality-adjusted life year is widely applied nowadays, which consider both survival and quality of life (QoL). When most diseases are becoming chronic, it is imperative to quantify the overall health impact of a disease in lifetime perspective. ObjectiveThe purpose of this study is to introduce methods for estimating quality-adjusted life expectancy (QALE) and loss of QALE in patients with a disease or specific conditions. MethodsThe QALE of an index cohort can be represented as the integration of the product of lifetime survival function and mean QoL function. We introduce a robust extrapolation approach for estimating lifetime survival function and propose an approach for estimating lifetime mean QoL function for studies with limited follow-up. The best part of the proposed method is that the survival data and QoL data can be collected separately. A cohort of patients with a specific condition can be identified by databases that regularly collect data for the control of diseases, and their survival status is verified by linking to a mortality registry. Although nationwide QoL data are not available, researchers can implement a relative short-term follow-up interview on a random sample of patients to collect QoL data. For demonstration, we applied the proposed methods to estimate QALE and loss of QALE of oral cancer patients. ResultsThe estimates (95% confidence interval) of QALE for oral cancer patients were 11.0 (10.5-11.6) and 14.2 (12.7-15.5) quality-adjusted life years (QALYs) for men and women, respectively. The estimates of loss of QALE for the male and female patients with oral cancer were 14.4 (13.8-14.9) and 7.5 (6.2-9.0) QALYs, respectively. ConclusionsThe methods for estimating QALE and loss of QALE can be applied to economic evaluation of cancer control, including screening.

Opioid agonist treatment reduces losses in quality of life and quality-adjusted life expectancy in heroin users: Evidence from real world data

BackgroundThis study estimated the long-term changes of opioid agonist treatment (OAT) in quality of life (QOL) and quantified the quality-adjusted life years (QALY) from the loss of quality-adjusted life expectancy (QALE) in heroin users. MethodsA total of 1283 heroin users stratified by OAT were linked to the National Mortality Registry for 8 years (2006–2014) to obtain survival functions, which were extrapolated to lifetime by applying a rolling extrapolation algorithm to survival ratio between the sub-cohorts and age- and sex-matched referents simulated from vital statistics of Taiwan. We performed cross-sectional measurement of EQ-5D on 349 participants, including those with a valid state of OAT or non-OAT plus newly recruited consecutive patients, during 2015–2017 for utility values, while the QOL of referents were abstracted from the 2009 National Health Interview Survey. The QALE was calculated by summing the products of the mean QOL and survival rate throughout life. The QALE difference between the cohort and corresponding referents was the loss-of-QALE. ResultsQOL of the OAT group was significantly better than that of the non-OAT group in every domain of the EQ-5D, which was quantified to be 0.23 for utility after controlling for other variables. After extrapolation to 70 years, the estimated QALE and loss-of-QALE were 17.8 and 18.2 QALY for OAT subjects, respectively, while those of the non-OAT group were 9.2 and 27.9 QALY. ConclusionsReceiving OAT could reduce QALE lost by 9.7 QALYs compared with non-OAT after accounting for QOL differences along time and different age and sex distributions.

Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults

Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants (n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20–39, 40–59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28–0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03–8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people’s dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted.

Cost of Cancer: Healthcare Expenditures and Economic Impact.

Healthcare expenditures for cancer account for a low share of total healthcare expenditures, compared to the relative burden of the disease. The share has also not changed very much over the last decades. Cost for cancer drugs has increased as a share of total expenditures, but this has been offset by a reduction of inpatient hospital care for cancer. Accounting for the cost of cancer should not be limited to healthcare expenditures. Resources are also used for public and private care of cancer patients outside the healthcare sector, for example for palliative care. Informal care by family and friends is an important complement to professional care, and estimates indicate that this amounts to between half and one-third of the costs of formal care. Indirect costs related to the loss of production for persons with cancer are estimated to be of the same magnitude as the direct healthcare expenditures. Indirect costs related to premature mortality dominate the estimate of indirect costs, but those costs have declined over time, despite increasing incomes, due to the reduction in mortality due to cancer in the economically active age groups. Estimates of indirect costs due to morbidity are uncertain and vary significantly between published studies. A full accounting of the costs of cancer should include an estimate of the health burden of cancer. Loss of quality-adjusted life expectancy (QALY) can be measured and valued based on the willingness to pay for a QALY. Such estimates are possible to derive from decisions about allocating resources for cancer. There are few estimates of these costs, but available studies indicate that the intangible costs of lost QALY are by far the dominating cost of cancer. The value for policy-making of costs of cancer estimates increases when results with consistent methods and data are available that allow comparisons between countries and over time. The evidence about the cost of cancer is still limited, but when current scientific progress produces an increasing number of new options for prevention, diagnosis and treatment, studies of the cost of cancer become increasingly important to inform decisions about resource allocation.

Population-Based Estimates of Decreases in Quality-Adjusted Life Expectancy Associated with Unhealthy Body Mass Index.

Being classified as outside the normal range for body mass index (BMI) has been associated with increased risk for chronic health conditions, poor health-related quality of life (HRQOL), and premature death. To assess the impact of BMI on HRQOL and mortality, we compared quality-adjusted life expectancy (QALE) by BMI levels. We obtained HRQOL data from the 1993-2010 Behavioral Risk Factor Surveillance System and life table estimates from the National Center for Health Statistics national mortality files to estimate QALE among U.S. adults by BMI categories: underweight (BMI <18.5 kg/m(2)), normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), obese (BMI 30.0-34.9 kg/m(2)), and severely obese (BMI ≥35.0 kg/m(2)). In 2010 in the United States, the highest estimated QALE for adults at 18 years of age was 54.1 years for individuals classified as normal weight. The two lowest QALE estimates were for those classified as either underweight (48.9 years) or severely obese (48.2 years). For individuals who were overweight or obese, the QALE estimates fell between those classified as either normal weight (54.1 years) or severely obese (48.2 years). The difference in QALE between adults classified as normal weight and those classified as either overweight or obese was significantly higher among women than among men, irrespective of race/ethnicity. Using population-based data, we found significant differences in QALE loss by BMI category. These findings are valuable for setting national and state targets to reduce health risks associated with severe obesity, and could be used for cost-effectiveness evaluations of weight-reduction interventions.

PCN171 - Comparison of expected Health impacts for Major Cancers:Integration of incidence rate and loss of quality-adjusted Life Expectancy

A B S T R A C T Purpose: The study aims to quantify the expected impacts of different cancers through multiplying the incidence rate by loss-of-QALE (quality-adjusted life expectancy), with QALY (quality-adjusted life year) as the common unit, to aid prevention policy decisions. Methods: 464,722 patients with pathologically verified cancer registered in the Taiwan Cancer Registry during 1998–2009 were used to estimate lifetime survival through Kaplan–Meier estimation combined with a semi-parametric method. A convenience sample for measuring the utility value with EQ-5D was conducted with 11,453 cancer patients, with the results then multiplied by the survival functions to estimate QALE. The loss-of-QALE was calculated by subtracting the QALE of each cancer cohort from the life expectancy of the corresponding age- and gender-matched reference population. The cumulative incidence rates from age 20 to 79 (CIR20–79) were calculated to estimate the lifetime risk of cancer for each organ-system. Results: Liver and lung cancer were found the highest expected lifetime health impacts in males and females, or expected lifetime losses of 0.97 and 0.41 QALYs that could be averted, respectively. While the priority changes for prevention based on expected health impacts were slightly different for females based on standardized mortality rates, those of males involve a broader spectrum, including oral, colorectal, esophageal and stomach cancer. Conclusion: The integration of incidence rate with loss-of-QALE could be used to represent the expected losses that could be averted by prevention, which may be useful in prioritizing strategies for cancer control.

Impact of depression on quality-adjusted life expectancy (QALE) directly as well as indirectly through suicide.

To estimate quality-adjusted life expectancy (QALE) loss among US adults due to depression and QALE losses associated with the increased risk of suicide attributable to depression. We ascertained depressive symptoms using the eight-item Patient Health Questionnaire (PHQ-8) on the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. We estimated health-related quality of life (HRQOL) scores from BRFSS data (n = 276,442) and constructed life tables from US Compressed Mortality Files to calculate QALE by depression status. QALE loss due to depression is the difference in QALE between depressed and non-depressed adults. QALE loss associated with suicide deaths is the difference between QALE from only those deaths that did not have suicide recorded on the death certificate and QALE from all deaths including those with a suicide recorded on the death certificate. At age 18, QALE was 28.0 more years for depressed adults and 56.8 more years for non-depressed adults, a 28.9-year QALE loss due to depression. For depressed adults, only 0.41 years of QALE loss resulted from deaths by suicide, and only 0.26 years of this loss could be attributed to depression. Depression symptoms lead to a significant burden of disease from both mortality and morbidity as assessed by QALE loss. The 28.9-year QALE loss at age 18 associated with depression markedly exceeds estimates reported elsewhere for stroke (12.4-year loss), heart disease (10.3-year loss), diabetes mellitus (11.1-year loss), hypertension (6.3-year loss), asthma (7.0-year loss), smoking (11.0-year loss), and physical inactivity (8.0-year loss).

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

PurposeThe study aims to quantify the expected impacts of different cancers through multiplying the incidence rate by loss-of-QALE (quality-adjusted life expectancy), with QALY (quality-adjusted life year) as the common unit, to aid prevention policy decisions. Methods464,722 patients with pathologically verified cancer registered in the Taiwan Cancer Registry during 1998–2009 were used to estimate lifetime survival through Kaplan–Meier estimation combined with a semi-parametric method. A convenience sample for measuring the utility value with EQ-5D was conducted with 11,453 cancer patients, with the results then multiplied by the survival functions to estimate QALE. The loss-of-QALE was calculated by subtracting the QALE of each cancer cohort from the life expectancy of the corresponding age- and gender-matched reference population. The cumulative incidence rates from age 20 to 79 (CIR20–79) were calculated to estimate the lifetime risk of cancer for each organ-system. ResultsLiver and lung cancer were found the highest expected lifetime health impacts in males and females, or expected lifetime losses of 0.97 and 0.41 QALYs that could be averted, respectively. While the priority changes for prevention based on expected health impacts were slightly different for females based on standardized mortality rates, those of males involve a broader spectrum, including oral, colorectal, esophageal and stomach cancer. ConclusionThe integration of incidence rate with loss-of-QALE could be used to represent the expected losses that could be averted by prevention, which may be useful in prioritizing strategies for cancer control.

Estimation of loss of quality-adjusted life expectancy (QALE) for patients with operable versus inoperable lung cancer: Adjusting quality-of-life and lead-time bias for utility of surgery

ObjectivesThis study attempts to quantify the difference in loss of quality-adjusted life expectancy (QALE) for patients with operable and inoperable non-small-cell lung cancer (NSCLC). Patients and methodsA cohort consisting of 1652 pathologically verified NSCLC patients with performance status 0–1 was monitored for 7 years (2005–2011) to obtain the survival function. This was further extrapolated to lifetime, based on the survival ratios between patients and age- and sex-matched referents simulated from the life tables of the National Vital Statistics of Taiwan. Between 2011 and 2012, EuroQol 5-dimension questionnaires were used to prospectively measure the quality-of-life (QoL) of a 518 consecutive, cross-sectional subsample. We adjusted the lifetime survival function by the utility values of QoL for the cancer cohort to obtain the QALE, while that for the age and sex-matched referents were adjusted to the values collected from the 2009 National Health Interview Survey, and the difference between them was the loss-of-QALE. ResultsThe QALE for patients with operable and inoperable NSCLC were 11.66±0.18 and 1.43±0.05 quality-adjusted life year (QALY), with the corresponding loss-of-QALE of 5.25±0.18 and 14.24±0.05 QALY, respectively. The lifetime utility difference for patients with operable and inoperable NSCLC was 9.00±0.18 QALY, after adjustment for QoL and lead-time bias. ConclusionThe utility gained from surgical operation for operable lung cancer is substantial, even after adjustment for lead-time bias. Future studies should compare screening programs with treatment strategies when carrying out cost-utility assessments to improve patients’ values.

Estimation of life expectancy and quality-adjusted life expectancy in non-metastatic nasopharyngeal cancer patients treated by intensity-modulated radiotherapy with or without chemotherapy

This study was designed to estimate the life expectancy (LE) and quality-adjusted life expectancy (QALE) in non-metastatic nasopharyngeal cancer (NPC) patients. Patients were eligible for the present study if they were diagnosed with NPC and had been treated with intensity-modulated radiotherapy (IMRT) between January 1, 2003 and December 31, 2010. The quality of life (QOL) data were collected using the questionnaires of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-H&N35. The LE of NPC patients was obtained using linear extrapolation of a logit-transformed curve and was adjusted by the corresponding QOL function to calculate the QALE. During the study period, 110 patients met the inclusion criteria, and 53 of these completed questionnaires. The median follow-up was 65.2 months (range 4.0-117.3 months). The average LE and QALE were estimated to be 20.6 years and 11.6 quality-adjusted life years (QALYs) for NPC patients and 24.4 years and 24.4 QALYs for the reference population, respectively. Compared to the reference population, the loss of LE and QALE for NPC patients were 3.8 years and 12.8 QALYs, respectively. This study offers a quick overview of the LE and the QALE of NPC patients treated with IMRT. Moreover, the results appear more understandable than the 5 year survival outcomes when communicating with patients or the general population regarding cancer risk. In the future, evaluating the robustness of comparative assessments for the outcome of NPC patients undergoing different treatment protocols will be possible.

Quality-adjusted life expectancy (QALE) loss due to smoking in the United States.

Estimate quality-adjusted life expectancy (QALE) loss due to smoking and examine trends and state differences in smoking-related QALE loss in the U.S. Population health-related quality of life (HRQOL) scores were estimated from the Behavioral Risk Factor Surveillance System. This study constructed life tables based on U.S. mortality files and the mortality linked National Health Interview Survey and calculated QALE for smokers, non-smokers, and the total population. In 2009, an 18-year-old smoker was expected to have 43.5 (SE=0.2) more years of QALE, and a non-smoker of the same age was expected to have 54.6 (SE=0.2) more years of QALE. Therefore, smoking contributed 11.0 (SE=0.2) years of QALE loss for smokers and 4.1years (37%) of this loss resulted from reductions in HRQOL alone. At the population level, smoking was associated with 1.9 fewer years of QALE for U.S. adults throughout their lifetime, starting at age 18. This study demonstrates an application of a recently developed QALE estimation methodology. The analyses show good precision and relatively small bias in estimating QALE--especially at the individual level. Although smokers may live longer today than before, they still have a high disease burden due to morbidities associated with poor HRQOL.

Estimation of potential quality-adjusted life years saved from wearing a helmet on riding a motorcycle in Taiwan

ObjectivesWe have developed method to estimate the cost-effectiveness of prevention in occupational and environmental health, which was illustrated with an empirical example of the quantification of the health benefit from...

Estimation of Quality-Adjusted Life Expectancy in Patients Under Prolonged Mechanical Ventilation

Objectives The purpose of this study was to estimate the quality-adjusted life expectancy (QALE) and the expected lifetime utility loss of patients with prolonged mechanical ventilation (PMV). Methods PMV was defined as more than 21 days of mechanical ventilation. A total of 633 patients fulfilled this definition and were followed for 9 years (1998–2007) to obtain their survival status. Quality of life of 142 patients was measured with the EuroQol five-dimensional (EQ-5D) questionnaire during the period 2008 to 2009. The survival probabilities for each time point were adjusted with a utility measurement of quality of life and then extrapolated to 300 months to obtain the QALE. We compared the age-, gender-matched reference populations to calculate the expected lifetime utility loss. Results The average age of subjects was 76 years old. The life expectancy and loss of life expectancy were 1.95 years and 8.48 years, respectively. The QALE of 55 patients with partial cognitive ability and the ability to respond was 0.58 quality-adjusted life years (QALY), whereas the QALEs of 87 patients with poor consciousness were 0.28 and 0.29 QALY for the EQ-5D measured by family caregivers and nurses, respectively. The loss of QALE for PMV patients was 9.87 to 10.17 QALY, corresponding to a health gap of 94% to 97%. Conclusions Theses results of poor prognosis would provide stakeholders evidence for communication to facilitate clinical decisions. The estimation may be used in future studies to facilitate the cost-effectiveness and reduction of the health gap.

Health impact of pneumoconiosis in Mongolia: Estimation of losses in life expectancy and quality adjusted life expectancy

To estimate the life expectancy (LE), quality-adjusted life expectancy (QALE), and their losses, in patients with pneumoconiosis in Mongolia. All patients (n = 432) diagnosed with occupational pneumoconiosis during 1986-2006 were recruited from the registry of the National Research Center of Occupational Diseases, which was linked to the National Mortality Registry of Mongolia to obtain the survival function. We simulated age and gender matched referents group based on the life table in 2000. The survival ratio between patients and referents was used to extrapolate and calculate the LE. The average expected years of life loss (EYLL) of pneumoconiosis were calculated as the mean survival difference between patients and referents. We adopted utility values for workers with pneumoconiosis and multiplied them with the survival function to estimate the QALE, which was then used to calculate the loss of QALE. The life expectancy and EYLL of a patient with pneumoconiosis were 18.1 and 9.5 years respectively. QALE and loss of QALE were 15.1 and 12.5 QALYs (quality-adjusted life years), respectively, indicating a health gap of 45%. The health inequality suffered by miners in Mongolia must be addressed through prevention, including exposure monitoring and control, early diagnosis and case management and rehabilitation of pneumoconiosis.

Quality-Adjusted Life Expectancy (QALE) and Loss of QALE for Patients With Ischemic Stroke and Intracerebral Hemorrhage

Few studies have evaluated the long-term health impact of stroke as categorized into different subtypes. The aim of this study is to quantify the loss of quality-adjusted life expectancy related to ischemic stroke and intracerebral hemorrhage. The hospital-based cohort, which consisted of 13,194 patients with first-ever stroke onset dates between 1995 and 2007, was classified into lacunar and nonlacunar infarctions and intracerebral hemorrhages. After linking with the National Mortality Registry, survival functions were determined and extrapolated over a 50-year period based on the survival ratio between the patients' survival and age- and sex-matched reference population's as calculated from the vital statistics of Taiwan. The survival functions were then multiplied by the quality of life assessed under the EuroQol 5-dimension (EQ-5D) questionnaire based on a sample of 486 patients with stroke. The quality-adjusted life expectancy for a patient with ischemic stroke was 8.7 quality-adjusted life-years with an average loss of 8.3 quality-adjusted life-years, and there appeared to be no difference between lacunar and nonlacunar infarctions. Patients with intracerebral hemorrhage had a similar quality-adjusted life expectancy as those with ischemic stroke but with a significantly greater loss relative to the reference population (14.1 quality-adjusted life-years) because of younger ages. The lifelong health burden due to stroke was approximately 9.5 quality-adjusted life-years and should be considered in future cost-effectiveness analyses for prevention.