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Estimation of benefit of prevention of occupational cancer for comparative risk assessment: methods and examples.

Lee LJ, Chang YY, Liou SH, Wang JD - Occup Environ Med (2012)

Bottom Line: By using the reimbursement data from the National Health Insurance Research Database, the authors calculated the average monthly healthcare expenditures, which were summed to estimate the lifetime healthcare expenditures after adjusting for the corresponding monthly survival probability.The burden of these occupational cancers, in terms of EYLL and lifetime healthcare expenditures, was substantial.Such estimates may provide useful empirical evidence for comparative risk assessment that can be applied in health policy-making and clinical decision-making.

View Article: PubMed Central - PubMed

Affiliation: Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli County, Taiwan.

ABSTRACT

Objectives: To quantify the life years gained and financial savings by preventing a case of occupational cancer.

Methods: The authors retrieved data from the Taiwan Cancer Registry and linked them with the National Mortality Registry to estimate the survival functions for major occupational cancers: lung, pleural mesothelioma, urinary bladder and leukaemia. Assuming a constant excess hazard for each type of cancer, the authors extrapolated lifetime survival functions by the Monte Carlo method. For each patient with cancer, the authors simulated an age- and gender-matched person without cancer based on vital statistics of Taiwan to estimate life expectancy and expected years of life lost (EYLL). By using the reimbursement data from the National Health Insurance Research Database, the authors calculated the average monthly healthcare expenditures, which were summed to estimate the lifetime healthcare expenditures after adjusting for the corresponding monthly survival probability.

Results: A total of 51,408, 136, 12,891 and 5285 new cases of lung, pleural mesothelioma, bladder and leukaemia cancers, respectively, were identified during 1997-2005 and followed until the end of 2007. The EYLL was predicted to be 13.7±0.1, 18.9±0.7, 4.7±0.3 and 19.4±0.5 years for these cancers, respectively, and the lifetime healthcare expenditures with a 3% annual discount were predicted to be US$22,359, US$14,900, US$51,987 and US$59,741, respectively.

Conclusions: The burden of these occupational cancers, in terms of EYLL and lifetime healthcare expenditures, was substantial. Such estimates may provide useful empirical evidence for comparative risk assessment that can be applied in health policy-making and clinical decision-making.

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Related in: MedlinePlus

The dynamic fluctuation of mean monthly healthcare expenditures reimbursed by the National Health Insurance beginning at the time of cancer diagnosis, as well as their 95% confidence limits. The shaded area under the curve is the lifetime healthcare expenditures for an average case of lung cancer patient.
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fig1: The dynamic fluctuation of mean monthly healthcare expenditures reimbursed by the National Health Insurance beginning at the time of cancer diagnosis, as well as their 95% confidence limits. The shaded area under the curve is the lifetime healthcare expenditures for an average case of lung cancer patient.

Mentions: The lifetime healthcare expenditures of the patients with bladder cancer were much greater than those with mesothelioma or lung cancer because these patients generally had a longer life expectancy than the others. Avritscher et al17 at the University of Texas MD Anderson Cancer Centre estimated that the average cost for bladder cancer was US$65 158, and the predicted lifetime costs for patients averaged US$120 684 for the best-case scenario and US$99 270 for the worst-case scenario. Longer survival is generally associated with a longer period of surveillance, a higher likelihood of treatment of recurrent tumours and a higher cost of treating with possible complications. The mean estimates of lifetime healthcare expenditures have their variance that is expressed in SE, as shown in the table 1. Because our data did not include the details of sources of variance,9 we simply show figure 1 to illustrate the temporal changes of lifetime healthcare expenditures, using lung cancer as an example, which shows that the cost is generally higher at the time of diagnosis and initial treatment, stabilises after 6–12 months and then is slightly elevated near the end of life. With the advanced development of new technologies, medications and therapies in cancer treatment, the survival of cancer patients will be improved and healthcare expenditures will increase. Thus, the current estimates may be lower than the true value of the healthcare expenditure paid by the NHI in the future.


Estimation of benefit of prevention of occupational cancer for comparative risk assessment: methods and examples.

Lee LJ, Chang YY, Liou SH, Wang JD - Occup Environ Med (2012)

The dynamic fluctuation of mean monthly healthcare expenditures reimbursed by the National Health Insurance beginning at the time of cancer diagnosis, as well as their 95% confidence limits. The shaded area under the curve is the lifetime healthcare expenditures for an average case of lung cancer patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3400143&req=5

fig1: The dynamic fluctuation of mean monthly healthcare expenditures reimbursed by the National Health Insurance beginning at the time of cancer diagnosis, as well as their 95% confidence limits. The shaded area under the curve is the lifetime healthcare expenditures for an average case of lung cancer patient.
Mentions: The lifetime healthcare expenditures of the patients with bladder cancer were much greater than those with mesothelioma or lung cancer because these patients generally had a longer life expectancy than the others. Avritscher et al17 at the University of Texas MD Anderson Cancer Centre estimated that the average cost for bladder cancer was US$65 158, and the predicted lifetime costs for patients averaged US$120 684 for the best-case scenario and US$99 270 for the worst-case scenario. Longer survival is generally associated with a longer period of surveillance, a higher likelihood of treatment of recurrent tumours and a higher cost of treating with possible complications. The mean estimates of lifetime healthcare expenditures have their variance that is expressed in SE, as shown in the table 1. Because our data did not include the details of sources of variance,9 we simply show figure 1 to illustrate the temporal changes of lifetime healthcare expenditures, using lung cancer as an example, which shows that the cost is generally higher at the time of diagnosis and initial treatment, stabilises after 6–12 months and then is slightly elevated near the end of life. With the advanced development of new technologies, medications and therapies in cancer treatment, the survival of cancer patients will be improved and healthcare expenditures will increase. Thus, the current estimates may be lower than the true value of the healthcare expenditure paid by the NHI in the future.

Bottom Line: By using the reimbursement data from the National Health Insurance Research Database, the authors calculated the average monthly healthcare expenditures, which were summed to estimate the lifetime healthcare expenditures after adjusting for the corresponding monthly survival probability.The burden of these occupational cancers, in terms of EYLL and lifetime healthcare expenditures, was substantial.Such estimates may provide useful empirical evidence for comparative risk assessment that can be applied in health policy-making and clinical decision-making.

View Article: PubMed Central - PubMed

Affiliation: Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli County, Taiwan.

ABSTRACT

Objectives: To quantify the life years gained and financial savings by preventing a case of occupational cancer.

Methods: The authors retrieved data from the Taiwan Cancer Registry and linked them with the National Mortality Registry to estimate the survival functions for major occupational cancers: lung, pleural mesothelioma, urinary bladder and leukaemia. Assuming a constant excess hazard for each type of cancer, the authors extrapolated lifetime survival functions by the Monte Carlo method. For each patient with cancer, the authors simulated an age- and gender-matched person without cancer based on vital statistics of Taiwan to estimate life expectancy and expected years of life lost (EYLL). By using the reimbursement data from the National Health Insurance Research Database, the authors calculated the average monthly healthcare expenditures, which were summed to estimate the lifetime healthcare expenditures after adjusting for the corresponding monthly survival probability.

Results: A total of 51,408, 136, 12,891 and 5285 new cases of lung, pleural mesothelioma, bladder and leukaemia cancers, respectively, were identified during 1997-2005 and followed until the end of 2007. The EYLL was predicted to be 13.7±0.1, 18.9±0.7, 4.7±0.3 and 19.4±0.5 years for these cancers, respectively, and the lifetime healthcare expenditures with a 3% annual discount were predicted to be US$22,359, US$14,900, US$51,987 and US$59,741, respectively.

Conclusions: The burden of these occupational cancers, in terms of EYLL and lifetime healthcare expenditures, was substantial. Such estimates may provide useful empirical evidence for comparative risk assessment that can be applied in health policy-making and clinical decision-making.

Show MeSH
Related in: MedlinePlus