Estimation of savings of life-years and cost from early detection of cervical cancer: a follow-up study using nationwide databases for the period 2002–2009

BMC Cancer

Mei-Chuan Hung²  Meng-Ting Liu²  Ya-Min Cheng³  Jung-Der Wang¹ 

[1] Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

[2] Department of Public Health, National Cheng Kung University College of Medicine, No.1, University Road, Tainan, Taiwan

[3] Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan

关键词: Semi-parametric extrapolation;    Cervical cancer;    Early detection;    Cost;    Life-years;   

Others  :  855114
DOI  :  10.1186/1471-2407-14-505

 received in 2014-02-22, accepted in 2014-07-04,  发布年份 2014

【 摘 要 】

Background

Few studies consider both the survival and financial benefits of detection of invasive cervical cancer (ICC) at earlier stages. This study estimated the savings in life-years and costs from early diagnosis of cervical cancer using an ex post approach.

Methods

A total of 28,797 patients diagnosed with cervical cancer in the period 2002–2009 were identified from the National Cancer Registry of Taiwan, and linked to the National Mortality Registry until the end of 2011. Life expectancies (LE) for cancer at different stages were estimated using a semi-parametric extrapolation method. The expected years of life lost (EYLL) for cancer were calculated by subtracting the LE of the cancer cohort from that of the age-and sex-matched general population. The mean lifetime costs after diagnosis paid by the single-payer National Health Insurance during (NHI) 2002–2010 were estimated by multiplying average monthly expenditures by the survival probabilities and summing up over lifetime.

Results

ICC at stages 1 to 4 had an average EYLL of 6.33 years, 11.64 years, 12.65 years, and 18.61 years, respectively, while the related lifetime costs paid by the NHI were $7,020, $10,133, $11,120, and $10,015 US dollars, respectively; the younger the diagnosis age, the higher the savings with regard to EYLL. The mean lifetime costs of managing cervical cancer were generally lower for the earlier stages compared with stages 3 and 4.

Conclusions

Early detection of ICC saves lives and reduces healthcare costs. These health benefits and monetary savings can be used for cost-effectiveness assessments and the promotion of regular proactive screening, especially among older women.

【 授权许可】

   
2014 Hung et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]GLOBOCAN: Cervical cancer incidence and mortality worldwide in 2008. 2013. Available online at: http://globocan.iarc.fr/ webcite
• [2]Waggoner SE: Cervical cancer. Lancet 2003, 361:2217-2225.
• [3]Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain JM, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER, Chelmow D, Herzig A, Kim JJ, Kinney W, Herschel WL, Waldman J: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. J Low Genit Tract Dis 2012, 16:175-204.
• [4]World Health Organization: World Cancer Report 2008. 2013. Available online at: http://www.iarc.fr/en/publications/pdfs-online/wcr/index.php webcite
• [5]Mishra GA, Pimple SA, Shastri SS: An overview of prevention and early detection of cervical cancers. Indian J Med Paediatr Oncol 2011, 32:125-132.
• [6]Report PSSRSA: Taipei: Bureau of Health Promotion. Taiwan: Department of Health; 2009. 2010
• [7]Chu PC, Wang JD, Hwang JS, Chang YY: Estimation of life expectancy and the expected years of life lost in patients with major cancers: Extrapolation of survival curves under high-censored rates. Value Health 2008, 11:1102-1109.
• [8]Chu PC, Hwang JS, Wang JD, Chang YY: Estimation of the financial burden to the National Health Insurance for patients with major cancers in Taiwan. J Formos Med Assoc 2008, 107:54-63.
• [9]Liu PH, Wang JD, Keating NL: Expected years of life lost for six potentially preventable cancers in the United States. Prev Med 2013. doi:10.1016/j.ypmed
• [10]Subramanian S, Trogdon J, Ekwueme DU, Gardner JG, Whitmire JT, Rao C: Cost of cervical cancer treatment: implications for providing coverage to low-income women under the Medicaid expansion for cancer care. Womens Health Issues 2010, 20:400-405.
• [11]Wolstenholme JL, Whynes DK: Stage-specific treatment costs for cervical cancer in the United Kingdom. Eur J Cancer 1998, 34:1889-1893.
• [12]Burnet NG, Jefferies SJ, Benson RJ, Hunt DP, Treasure FP: Years of life lost (YLL) from cancer is an important measure of population burden – and should be considered when allocating research funds. Br J Cancer 2005, 92:241-245.
• [13]Taiwan Cancer Registry: Cancer Registry Dataset. 2013. Available online at:http://tcr.cph.ntu.edu.tw/main.php?Page=N1 webcite
• [14]Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S: FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000, 70:209-262.
• [15]NCCN (National Comprehensive Cancer Network): NCCN guidelines version 3.2013. 2013. http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf webcite
• [16]Hwang JS, Wang JD: Monte Carlo estimation of extrapolation of quality-adjusted survival for follow-up studies. Stat Med 1999, 18:1627-1640.
• [17]Fang CT, Chang YY, Hsu HM, Twu SJ, Chen KT, Lin CC, Huang LY, Chen MY, Hwang JS, Wang JD, Chuang CY: Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy. QJM 2007, 100:97-105.
• [18]Hwang JS: iSQoL Package. 2013. Available online at: [http://www.stat.sinica.edu.tw/jshwang webcite]
• [19]Lee LJ, Chang YY, Liou SH, Wang JD: Estimation of benefit of prevention of occupational cancer for comparative risk assessment: Methods and examples. Occup Environ Med 2012, 69:582-586.
• [20]Hung MC, Lu HM, Chen L, Lin MS, Chen CR, Yu CJ, Wang JD: Cost per QALY (quality-adjusted life year) and lifetime cost of prolonged mechanical ventilation in Taiwan. PLoS One 2012, 7:e44043.
• [21]National Statistics in Taiwan: Consumer Price Indices in Taiwan. 2013. http://eng.stat.gov.tw/lp.asp?ctNode=1557&CtUnit=711&BaseDSD=7 webcite
• [22]Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL: Methods for the Economic Evaluation of Health Care Programmers. 3rd edition. New York: Oxford University Press; 2005.
• [23]Repetto L, Comandini D, Mammoliti S: Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients. Crit Rev Oncol Hematol 2001, 37:147-152.
• [24]Dugué PA, Lynge E, Rebolj M: Mortality of non-participants in cervical screening: Register-based cohort study. Int J Cancer 2014, 134:2674-2682.
• [25]Liu PH, Hu FC, Lee PI, Chow SN, Huang CW, Wang JD: Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan. BMC Health Serv Res 2010, 10:11. doi:10.1186/1472-6963-10-11