Cost effectiveness of cancer treatment in Taiwan

Mei-Chuan Hung; Wu-Wei Lai; Helen H W Chen; Jenq-Chang Lee; Yih-Jyh Lin; Jenn-Ren Hsiao; Ya-Min Cheng; Yan-Shen Shan; Wu-Chou Su; Jung-Der Wang

doi:10.1016/j.jfma.2016.04.002

Cost effectiveness of cancer treatment in Taiwan

J Formos Med Assoc. 2016 Aug;115(8):609-18. doi: 10.1016/j.jfma.2016.04.002. Epub 2016 Jun 11.

Authors

Affiliations

¹ Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan.
² Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: jdwang121@gmail.com.

PMID: 27302557
DOI: 10.1016/j.jfma.2016.04.002

Abstract

Background/purpose: This study aims to examine the cost effectiveness of treating major cancers compared with other major illnesses in Taiwan.

Methods: We collected data on 395,330 patients with cancer, 125,277 patients with end-stage renal disease, and 50,481 patients under prolonged mechanical ventilation during 1998-2007. They were followed for 10-13 years to estimate lifetime survival functions using a semiparametric method. EuroQol five-dimension was used to measure the quality of life for 6189 cancer patients and 1401 patients with other illnesses. The mean utility values and healthcare costs reimbursed by the National Health Insurance were multiplied with the corresponding survival probabilities to estimate quality-adjusted life expectancies and lifetime costs, respectively. Data of 22,344 cancer patients under hospice care (considered as a comparison group) were used to conduct a cost-effectiveness analysis. Sensitivity analysis was conducted by assuming patients without treatment survived for 2 years with a quality of life value of 0.5.

Results: The costs of care for patients under prolonged mechanical ventilation and those with end-stage renal disease were US$41,780-53,708 per quality-adjusted life year (QALY) and US$18,222-18,465 per QALY, respectively, which are equivalent to 2.17-2.79 gross domestic product (GDP) per capita per QALY and 1.18-1.25 GDP per capita per QALY. The costs of care for the nine different cancers were less than 1 GDP per capita per QALY, with those of lung, esophagus, and liver cancers being the highest. Sensitivity analysis showed the same conclusion. Lifetime risks of six out of nine cancer sites show an increased trend.

Conclusion: Cancer care in Taiwan seemed cost effective compared with that of other illnesses, but prevention is necessary to make the National Health Insurance more sustainable.

Keywords: cancer; cost effectiveness; cost per quality-adjusted life year; healthcare expenditure; lifetime survival function; semiparametric method.

MeSH terms

Adult
Aged
Aged, 80 and over
Cost-Benefit Analysis*
Female
Health Expenditures*
Humans
Kidney Failure, Chronic / economics
Kidney Failure, Chronic / therapy
Male
Middle Aged
Neoplasms / classification
Neoplasms / economics*
Neoplasms / therapy
Quality of Life
Quality-Adjusted Life Years
Registries
Respiration, Artificial / economics
Taiwan