title: Estimating the lifelong health impact and financial burdens of different types of lung cancer.
abstract: BACKGROUND
  Owing to the high mortality and rapidly growing costs related to lung cancer, it is worth examining the health benefits of prevention for major types of lung cancer. This study attempts to quantify the quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures of patients with different pathological types of lung cancer.
  
  
  METHODS
  A national cohort consisting of 66,535 patients with pathologically verified lung cancer was followed for 13 years (1998-2010) to obtain the survival function, which was further extrapolated to lifetime. Between 2011 and 2012, EuroQol 5-dimension questionnaires were used to measure the quality of life (QoL) for 1,314 consecutive, cross-sectional samples. After multiplying the lifetime survival function by the utility values of QoL, we estimated the QALE and loss-of-QALE. We also collected the monthly healthcare expenditures, which included National Health Insurance-reimbursed and out-of-pocket direct medical costs, for 2,456 patients from 2005 to 2012. These values were multiplied by the corresponding survival probabilities to calculate lifetime healthcare expenditures after adjustments with medical care inflation rates and annual discount rates.
  
  
  RESULTS
  The QALE for patients with small cell lung cancer, squamous cell carcinoma, and adenocarcinoma were 1.21, 2.37, and 3.03 quality-adjusted life year (QALY), with the corresponding loss-of-QALE of 13.69, 12.22, and 15.03 QALY, respectively. The lifetime healthcare expenditures were US$ 18,455 ± 1,137, 20,599 ± 1,787, and 36,771 ± 1,998, respectively.
  
  
  CONCLUSIONS
  The lifelong health impact and financial burdens in Taiwan are heavier for adenocarcinoma than for squamous cell carcinoma. The cost-effectiveness of prevention programs could be directly compared with that of treatment strategies to improve patient value. And the methodology could be applied to other chronic diseases for resources planning of healthcare services.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, 138 Sheng Li Road, Tainan 70403, Taiwan. jdwang121@gmail.com.
authors.forename: Szu-Chun
authors.initials: SC
authors.lastname: Yang
authors.forename: Wu-Wei
authors.initials: WW
authors.lastname: Lai
authors.forename: Wu-Chou
authors.initials: WC
authors.lastname: Su
authors.forename: Shang-Yin
authors.initials: SY
authors.lastname: Wu
authors.forename: Helen H W
authors.initials: HH
authors.lastname: Chen
authors.forename: Yi-Lin
authors.initials: YL
authors.lastname: Wu
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Hung
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000191:economics / Q000401:mortality / Q000523:psychology*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000401:mortality / Q000523:psychology*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D055752:Small Cell Lung Carcinoma / Q000191:economics / Q000401:mortality / Q000523:psychology*