title: 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.
abstract: OBJECTIVE
  This 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).
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan; Department of Public Health, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Szu-Chun
authors.initials: SC
authors.lastname: Yang
authors.affiliation: Department of Surgery, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Wu-Wei
authors.initials: WW
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Han-Yu
authors.initials: HY
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Wu-Chou
authors.initials: WC
authors.lastname: Su
authors.affiliation: Department of Radiation Oncology, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan.
authors.forename: Helen H W
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan; Department of Public Health, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan. Electronic address: jdwang121@gmail.com.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000601:surgery; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results
keywords: Lead-time bias; Lung cancer surgery; Quality-adjusted life expectancy; Quality-adjusted life year; Quality-of-life; Utility