title: Estimation of life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for schizophrenia in Taiwan.
abstract: By employing a novel semi-parametric extrapolation method, the life expectancies after the first hospitalization for schizophrenia and the associated lifetime healthcare expenditures were both estimated. Based on the linkage between the National Health Insurance Research Database and the National Mortality Registry of Taiwan, we have established a schizophrenic cohort for 2000-2010 and followed up to 2011. Survival function was estimated through Kaplan-Meier's method and extrapolated throughout life. We applied a simple linear regression to the logit-transformed survival ratio between the schizophrenic cohort and the sex-, age-matched referents via Monte Carlo simulation from the national life table. The monthly survival probability was multiplied by the average healthcare expenditures and summed throughout life to estimate the lifelong cost reimbursed by the National Health Insurance. The results showed that patients diagnosed at age 20-29 had the highest expected years of life lost (EYLL), 15 and 9years, in men and women, respectively, with corresponding lifetime healthcare expenditures of USD 48,000 and 53,000. Males generally had higher health cost per life-year than their female counterparts across their lifespan. We applied the same method to the first 6years of the cohort and extrapolated to 12years, which showed that the relative biases for different age strata were less than 5%. We thus concluded that the semi-parametric extrapolation method might provide a timely estimation of lifetime outcomes for health care planning of schizophrenia.
authors.affiliation: Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; School of Medical Sociology and Social Work, Chung Shan Medical University, 402 Taichung, Taiwan.
authors.forename: Chhian Hūi
authors.initials: CH
authors.lastname: Lêng
authors.affiliation: Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; Psychiatric Hospital, Home of Philanthropy, Tainan 712, Taiwan.
authors.forename: Ming Hui
authors.initials: MH
authors.lastname: Chou
authors.affiliation: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
authors.forename: Sheng-Hsiang
authors.initials: SH
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, National Cheng Kung University and Hospital, Tainan 701, Taiwan.
authors.forename: Yen Kuang
authors.initials: YK
authors.lastname: Yang
authors.affiliation: Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; Departments of Occupational and Environmental Medicine and Internal Medicine, National Cheng Kung University Hospital, Tainan 701, Taiwan. Electronic address: jdwang121@gmail.com.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D012042:Registries; D012044:Regression Analysis; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000453:epidemiology / Q000503:physiopathology*; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Expected years of life lost; Life expectancy; Lifetime health care costs; Schizophrenia; Statistical method