Cost effectiveness of cancer treatment in Taiwan.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan.
Mei-Chuan
MC
Hung
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Wu-Wei
WW
Lai
Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Helen H W
HH
Chen
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Jenq-Chang
JC
Lee
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yih-Jyh
YJ
Lin
Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Jenn-Ren
JR
Hsiao
Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Ya-Min
YM
Cheng
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yan-Shen
YS
Shan
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Wu-Chou
WC
Su
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.
Jung-Der
JD
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000191:economics* / Q000628:therapy; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012042:Registries; D012121:Respiration, Artificial / Q000191:economics; D013624:Taiwan
cancer; cost effectiveness; cost per quality-adjusted life year; healthcare expenditure; lifetime survival function; semiparametric method