title: Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.
abstract: This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.
authors.affiliation: National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Lukas Jyuhn-Hsiarn
authors.initials: LJ
authors.lastname: Lee
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, United States; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Cheng-Kuan
authors.initials: CK
authors.lastname: Lin
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Hung
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
keywords: AF, Attributable fraction; Attributable fraction (AF); CAREX, CARcinogen EXposure; DALY, Disability-adjusted life year; IARC, International Agency for Research on Cancer; LTHE, Lifetime healthcare expenditure; Lifetime healthcare expenditure (LTHE); NHI, National Health Insurance; NHIRD, National Health Insurance Research Database; NMR, National Mortality Registry; QALE, Quality-adjusted life expectancy; QALY, Quality-adjusted life year; QOL, Quality of life; Quality-adjusted life expectancy (QALE); TCR, Taiwan Cancer Registry; WHO, World Health Organization; Work-related cancer