Szu-Chun Yang1, Wu-Wei Lai2, Han-Yu Chang3, Wu-Chou Su3, Helen H W Chen4, Jung-Der Wang5. 1. 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. 2. Department of Surgery, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan. 3. Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan. 4. Department of Radiation Oncology, National Cheng Kung University College of Medicine and Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan. 5. 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.
Abstract
OBJECTIVES: 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). PATIENTS AND 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. CONCLUSION: 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.
OBJECTIVES: 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). PATIENTS AND METHODS: A cohort consisting of 1652 pathologically verified NSCLCpatients 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. CONCLUSION: 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.