College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, South Korea.
Division of Mathematics and Big Data Science, Daegu University, Gyeongsan-si, 38453, South Korea.
BMC Cancer. 2020 Sep 3;20(1):846. doi: 10.1186/s12885-020-07353-8.
It is essential to have information on the disease burden of lung cancer at an individual level throughout the life; however, few such results have been reported. Thus, this study aimed to assess the lifetime disease burden in patients with lung cancer by assessing various factors, such as survival, years of life lost (YLL) and medical expenditure in South Korea based on real-world data and extrapolation.
Newly diagnosed lung cancer patients (n = 2919) in 2004-2010 were selected and observed until the end of 2015 using nationwide reimbursement claim database. The patients were categorised into the Surgery group, Chemo and/or Radiotherapy group (CTx/RTx), and Surgery+CTx/RTx according to their treatment modality. Age- and sex-matched control subjects were selected from among general population using the life table. The survival and cost data after diagnosis were analysed by a semi-parametric method, the Kaplan-Meier analysis for the first 100 months and rolling extrapolation algorithm for 101-300 months. YLL were derived from the difference in survival between patients and controls.
Lifetime estimates (standard error) were 4.5 (0.2) years for patients and 14.5 (0.1) years for controls and the derived YLL duration was 10.0 (0.2) years. Lifetime survival years showed the following trend: Surgery (14.2 years) > Surgery+CTx/RTx (8.5 years) > CTx/RTx group (3.0 years), and YLL were increased as lifetime survival years decreased (2.3, 8.7, 12.2 years, respectively). The mean lifetime medical cost was estimated at 30,857 USD/patient. Patients in the Surgery group paid higher treatment cost in first year after diagnosis, but the overall mean cost per year was lower at 4359 USD compared with 7075USD of Surgery+CTx/RTx or 7626USD of CTx/RTx group.
Lung cancer has resulted in about 10 years of life lost in overall patients. The losses were associated with treatment modality, and the results indicated that diagnosing lung cancer in patients with low stage disease eligible for surgery is beneficial for reducing disease burden in terms of survival and treatment cost per year throughout the life.
在个人层面上，了解肺癌的疾病负担信息至关重要；然而，目前鲜有此类研究结果。因此，本研究旨在基于真实世界的数据和外推法，通过评估生存率、生命损失年（years of life lost，YLL）和医疗支出等各种因素，评估韩国肺癌患者的终生疾病负担。
我们从 2004 年至 2010 年的全国性报销索赔数据库中选择了 2919 例新诊断的肺癌患者，并对其进行观察，直至 2015 年底。根据治疗方式，患者被分为手术组、化疗和/或放疗组（chemotherapy and/or radiotherapy，CTx/RTx）以及手术+CTx/RTx 组。使用寿命表从普通人群中选择与年龄和性别相匹配的对照受试者。采用半参数法（Kaplan-Meier 分析前 100 个月，滚动外推算法分析 101-300 个月）分析诊断后的生存和成本数据。YLL 源自患者和对照者之间的生存差异。
患者的终生估计值（标准误差）为 4.5（0.2）年，对照者为 14.5（0.1）年，YLL 持续时间为 10.0（0.2）年。终生生存年限呈现以下趋势：手术组（14.2 年）>手术+CTx/RTx 组（8.5 年）>CTx/RTx 组（3.0 年），YLL 随终生生存年限的缩短而增加（分别为 2.3、8.7 和 12.2 年）。每位患者的终生医疗费用估计为 30857 美元。手术组患者在诊断后第一年的治疗费用较高，但每年的总平均费用为 4359 美元，低于手术+CTx/RTx 组的 7075 美元或 CTx/RTx 组的 7626 美元。
肺癌导致所有患者损失约 10 年的生命。损失与治疗方式有关，结果表明，对适合手术的低期疾病患者进行肺癌诊断，有利于降低生存和每年治疗成本方面的终生疾病负担。
