Hui-Yao Huang

Quality-of-life and health utility scores for common cancers in China: a multicentre cross-sectional survey

BACKGROUND The measurement of quality-adjusted life-years (QALYs) forms a key component of cost-utility evaluation in cancer intervention; however, detailed data for utility weights by cancer type and health status are still scarce both in China and other regions. The aim of this study was to systematically evaluate utility scores in relation to the most common six cancers in China in 2012 (lung, breast, colorectal, oesophageal, liver, and stomach cancer). METHODS As a part of a Screening Program in Urban China (CanSPUC) supported by the central government of China, we undertook a cross-sectional survey in 13 provinces across China from 2013 to 2014. Two generic instruments, EQ-5D (EuroQol 5-dimensions) and SF-12 (12-item Short Form Health Survey), and a cancer-specific instrument, FACTs (Function Assessment of Cancer Therapy) were applied. 46 394 participants were interviewed in five groups: general population (n=11 699, group A), individuals who had attended single cancer screening (n=11 805, group B), individuals who had attended multiple screenings (n=6838, group C), patients with precancerous lesions (n=1942, group D), and patients with cancer (n=14 110, group E). All participants had no psychosis and provided written consent to participate in the study. The survey was approved by the Institutional Review Board of the Cancer Hospital of Chinese Academy of Medical Sciences. FINDINGS The EQ-5D utility scores were 0·96 (95% CI 0·96-0·96) for group A, 0·94 (0·94-0·94) for group B, 0·94 (0·94-0·94) for group C, 0·85 (0·84-0·86) for group D, and 0·77 (0·77-0·77) for group E. Cancer-specific analysis showed that EQ-5D utility scores were 0·77 (0·76-0·78) for lung cancer, 0·78 (0·77-0·79) for breast cancer, 0·75 (0·74-0·76) for colorectal cancer, 0·75 (0·74-0·76) for oesophageal cancer, 0·80 (0·79-0·81) for liver cancer, and 0·76 (0·75-0·77) for stomach cancer. The utility scores for cancer at different clinical stages also differed; for example, the scores for patients with breast cancer were estimated as 0·79 (0·77-0·80) at stage I, 0·79 (0·78-0·80) at stage II, 0·77 (0·76-0·79) at stage III, and 0·69 (0·65-0·72) at stage IV. Compared with data from EQ-5D, results from SF-12 on differences among subgroups seemed narrower; for example, the utility score among the six cancers ranged from 0·60 to 0·62. INTERPRETATION These data will be applied to future cost-utility evaluation on various cancer screening strategies in China, and could contribute more precise evaluation of burden of disease related to disability-adjusted life-years globally. FUNDING The National Health and Family Plan Committee of China.

International trends in lung cancer incidence from 1973 to 2007

Lung cancer is the commonly diagnosed cancer and one of the most important avoidable causes of death around the world. We conducted the study to investigate the pattern of lung cancer incidence worldwide. Joinpoint analysis was used to extend international lung cancer incidence rates by the latest data from Cancer Incidence in Five Continents over the 35‐year period 1973–2007 from 24 populations from Americas, Asia, Europe, and Oceania. Age‐standardized incidence rates (ASRs) of lung cancer were from 33.3 to 66.8 per 100,000 among males and 10.5 to 37.4 per 100,000 among females in most of Americas, Europe, and Oceania populations during the period 2003–2007. In Asia, ASRs in China (Hong Kong) were the highest, up to 53.3 per 100,000 in males and 21.9 per 100,000 in females during the period 2003–2007. The international trends between 1973 and 2007 showed that ASRs of lung cancer among males were declining in 13 of 18 selected Americas, Oceania, and Europe populations, with AAPC from −0.7% to −2.9%, whereas the rates among females in 18 selected populations were increasing, with AAPC from 1.3% to 5.0%. The increasing and decreasing trends of ASRs of lung cancer in Asia have a geographic variation but no gender differences. Although the decreasing trends in ASRs of lung cancer for males were observed, the ASRs were higher than females. The declining trends in males were mainly attributed to tobacco control, whereas the increasing trends in females should be given more concern and need to be further studied in etiology factors.

Health-related quality of life and utility scores of patients with breast neoplasms in China: A multicenter cross-sectional survey

BACKGROUND Health-related quality of life and utility scores of patients with breast cancer and precancerous lesions are sparse in China. This study aimed to derive utility scores of patients with breast cancer and precancer in China. MATERIAL AND METHODS An interviewer-administered cross-sectional survey was conducted in 12 provinces across China from 2013 to 2014. The three-level EuroQol-5-Dimension instrument was used to evaluate quality of life, and utility scores were generated using the Chinese value set. Univariate and multivariate analyses were performed to explore the determinants of utility scores. RESULTS In total, 2626 breast cancer and 471 precancer patients were included. Mean age was 49.1 for breast cancer and 41.4 years for precancer (p < 0.001). Among the five dimensions, pain/discomfort was the most reported problem, 53.9% in breast cancer and 29.3% in precancer patients. Mean (95% CI) utility scores for breast cancer and precancer patients were estimated as 0.887 (0.875-0.899) and 0.781 (0.774-0.788), and the scores of breast cancer at stage-I, stage-II, stage-III and stage-IV were 0.789 (0.774-0.805), 0.793 (0.783-0.802), 0.774 (0.759-0.788) and 0.686 (0.654-0.717), respectively. Mean (95% CI) visual analogue scale scores for breast cancer and precancer were 75.6 (74.0-77.3) and 72.8 (72.3-73.3). Multiple regression showed advanced clinical stage, lower educational level, lower household income, surgery treatment, and undergoing treatment were independently associated with lower utility scores for breast cancer patients. CONCLUSION The utility scores deteriorate with the severity of breast neoplasms. Detailed utility scores of breast cancer and precancer are fundamental for further cost-utility analysis in China.

Medical and non‐medical expenditure for breast cancer diagnosis and treatment in China: a multicenter cross‐sectional study

We aimed to assess economic burden of breast cancer (BC) diagnosis and treatment in China through a multicenter cross‐sectional study, and to obtain theoretical evidence for policy‐making.

Sustainability of cancer screening in China: a multicentre assessment from the perspective of service suppliers and demanders

Abstract Background In 2012, Chinas central government initiated the Cancer Screening Program in Urban China (CanSPUC). The aim of this study was, based on the CanSPUC, to assess the long-term sustainability of cancer screening in China. Methods This multicentre survey was conducted in 17 provinces across China between Oct 8, 2012, and Sept 15, 2015. 54 250 web-based or face-to-face interviews were completed among participants from four perspectives: actual suppliers of screening services (n=4626); potential suppliers (n=2201); actual demanders of screening services (n=31 029); and potential demanders (16 394). All percentages were calculated after eliminating missing values. Findings From the perspective of actual suppliers of screening services, the main gains from providing screening emphasised promotion in social value (63·6%; n=2926), local reputation (35·9%; n=1654), and professional skills (30·6%; n=1408), whereas difficulties encountered included inadequate compensation (30·9%; n=1421) and discordance among information systems (28·3%; n=1303). 2936 (63·7%) expressed willingness to provide routine screening. From the perspective of potential suppliers, the management personnel subgroup (n=508) were most willing in implementing the service (92·5%; n=459) and preferred it being financed by governments (68·3%; n=334) or insurance agencies (14·3%; n=70); the clinical professional subgroup (n=1693) were also most interested in professional skills improvement through the project (72·4%; n=1225). Among the actual demanders of screening services, 19 448 (94·6%) thought the involved screening technologies acceptable, more than 20 905 (>67·3%) preferred annual, biennial, or triennial screening frequency, and more than three-quarters were willing to pay for screening, but only 2659 (11·2%) were willing to pay more than ¥500 (about US

Expenditure and financial burden for common cancers in China: a hospital-based multicentre cross-sectional study

70). Among the potential demanders, 12 738 (77·7%) had never received cancer screening and 4719 (43·7%) preferred screening at general hospitals, but only 3928 (36·4%) would choose a hospital at reasonable level. Willingness to pay was similar between potential and actual demanders. Interpretation Differences and consistencies between actual and potential suppliers of screening services indicated the aspects that need to be strengthened in longer-term management. Both actual and potential demanders of screening services showed considerable demand or acceptability for screening. The low willingness to pay from multiple perspectives suggests the importance of introducing stable co-compensation mechanisms mainly supported by local governments and the medical insurance systems. Funding National Health and Family Planning Commission of China; China-WHO Biennial Collaborative Projects (2016/664439-0).