Xian-Zhen Liao

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.

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.

Annual cost of illness of stomach and esophageal cancer patients in urban and rural areas in China: A multi-center study

Objective Stomach and esophageal cancer are imposing huge threats to the health of Chinese people whereas there were few studies on the financial burden of the two cancers. Methods Costs per hospitalization of all patients with stomach or esophageal cancer discharged between September 2015 and August 2016 in seven cities/counties in China were collected, together with their demographic information and clinical details. Former patients in the same hospitals were sampled to collect information on annual direct non-medical cost, indirect costs and annual number of hospitalization. Annual direct medical cost was obtained by multiplying cost per hospitalization by annual number of hospitalization. Annual cost of illness (ACI) was obtained by adding the average value of annual direct medical cost, direct non-medical cost and indirect cost, stratified by sex, age, clinical stage, therapy and pathologic type in urban and rural areas. Costs per hospitalization were itemized into eight parts to calculate the proportion of each part. All costs were converted to 2016 US dollars (1 USD=6.6423 RMB). Results Totally 19,986 cases were included, predominately male. Mean ages of stomach cancer and urban patients were lower than that of esophageal cancer and rural patients. ACI of stomach and esophageal cancer patients were

Health-related quality of life of esophageal cancer patients in daily life after treatment: A multicenter cross-sectional study in China

10,449 and

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

13,029 in urban areas, and

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

2,927 and

Effect of socioeconomic status on stage at diagnosis of lung cancer in a hospital-based multicenter retrospective clinical epidemiological study in China, 2005–2014

3,504 in rural areas, respectively. Greater ACI was associated with male, non-elderly patients as well as those who were in stage I and underwent surgeries. Western medicine fee took the largest proportion of cost per hospitalization. Conclusions The ACI of stomach and esophageal cancer was tremendous and varied substantially among the population in China. Preferential policies of medical insurance should be designed to tackle with this burden and further reduce the health care inequalities.

Abstract 1795: The feasibility study of a randomized cancer screening trial in China

The improvement of diagnostic and therapeutic techniques has prolonged the survival time of patients with esophageal cancer. Little is known, however, about their health‐related quality of life (HRQoL) in daily life after treatment.

The China Cancer Screening Trial Feasibility 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.

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

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