Download cost and burden of non-small cell lung cancer in portugal

COST AND BURDEN OF NON-SMALL CELL LUNG CANCER IN PORTUGAL
Borges M1,2,3, Gouveia M4, Alarcão J1, Sousa R1, Teixeira E5, Barata F6, Laranjeira E1, Lopes F1, Parente B7, Pinheiro L1, Vaz-Carneiro A1, Costa J1,2
1
Center for Evidence Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal 2 Clinical Pharmacology Unit, Institute of Molecular
Medicine, Lisbon, Portugal 3 Centro Hospitalar Lisboa Central, Lisbon Portugal 4 Católica Lisbon School of Business and Economics, Lisbon, Portugal 5 Centro
Hospitalar Lisboa Norte, Lisbon, Portugal 6 Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal 7 Hospital CUF Porto, Porto, Portugal
Objectives



Results
Lung cancer is the leading cause of cancer death accounting for 1,3 million deaths
Burden of Disease
each year in the world. 1
Years of Life Lost (YLL)
Lung cancer was the first cause of cancer death in Portugal with 3,514 deaths in

2011.2
deaths account for 78% of all NSCLC deaths. In 2012 NSCLC mortality
Non-Small Cell Lung Cancer (NSCLC) is the most common type of lung cancer,
accounted for 3.0% of total mortality in Portugal.

representing 80 to 85% of all cases.3

A total of 3,180 deaths in Portugal in 2012 were caused by NSCLC. Male
This study estimates the costs of illness and the burden of disease attributable to
The estimated YLL added up to 25,071, representing 4.5% of the total years of
life lost for all deaths in the country.
NSCLC in Portugal in 2012.
Years Lost due to Disability (YLD)
Methods

In 2012 an incidence of 3,613 new cases was estimated for NSCLC in Portugal.

The estimated mean duration of the disease for patients diagnosed in a
locoregional stage (I to IIIA) was 2.8 years, while it was 1.2 years for patients
Burden of Disease

diagnosed in an advanced stage (IIIB to IV).
Disability Adjusted Life-Years (DALY) is the unit measure of disease burden. This

indicator combines the years of potential life lost due to premature mortality (YLL)
and the years of healthy life lost due to disability (YLD).4

advanced stages was 0.869.

The total estimate of YLD attributed to NSCLC in Portugal was 3,236.
The YLL correspond to the number of deaths multiplied by the socially weighted and
discounted life expectancy at the age at which death occurs using a standardized life

The mean disability weight for the locoregional stages was 0.499 and for the
Overall disease burden
table.4

The global burden of NSCLC was estimated to be 28.307 DALY (Table 1).
Lung cancer deaths by age and gender were estimated based on the European

YLL represented 89% of the total DALY, underlining the impact of this disease
Detailed Mortality Database from WHO.5 The proportion of NSCLC deaths among the
in terms of mortality.
total of lung cancer deaths was estimated applying a ratio of 85.7%, estimated from
the Diagnosis-Related Groups (DRG) Portuguese database for 2012.6

Table 1. DALY attributable to NSCLC in Portugal in 2012.
In order to estimate YLD in a particular period of time, the number of incident cases
YLL
YLD
DALY
Men
19.556
2.560
22.116
Women
5.515
675
6.190
Total
25.071
3.236
28.307
in that period is multiplied by the adjusted average duration of the disease. The
duration is weighted by an indicator reflecting the severity of the disease on a scale
ranging from 0 (perfect health) to 1 (death).3

NSCLC incidence in 2012 was estimated based on trends in the Portuguese National
Cancer Registry 2006 and Regional Cancer Registries 2006 to 2009.7,8

The average duration of the disease was derived from the survival curves published
by the International Association for the Study of Lung Cancer.9

Disability weights were taken from the Netherlands Study, available separately for
stages of the disease. 10
Cost of illness

The estimated direct cost attributable to NSCLC in 2014 prices is € 89 million
which can be broken down into € 32 million for inpatient care and € 57 million
Cost of illness
for outpatient care.

Cost of illness was estimated based on NSCLC prevalence in 2012.

Data from 1) a cohort of 581 Portuguese patients with NSCLC , 2) on past incidence

locoregional stages and € 50 million from advanced stages. These estimates
rates and 3) from an expert panel was used to develop a model predicting the
include both long run effects such as premature retirement and short run
distribution and transitions of patients across stages throughout 2012.

The indirect costs due to disability add up to € 54 million: € 4 million from the
effects such as absenteeism.
To simplify the staging of disease patients were distributed in 2 main stages:
locoregional stage (I to IIIA) and advanced stage (IIIB to IV) (Figure 1).
Conclusions
Figure 1. Simplified structure of the model.

NSCLC is an important cause of disease burden, accountable for 28,307 DALY.

The majority of NSCLC burden is due to mortality.

The disease burden falls mostly on male patients.

The overall costs of disease are estimated at € 143 million, about 0.1% of
Portuguese GDP and 0.9% of the overall Portuguese 2012 health expenditure.

The costs and burden of disease suggest that NSCLC has a sizeable impact on
Portuguese health costs and society ´s welfare. Consequently NSCLC should
receive appropriate attention from policy makers.

Acknowledgements
The incidence distribution of patients by stage was estimated based on the
aforementioned cohort of 581 patients. Most patients (70%) were diagnosed in
advanced stages (IIIB-IV).


Death probabilities were derived from the survival curves published by International
Association for the Study of Lung Cancer (IASLC). Five year survival was 28.5% for
patients in locoregional stages and 1.81% for patients in advanced stages. 9

The economic impact analysis included two components: the direct costs generated
by NSCLC including consumption of inpatient and outpatient care (visits, medication,
diagnostic exams, transportation, etc.) and the indirect costs related to loss of
productivity due to NSCLC.

Inpatient costs were estimated using the Portuguese DRG 2012 database. Patients
with hospitalization episodes were identified using the 9th International Classification
of Diseases.

Outpatient costs were estimated based on outpatient information in the Portuguese
DRG database and the expert panel.

Unit costs were taken from Portuguese legislation and drug costs from the Catalogue
for Public Health Procurement and Infomed database.

References
Recurrence probabilities were derived from the literature. 5-year local recurrence
was 9% and distant recurrence was 27%. 11

This study was financially supported by Pfizer Portugal.
Indirect costs related to loss of productivity were estimated using the Human Capital
approach and a Labor Ministry database with compensation information.12
Corresponding author: [email protected]
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