- Title
- The economic evaluation of the management on lunch cancer in China
- Creator
- Yang, Ke Hong
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philospohy (PhD)
- Description
- Lung cancer is the most common cancer in both developed and developing countries and it is also the leading cause of cancer-related deaths globally. Financially, lung cancer imposes a heavy economic burden to patients, their families and society. Quality of life (QoL) measurement has been verified contributing to the prediction of patient survival of lung cancer significantly. Coupled with the increasing prevalence of lung cancer, a better understanding of the pharmacoeconomic issues related to lung cancer is important. However, evidence for disease impact on health-related quality of life (HRQoL) and cost-effectiveness of treatments in Chinese lung cancer patients is lacking. The aims of this thesis were therefore to evaluate the impact of lung cancer on HRQoL, cost and pharmacoeconomic outcomes among lung cancer patients in China. In the first part of this thesis, we assessed the domain structure and psychometric properties of the Chinese version of the cancer treatment satisfaction questionnaire (CTSQ), and at the same time evaluated the relationship between the CTSQ and the quality of life questionnaire-core 30 (QLQ-C30) as CTSQ had never been used in China. Our study results confirmed the internal consistency reliability and construct validity of the CTSQ as a valid patient-reported-outcomes (PROs) instrument, thus verifying the Chinese version of CTSQ for use among cancer patients (including lung cancer patients) receiving treatment. The clinical use of the Chinese version of CTSQ would allow a more holistic assessment of cancer therapy by incorporating patient’s satisfaction level. This can be a step forward for more patient involvement in clinical decision making – an approach congruent with the global trend. Chinese lung cancer patients' willingness-to-pay (WTP) for their treatments was then assessed and the influencing factors analyzed for the first time in China. Education level, household income, and number of family members were found to significantly affect patients' WTP. This information would be valuable for healthcare and health insurance administrators and policy makers in formulating more equitable healthcare policy and insurance coverage in China. Such policy would contribute to improving patient’s access to affordable cancer treatments. In the next study, we examined the potential use of a disease-specific PROs instrument, QLQ-C30 to generate utility values in lung cancer patients for future cost-utility analysis. Besides generating utility values for cost-effectiveness study, the success of such attempt would also facilitate the routine assessment of PROs among cancer patients by eliminating the need of using multiple PROs instruments (usually one generic and one disease-specific), thus reducing burden to both healthcare providers and the patients. In this study, QLQ-C30 was mapped onto EuroQol-five-dimensional-questionnaire-level-5 (EQ-5D-5L) index scores using data obtained from Chinese lung cancer patients. Our results revealed that the OLS mapping algorithm showed a good fit to the data, indicating that the QLQ-C30 can be used indirectly to measure utility. Furthermore, in the same study, PROs of lung cancer patients were assessed and factors that may affect patients’ PROs were also analyzed. Congruent with expectation based on clinical studies, our results showed that patients on targeted therapy had significantly better quality of life than those on chemotherapy, especially when targeted therapy are found to have significantly less adverse effects of pain, nausea, vomiting and alopecia. These results provide further support that the QLQ-C30 can accurately measure quality of life in Chinese lung cancer patients. In the next part of this thesis, cost of lung cancer treatments including direct cost, indirect cost and intangible cost was evaluated among Chinese patients. Education level, occupation, household income, lung cancer classification, and city of residence were found affecting patients’ treatment cost significantly. Additionally, our results showed patients taking chemotherapy had significantly higher cost than patients undergoing targeted therapy. The results of this study would provide valuable background data for comparison when newer treatment options for lung cancer emerge in China. For the last study in this thesis, cost-effectiveness analysis of targeted therapy using gefitinib was evaluated for lung cancer patients in China. In the modelled evaluation conducted in this study, we found that the use of gefitinib or gefitinib in combination with conventional chemotherapy in first-line treatment of lung cancer was not cost-effective compared to conventional chemotherapy nationwide in China in 2017. However, the uneven economic development among regions in China would make gefitinib cost-effective relative to conventional chemotherapy when used in economically more developed regions of China. However, with the positive economic growth trends nationally and healthcare policies to improve accessibility of high-cost drugs, the use of gefitinib is increasingly becoming cost-effective compared to conventional chemotherapy as the first-line treatment of lung cancer in China. Hence, in addition to the pharmacoeconomic evaluation results may have implications for drug reimbursement decisions on lung cancer treatment in China; this highlights the need of periodic re-assessment of the cost-effectiveness of high-cost pharmacotherapies to allow better accessibility to newer and more costly drugs to fulfill the unmet clinical needs of patients through public reimbursement and subsidy. In summary, we had attempted to conduct a series of studies to more comprehensively evaluating lung cancer management in China. These studies measured the humanistic, financial and cost-effectiveness outcomes and patients’ willing to pay for lung cancer, with many studies being the first ever conducted in China for lung cancer, a current major public health problem in China and also in the foreseeable future. Besides able to inform decision makers and clinicians about better management and reimbursement/subsidy for newer drugs, the approach used in this thesis would also provide a template for studying other chronic diseases especially different kinds of cancers in China.
- Subject
- lung cancer; quality of life; economic burden; pharmacoeconomic; China
- Identifier
- http://hdl.handle.net/1959.13/1470119
- Identifier
- uon:48384
- Rights
- Copyright 2023 Ke Hong Yang
- Language
- eng
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