Estimation of benefit of prevention of occupational cancer for comparative risk assessment: methods and examples
- 1Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli County, Taiwan
- 2Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
- 3Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- 4Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
- 5Department of Public Health, College of Medicine and Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Correspondence to Professor Jung-Der Wang, Department of Public Health, College of Medicine, National Cheng Kung University and Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, No.1, University Road, Tainan 701, Taiwan;
Contributors LJ-HL, S-HL and J-DW contributed to the conception and design of the work; Y-YC and LJ-HL performed the data analysis. All authors have contributed to interpretation of the results and take public responsibility for its accuracy. Each author is confident in the validity of this work, has reviewed the final version of the manuscript and approves it for submission.
- Accepted 2 April 2012
- Published Online First 10 May 2012
Objectives To quantify the life years gained and financial savings by preventing a case of occupational cancer.
Methods The authors retrieved data from the Taiwan Cancer Registry and linked them with the National Mortality Registry to estimate the survival functions for major occupational cancers: lung, pleural mesothelioma, urinary bladder and leukaemia. Assuming a constant excess hazard for each type of cancer, the authors extrapolated lifetime survival functions by the Monte Carlo method. For each patient with cancer, the authors simulated an age- and gender-matched person without cancer based on vital statistics of Taiwan to estimate life expectancy and expected years of life lost (EYLL). By using the reimbursement data from the National Health Insurance Research Database, the authors calculated the average monthly healthcare expenditures, which were summed to estimate the lifetime healthcare expenditures after adjusting for the corresponding monthly survival probability.
Results A total of 51 408, 136, 12 891 and 5285 new cases of lung, pleural mesothelioma, bladder and leukaemia cancers, respectively, were identified during 1997–2005 and followed until the end of 2007. The EYLL was predicted to be 13.7±0.1, 18.9±0.7, 4.7±0.3 and 19.4±0.5 years for these cancers, respectively, and the lifetime healthcare expenditures with a 3% annual discount were predicted to be US$22 359, US$14 900, US$51 987 and US$59 741, respectively.
Conclusions The burden of these occupational cancers, in terms of EYLL and lifetime healthcare expenditures, was substantial. Such estimates may provide useful empirical evidence for comparative risk assessment that can be applied in health policy-making and clinical decision-making.
- Expected years of life lost (EYLL)
- life expectancy
- lifetime healthcare expenditure
- public health
- preventive medicine
Funding This study was supported by the National Health Research Institutes (NHRI) intramural project EO-100-EO-PP04, and the Institute of Occupational Health and Safety (IOSH-100-M303). The funder helps in acquisition of data from the National Health Insurance Research Database. The authors have worked on the research independently. The interpretation and conclusions contained herein do not represent those of the National Health Research Institutes.
Competing interests None declared.
Ethics approval Ethics approval was provided by the Institutional Review Board of the National Taiwan University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.