Cost-Effectiveness of Cancer in Korea Eun-Cheol Park, MD, PhD Sung-In Jang, MD

Transcription

1 Cost-Effectiveness of Cancer in Korea Eun-Cheol Park, MD, PhD Sung-In Jang, MD Department of Preventive Medicine & Institute of Health Services Research Yonsei University College of Medicine

2 Contents Economic Burden of Cancer Single Measure of Cancer Burden CEA for Cancer Conclusions

3 Annual Cancer Incidence and Mortality Rate Jung KW, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in Cancer Res Treat Apr ; 46(2):

4 Economic Burden of Cancers

5 Methodology Estimation of Ø Cost of Illness (COI) Method by cancer site, gender, and age groups ü Direct costs v Direct medical costs: Hospitalization, outpatients visits, prescription drugs v Direct non-medical costs: Transportation, caregiver s time cost, costs of complemen tary and alternative medicine ü Indirect costs Projection of v Costs of productivity loss due to morbidity Work time loss and Job loss of patients and families v Costs of productivity loss due to mortality Ø Cost of Illness (COI) method Ø Log-linear model of incidence projection Ø Global Burden of Disease Study approach for mortality prediction Ø Incidence-Prevalence-Mortality (IPM) Model for prevalence prediction **Data sources : Health Insurance Claims, Statistics Korea, and other studies

6 Estimation of Billion US$ Productivity loss costs due to mortality Economic Burden of Cancer (2010): 24.1 billion US$ (2.1% of GDP) 4.4 Productivity loss costs due to morbidity Other direct costs Medical costs not covered to HI Medical costs covered to HI

7 Projection of Male Cancer Prevalence in Korea during (Major Cancer Sites, Per 100,000) Stomach (Men) Colorectum (Men) Liver (Men) Leukemia (Men) The incidence rate follows the trend * Remains constant as in Y2010)

8 Projection of Female Cancer Prevalence in Korea during (Major Cancer Sites, Per 100,000) Thyroid (Women) Breast (Women) Colorectum (Women) Stomach (Women) The incidence rate follows the trend * Remains constant as in Y2010)

9 Projection of Economic Burden of Cancer in Korea by Cost Component during (Million US$) Year 2020 S1 a S2 a S3 a S4 b S5 b S6 b Direct Cost 27,093 23,983 21,375 24,735 21,868 19,465 Share in Total Cost (%) Indirect Cost Morbidity 22,293 22,293 22,293 20,552 20,552 20,552 Share in Total Cost (%) Mortality 16,544 16,544 16,544 16,544 16,544 16,544 Share in Total Cost (%) Total Cost 65,930 62,819 60,212 61,831 58,964 56,561 Gross Domestic Product (GDP) 1,505,256 1,505,256 1,505,256 1,505,256 1,505,256 1,505,256 Total Burden/GDP (%) Economic Burden of Cancer (2020): 56.6~65.9 billion US$ (3.8%~4.4% of GDP) a The incidence rate follows the Y trend and the annual growth rate of medical cost per patient is 4% (S1), 2% (S2), 0% (S3) b The incidence rate remains as in Y2010 and the annual growth rate of medical cost per patient is 4% (S4), 2% (S5), 0% (S6)

10 Single Measure of Cancer Burden [SMCB ]

11 SMCB Methodology 1. Estimation age-adjusted incidence and mortality using with the mid-year population in 2005 fro m 1999 to Identification the maximum value of age-adjusted incidence/mortality in 2010 for whole populat ion. The maximum value of incidence/mortality: 67.5 cases of thyroid cancer per 100,000 peop le/25.3 cases of lung cancer per 100,000 people. 3. Dividing into 10 equal intervals from 0 to 67.5(I) and 0 to 25.3(M). 4. Giving the score by sex and cancer sites 5. Adding the incidence score and mortality score: Determining the rank of cancer sites by sum of scores. The range of age-adjusted incidence Incidence score The range of age-adjusted mortality Mortality score 0.00 x < point 0.00 x < point 6.75 x < points 2.53 x < points x < points x < points x points x points Cho KH et al. A single measure of cancer burden in Korea from 1999 to Asian Pac J Cancer Prev. 2013;14(9):

12 Cancer-specific burden in 2010 : Korea Cancer sites Incidence Mortality SMCB Score Total Incidence Mortality Rank comparison Incidence Mortality SMCB Male Stomach(C16) Lung(C33-C34) Liver(C22) Colon, rectum, and anus(c18-c21) Pancreas(C25) Gallbladder(C23-C24) Thyroid(C73) Esophagus(C15) Bladder(C67) Non-Hodgkin's lymphoma(c82-c85,c96) Female Breast(C50) Thyroid(C73) Stomach(C16) Lung(C33-C34) Colon, rectum, and anus(c18-c21) Liver(C22) Pancreas(C25) Cervix uteri(c53) Gallbladder(C23-C24) Larynx(C32)

13 Annual Cancer-Specific SMCB : Korea Annual cancer-specific SMCB ( ) for Males Annual cancer-specific SMCB ( ) for Females

14 Worldwide : High SMCB ( 7) by Regions

15 Cost-Effectiveness on Cancer

16 Dimension of Cancer Control Prevention Early Detection(Screening) Diagnosis & Treatment Palliative Care Prevention Early Detection Diagnosis & Treatment Palliative Care Park EC. Theories and Practice of National Cancer Control Program. NCC, 2011

17 Prevention: PAF(%) of Cancer Smoking Alcohol Infection Obesity Physical Activity Hormone Reproduc tion Radiation Stomach Colon Rectum Liver Gall Blad der 0.81 Pancreas Larynx Lung 8.05 Breast Cervix Thyroid Total Source: Park SH, 2011

18 Prevention Stomach Ca Cost effective on eradicating H. pylori Liver Ca Cost effective on vaccination Smoking Cost effective on tobacco price policy and non-pric e policy Eating Habit Cost effective on managing salted food

19 Early Detection Gastric Cancer of NCSP (Cho et al., 2013) UGI: 13,782(m) 13,614(f) US$/LYS Endo: 8,389(m) 8,772(f) US$/LYS

20 Early Detection Cervical Cancer (Cho et al., 2013) ICER: 6,727 USD/LYS

21 Early Detection Breast Cancer (Kang et al., 2013) ICER: 38,883 USD/LYS (5.8 times of Cervical Cancer)

22 Early Detection Breast Cancer (Yoo et al., 2013) Western Countries: Cost-effective Asian Countries: NOT cost-effective

23 Diagnosis & Treatment Benefit Coverage of New Drug & Technology National Evidence-Based Healthcare Collaboratin g Agency (NECA) Effectiveness of medical technologies Health Insurance Review and Assessment Service (HIRA) Coverage decision

24 Diagnosis & Treatment Anti-cancer drugs assessed by HIRA ( ) The results of 12 drugs Approval 5 Sprycel(Dasatinib), Dacogen(Decitabine) Hycamtin(Topotecan), Tasigna(Nilotinib) Tykerb(Lapatinib) Rejection 7 Erwinase(L-asparaginase), Oncaspar(Pegaspargase) Erbitux(Cetuximab), Vorina(Sodium folinate) Faslodex(Fulvestrant), Nipent(Pentostatin) Yondelis(Trabectedin) Cho et al, 2013

25 Diagnosis & Treatment Different results with Korea and Australia Korea Australia Dasatinib Approval Approval Cetuximab Rejection Approval Topotgecan Approval Rejection Niltinib C. Approval Approval Lapatinib Approval Approval Cho et al, 2013

26 Conclusions

27 Burden of Cancer Heavy burden of cancer in Asia Male: Lung, Liver, Stomach, Colorectum, Esophagus Female: Lung Heavy burden of cancer in developed regions Male: Lung, Prostate, Colorectum Female: Breast, Colorectum, Lung

28 Early Detection Screening method ICER (USD/LYS) - Direct cost only Stomach cancer Cervical cancer Breast cancer UGI series Endoscopy 5,507 (UGI) 1,991 (Endoscopy) PAP smear Mammography 2,919 27,540 GDP per capita (USD) 17,074 (2009) 23,113 (2012) 17,074 (2009) % of ICER/ GDP per capita 32.3 (UGI) 11.7 (Endoscopy) Cost-effectiveness Acceptable Acceptable Questionable

29 Early Detection Stomach cancer screening Not recommended by WHO BUT in Korea Breast cancer screening Recommended by WHO But not in Korea Evidence-based program from Asia itself

30 Conclusion More evidences reduce burden of cancers Effectiveness evidences Cost-effectiveness evidences From Asian evidences

31 Thanks for your attention