轉移性攝護腺癌的預期壽命與醫療花費：2008-2019年台灣世代研究

劉品均、林益聖、歐宴泉、邱瑩明、許兆畬、童敏哲

童綜合醫院外科部泌尿科

Life Expectancy and Lifetime Cost for Synchronous Metastatic Prostate Cancer:  Taiwan National Cohort Study in 2008-2019

Pin-Chun Liu, Yi-Sheng Lin, Yen-Chuan Ou, Ying-Ming Chiu, Chao-Yu Hsu, Min-Che Tung

Dept. of Urology, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan

Purpose:

Prostate cancer (PCa) is the second most commonly diagnosed cancer worldwide and the 5th cause of death from cancer for men in Taiwan. The incidence of synchronous metastatic PCa in Taiwan is higher than U.S. and Europe. It is associated with enormous societal costs and health care despite a rising number of therapy and treatment in PCa. We aimed to present the latest synchronous metastatic PCa life expectancy (LE), loss of LE and lifetime cost in Taiwan.

Materials and Methods:

We analyzed PCa data based on Taiwan Cancer Registry and Taiwan’s National Health Insurance Research Database. Total 30,207 new cases of PCa were recorded during 2008-2019 nationwide. LE, estimated loss of LE and lifetime cost were stratified by age, cancer stage, Gleason score, grade group and serum PSA level at diagnosis. We compared life expectancy and healthcare cost outcomes between synchronous metastatic PCa patients in 3 age groups.

Results:

Three age groups (20-64, 65-74, 75-89) stratified by cancer stage are shown in table 1. There were 1,652 patients diagnosed with stage 4 of PCa younger than 64 years-old; 3,173 patients in ages 65-74 years and 5,024 patients in the group more than 75 years-old. Among 30,207 new cases, low to intermediate risk groups, high risk groups and regional and metastatic PCa accounted for 54.1%, 13.2% and 32.6% of cases, respectively. Considerable proportion of synchronous metastatic PCa was noted in Taiwan when compared with the U.S and Europe. 

For synchronous metastatic PCa, the highest LE is 9.22 years for ages 20-64 years, followed by ages 65-74 (8.29 years) and ages 75-89 years (4.58 years). Loss of LE in 3 groups are 13.63, 6.75 and 3.87 years, respectively. No statistical difference of loss of LE in normal population and stage 1 to 3 PCa is found. The healthcare cost of synchronous metastatic PCa in all age groups is higher than the average cost (NT$ 139,557) for prostate cancer patients in Taiwan.

Conclusion:

This study provided real-world evidence to support health care policy-making and clinical decision of PCa. Due to the characteristics of high proportion of synchronous metastatic PCa in Taiwan. This analysis emphasizes the importance of early detection of PCa which can save LE and decrease total cost burden of the healthcare system.