Health literacy and all-cause mortality among cancer patients

Cost-utility evaluation of mammography screening program in Taiwan based on real-world data accounting for false positives

PURPOSE

We estimated stage-specific loss of quality-adjusted life expectancy (loss-of-QALE) and weighted by stage distributions considering false-positive (FP) costs for cost-utility evaluation of mammography screening in Taiwan.

METHODS

FP costs included related reimbursements by the National Health Insurance for inpatients' and outpatients' services within one year after positive screening without BC diagnosis. Using the EuroQol five dimensions questionnaire (EQ-5D-3L), we collected the utilities from 1,181 women who visited a medical center with 2,247 repeated measurements in 2011-2021. We used a rolling-over algorithm to extrapolate survival to lifetime to estimate QALEs by multiplying survival probability with utilities and the loss of QALEs by comparing with age- and calendar year-matched referents. We calculated the incremental cost-effectiveness ratio (ICER) yearly by comparing the stage proportion weighted sums of loss-of-QALE between women detected by screening versus non-screening within six-month observed intervals in 2004-2013.

RESULTS

QALEs of stages I, II, III, and IV were 29.4, 25.0, 18.2, and 4.5 years, respectively, while loss-of-QALEs were 0.3, 4.2, 10.6, and 22.9 quality-adjusted life year (QALYs), respectively. A total of 355,489 (11.1 %) FP were found with an average cost of US$ 2,126 per screen-detected BC. After the nationwide promotion of mammography in 2010-2013, ICER was US$ 855 per QALY.

CONCLUSION

The mammography screening, which exceeded 530,000 women with a 22 % coverage rate, showed promising cost-utility; the ICER was about one-third of the willingness-to-pay (WTP) of one gross domestic product per QALY. Future studies are warranted to explore the saving of productivity loss from a societal perspective.

Health literacy and all-cause mortality among cancer patients

BACKGROUND

The association between health literacy and all-cause mortality among cancer patients remains unclear.

METHODS

This is a retrospective cohort study of 9603 patients diagnosed with prostate, lung, breast, renal, colorectal, brain, head and neck, bladder, pancreatic, liver, sarcoma, and gastric cancers who were screened for health literacy between 2008 and 2018, using the Brief Health Literacy Screen (BHLS). Higher scores (range, 3-15) indicate higher health literacy. The association between all-cause mortality and health literacy was estimated using multivariable Cox proportional hazards models.

RESULTS

A total of 8608 (89%) patients were non-Hispanic White. The median follow-up was 3.1 years. Patients with a BHLS score of 15 had a median survival improvement of 9.4 months (95% confidence interval [CI], 6.0-13.2 months) compared to those with a score of 9. Lower BHLS scores (9 vs. 15) were associated with higher mortality in stages II (adjusted hazard ratio [aHR], 2.6 [95% CI, 1.5-5.1]) and III (aHR 2.9 [95% CI, 1.4-6.0]) prostate cancer; stages I (aHR 1.7 [95% CI, 1.1-2.5]) and IV (aHR, 1.6 [95% CI, 1.2-2.1]) lung cancer; stage I colorectal cancer (aHR, 2.2 [95% CI, 1.3-4.7]); stage I renal cancer (aHR, 1.8 [95% CI, 1.1-3.4]); stages I (aHR, 2.6 [95% CI, 1.3-7.1]) and IV (aHR, 1.7 [95% CI, 1.2-2.7]) head and neck cancer; stage II bladder cancer (aHR, 1.6 [95% CI, 1.0-2.8]); stage I liver cancer (aHR, 4.1 [95% CI, 1.9-9.3]); and all stages of breast cancer.

CONCLUSIONS

Lower health literacy was associated with higher all-cause mortality among patients with 12 different types of cancer, varying by cancer type and stage.