Health-related Quality of Life and Cost-effectiveness Evaluation in Colorectal Cancer Patient One Year after Surgery

• Main Authors: Chi-Lin Wan, 萬紀伶
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/abp8zt

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 103 === Background Colorectal cancer (Colorectal Cancer, CRC) is the second common cancer in the world. The incidence of CRC is top at all cancers, and CRC also ranked third leading causes of death. Medical outcomes, health utilization as well as health-related quality of life had been deserving attention in recent years. The thesis has three aims : first, to explore the trends of Health-related quality of life (HRQOL) and factor associated with for CRC patient underwent surgical treatment; secondly, to explore the factors of long-term survival; and thirdly, to conduct cost-effectiveness analysis for different surgical approaches one year after surgery. Method The study adopted prospective and retrospective study design. The study sample was CRC patients underwent surgery during January 2010 to December 2013 at one southern medical center. Data Sources included patient clinical parameters derived from chart review, medical utilization obtained from hospital claim data, and HRQOL were obtained from patients’ survey at pre-operation, 1-month, 3-month, 6-month, 12-month post operation. HRQOL instruments were used European Organization for Research and Treatment Quality of life Questionnaires (EORTC QLQ-C30), Functional Assessment of Chronic Illness Therapy (FACT-C) and Hospital Anxiety and Depression Scale (HADS). We used chi-square test, independent samples t-test, Cox regression analysis by using SPSS 20.0 version. Generalized Estimating Equations (GEE) and bootstraps by STATA 11.0 version, was used to evaluate long-term trends and factor associated with HRQOL and cost-effectiveness for different operation one year after surgery. Results The patients with mean age 66.0 years old (SD=12.0). There was 46.6% patients received traditional open laparotomy. Patients overall generic quality of life (QLQ-C30) were 55.47、60.31、65.15、69.04、69.94 at pre-Op, 1-month, 3-month, 6-month, 12-month after operation. Cancer specific measure (FACT-C) were 78.37、81.87、84.65、87.46、88.87 respectively. Patients anxiety score were 4.05、2.21、1.56、1.24、1.00, whereas depression scale were 3.07、2.20、1.78、1.52、1.42. Overall, the HRQOL score have been increasing over time. After adjusting time and other covariates, age, AJCC stage, surgery mode and complication were significant predictors of HRQOL. No difference in HRQOL in patients received Laparoscopic and conventional surgery, however, difference was found between mini and conventional. With respect to long-term outcome, surgery mode, complication, pre-Op Cancer specific quality of life (FACT-C) and psychological stress (HADS) were the factors associated survival. Result indicated that higher pre-Op quality of life and lower anxiety significantly decreased risk of death (hazard ratio 0.98 and 0.87), on the other hand, higher pre-Op depression significantly increased risk of death (hazard ratio, 1.15). The cost-effectiveness analysis indicted that compared with conventional laparotomy, mini-laparotomy patients per QALYs saved 789,687 NT$ for total medical expenses one year after surgery. Compared with conventional laparotomy, laparoscopic surgery patients per QALYs saved 170,702 NT$ for total medical expenses one year after surgery. Conclusions CRC patients had improved their quality of life after surgery and the trends were significant in both physical and mental quality of life. Operative techniques were the important factor associated with health quality of life and overall survival. The surgical complication was also significant factor with HRQOL. The clinical team is suggested to have attention on the post-operative care to improve quality of life for CRC patients. The studies found that Mini-laparotomy not only enhanced the Life years and QLAYs, but also saved total medical cost. The ICER analysis concluded that surgical innovation achieved quality of care and efficient of care. The cross-institutional learning is recommended for the related society.