Publications (3)8.08 Total impact
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Article: Long-term results of a randomized, observation-controlled, phase III trial of adjuvant interferon Alfa-2b in hepatocellular carcinoma after curative resection.
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ABSTRACT: To investigate the clinical efficacy of adjuvant interferon alfa-2b (IFNα-2b) therapy on recurrence-free survival (RFS) of patients with postoperative viral hepatitis-related hepatocellular carcinoma (HCC). Despite most individual trials have failed to meet their primary endpoint, recent pooled-data meta-analyses suggest that adjuvant IFN therapy may significantly reduce the incidence of recurrence in curatively ablated HCC. Patients with curative resection of viral hepatitis-related HCC were eligible, and were stratified by underlying viral etiology and randomly allocated to receive either 53 weeks of adjuvant IFNα-2b treatment or observation alone. The primary endpoint of this study was RFS. A total of 268 patients were enrolled with 133 in the IFNα-2b arm and 135 in the control arm. Eighty percent of them were hepatitis B surface antigen seropositive. At a median follow-up of 63.8 months, 154 (57.5%) patients had tumor recurrence and 84 (31.3%) were deceased. The cumulative 5-year recurrence-free and overall survival rates of intent-to-treat cohort were 44.2% and 73.9%, respectively. The median RFS in the IFNα-2b and control arms were 42.2 (95% confidence interval [CI], 28.1-87.1) and 48.6 (95% CI, 25.5 to infinity) months, respectively (P = 0.828, log-rank test). Adjuvant IFNα-2b treatment was associated with a significantly higher incidence of leucopenia and thrombocytopenia. Thirty-four (24.8%) of treated patients required dose reduction, and 5 (3.8%) of these patients subsequently withdrew from therapy because of excessive toxicity. Adjuvant IFNα-2b only temporarily suppressed viral replication during treatment period. In this study, adjuvant IFNα-2b did not reduce the postoperative recurrence of viral hepatitis-related HCC. More potent antiviral therapy deserves to be explored for this patient population. This study is registered at ClinicalTrials.gov and carries the identifier NCT00149565.Annals of surgery 11/2011; 255(1):8-17. · 7.90 Impact Factor -
Article: Medical resource utilizations and economic burden in Chinese cancer patients with chemotherapy-induced anemia: A populational database study
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ABSTRACT: ObjectiveMost of published studies emphasized the medical cost of treating chemotherapy-induced anemia (CIA) by using specific agents, for example, epoetin α, epoetin β, darbepoetin α or combined with red blood cell transfusions, however, the investigation of the overall medical resources utilizations and economic burden of CIA is still limited. Besides, such studies which emphasized Chinese population still lack. The aim of this study is to investigate the medical resource utilization and the economic burden of Chinese cancer patients with CIA by using a populational representative claim database. MethodsThe data for this study are from the 2000-2003 Population Health Insurance Research Database (PHIRD) in Taiwan. On the basis of issuing catastrophic illness cards in the enrollment data files, a total of 26,053 beneficiaries were identified from the PHIRD, who were newly diagnosed with these four cancers in 2001 and 2002 (2001: n=12,954; 2002: n=13099). A generalized linear model (GLM) was employed for analyzing the differences of medical resource utilization and economic burden between the anemic and non-anemic groups. ResultsAnalyses showed that the anemic patients were significantly more likely to have longer length of hospital stay than non-anemic patients (P<0.05) across all these four cancers and in two study periods (except women breast cancer in 2002/03). As regards the health care expenditures, the average one-year total medical cost was USD8,982 (2001/02) and USD8,982 (2001/02) and USD8,990 (2002/03) for anemic patients among these four cancers, and USD7,769 (2001/02) and USD7,769 (2001/02) and USD7713 (2002/03) for non-anemic patients (P<0.0001). As for ambulatory costs, anemic patients’ was significantly higher than non-anemic patients’ for lung cancer (in 2001/02), women breast cancer (in 2001/02 and 2002/03) and the summarized data (in 2001/02). As for inpatient costs, anemic patients’ was significantly higher than non-anemic patients’ for gastric cancer (in 2002/03), colon and rectal cancer (in 2001/02 and 2002/03), lung cancer (in 2001/02 and 2002/03), women breast cancer (in 2001/02) and the summarized data (in 2001/02 and 2002/03). ConclusionThis study is the first study to demonstrate that cancer patients who receive chemotherapy and with anemia utilize more medical resources and have heavier economic burden among Chinese cancer patients. Although the Population Health Insurance Program in Taiwan was established to provide more low-burdened medical care for all cancer patients, further effort is still needed to reduce the economic burden for cancer patients who have specific complications.Chinese Journal of Cancer Research 11/2008; 20(4):307-315. · 0.18 Impact Factor -
Article: Original Article 2001~2003 National Health Insurance (NHI) Reimbursement for Five Prevalent Cancers in Taiwan (Lung Cancer, Liver Cancer, Colorectal Cancer, Gastric Cancer and Women's Breast Cancer)
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ABSTRACT: Background: Since the inception of the National Health Insurance (NHI) in 1995, studies on NHI reimbursement for cancer treatment have been lacking. Published studies used the cost items from the Bureau of National Health Insurance (BNHI) database, however such cost items do not clearly reflect the real cost structure of cancer treatment, and therefore, further studies are needed. This study was aimed at studying: (1) the incidence trend of prevalent cancers in Taiwan; (2) the trend of cancer patients receiving chemotherapy; (3) the trend of BNHI claimed medical costs of prevalent cancers; (4) the trend and the cost structure of cancer treatments (di- vided into chemotherapy, hormone therapy and supportive treatment). Methods: This study adopted a retrospective observational design and the data were retrieved from the National Health Insurance Research Database (NHIRD), which is managed by the Na- tional Health Research Institutes (NHRI). This study linked the four main databases of NHIRD: CD, DD, OO and OD, to form a complete cancer research database. This study mainly adopted descriptive statistical methods to display data and time trend. In addition, this study used non- parametric regression to investigate the relationship between annual patient number and NHI reimbursement. Results: A total of 508,891 records (five prevalent cancers in three years) were eligible. The number of patients with lung cancer, liver cancer and gastric cancer showed remained stable in these three years, however, the number of patients with colorectal cancer and women's breast cancer showed an increasing trend in these three years. Women's breast cancer had the highest annual increase, followed by colorectal cancer. The number of cancer patients receiving che- motherapy also showed an increasing trend for the five cancers. The highest annual increase rate was seen for women's breast cancer, followed by colorectal cancer. The total amount of NHI reimbursement for these five cancers also showed an increasing trend, especially for women's breast cancer, which had the highest annual rate increase. The highest percentage of hormone therapy was for women's breast cancer (17%). The total amount of drug cost also showed an increasing trend for these five cancers, led by women's breast cancer. Lung cancer and breast cancer had the highest average outpatient cost for each patient per year (over NTD$35,000), while lung cancer, colon cancer and gastric cancer had the highest average inpa- tient cost for each patient per year (over NTD$150,000). Overall, the total outpatient and inpa- tient costs showed an increasing trend in recent years. Finally, the NHI reimbursement in- creased to NTD$140,000 for each lung cancer patient, NTD$110,000 for each colon cancer pa- tient and NTD$100,000 for each women's breast cancer patient.
