Estimates of expected years of life lost and lifetime direct medical costs for malignant pleural mesothelioma patients: Data from Taiwan and New South Wales, Australia

[[abstract]]Background: Quantifying the burden of malignant pleural mesothelioma (MPM) is an important yet challenging task. Little is understood about the societal and economic costs following a diagnosis of MPM. We investigated survival, years of life lost, and direct medical costs associated with MPM using data from Australia and Taiwan. Methods: 159 and 136 MPM patients from New South Wales (NSW) Disease Dust Board data and Taiwanese Cancer Registry (TCR) data respectively were included in: (i) survival function analyses and (ii) analyses to estimate the years of life lost associated with a MPM diagnosis. Further, data on 428 patients from the Taiwanese National Health Insurance Research Database, and the NSW data linked to Medicare data, were also used to (iii) estimate lifetime healthcare expenditure following a MPM diagnosis. Results: (i) The mean age at MPM diagnosis in NSW was 71 and 60 in Taiwan. Median survival in months for NSW MPM patients was 11.7 (95% CI 9.3, 13.5) and 6.0 (95% CI 5.1, 7.8) for TCR patients. Four and eight percent of patients in NSW and Taiwan respectively were estimated to survive up to five years following a MPM diagnosis. (ii) The lifetime survival difference between the MPM patient cohort and a comparable population free of the disease was estimated to be 13.6 (95% CI 13.4, 13.8) years in the NSW cohort and 18.8 (95% CI 18.5, 19.1) years in the TCR cohort. (iii) Using national health insurance data in Taiwan, we estimated that the direct heath care costs following a MPM diagnosis to be USD$18,812. In NSW, this cost was estimated to be USD$20,573. Conclusion: We analysed MPM cohort data from Taiwan and Australia to estimate survival and expected life years lost, with possible differences in the age at diagnosis and median survival. We also analysed Taiwan and Australian data to estimate direct medical costs following a MPM diagnosis. The impact of selection bias in this study cannot be ruled out as there is likely under-ascertain-ment of MPM cases in the Taiwanese Cancer Registry and the NSW data is a subset of all MPM cases diagnosed in NSW. However, these estimates provide useful data to contribute to evidence-based clinical and policy decision-making in the area of MPM prevention and care services