An analysis of policy options to tackle the problem of expanding expenditure in public healthcare in Hong Kong

1999 ◽  
Author(s):  
Wai-ping, Tiki Hon
Keyword(s):  
Hong Kong ◽  
Public Healthcare ◽  
Policy Options

scholarly journals EGFR mutation-guided use of afatinib, erlotinib and gefitinib for advanced non-small-cell lung cancer in Hong Kong – A cost-effectiveness analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247860
Author(s):  
Joyce H. S. You ◽  
William C. S. Cho ◽  
Wai-kit Ming ◽  
Yu-chung Li ◽  
Chung-kong Kwan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hong Kong ◽  
Egfr Mutation ◽  
Small Cell ◽  
Gdp Per Capita ◽  
Public Healthcare ◽  
Small Cell Lung ◽  
First Line ◽  
Per Capita ◽  
Empirical Chemotherapy

Introduction Tyrosine kinase inhibitors (TKIs) therapy targets at epidermal growth factor receptor (EGFR) gene mutations in non-small-cell lung cancer (NSCLC). We aimed to compare the EGFR mutation-guided target therapy versus empirical chemotherapy for first-line treatment of advanced NSCLC in the public healthcare setting of Hong Kong. Methods A Markov model was designed to simulate outcomes of a hypothetical cohort of advanced (stage IIIB/IV) NSCLC adult patients with un-tested EGFR-sensitizing mutation status. Four treatment strategies were evaluated: Empirical first-line chemotherapy with cisplatin-pemetrexed (empirical chemotherapy group), and EGFR mutation-guided use of a TKI (afatinib, erlotinib, and gefitinib). Model outcome measures were direct medical cost, progression-free survival, overall survival, and quality-adjusted life-years (QALYs). Incremental cost per QALY gained (ICER) was estimated. Sensitivity analyses were performed to examine robustness of model results. Results Empirical chemotherapy and EGFR mutation-guided gefitinib gained lower QALYs at higher costs than the erlotinib group. Comparing with EGFR mutation-guided erlotinib, the afatinib strategy gained additional QALYs with ICER (540,633 USD/QALY). In 10,000 Monte Carlo simulations for probabilistic sensitivity analysis, EGFR mutation-guided afatinib, erlotinib, gefitinib and empirical chemotherapy were preferred strategy in 0%, 98%, 0% and 2% of time at willingness-to-pay (WTP) 47,812 USD/QALY (1x gross domestic product (GDP) per capita), and in 30%, 68%, 2% and 0% of time at WTP 143,436 USD/QALY (3x GDP per capita), respectively. Conclusions EGFR mutation-guided erlotinib appears to be the cost-effective strategy from the perspective of Hong Kong public healthcare provider over a broad range of WTP.

scholarly journals Incidence and Demographics of Nasopharyngeal Carcinoma in Cheung Chau Island of Hong Kong—A Distinct Geographical Area With Minimal Residential Mobility and Restricted Public Healthcare Referral Network

2021 ◽  
Vol 28 ◽  
pp. 107327482110471
Author(s):  
Sik-Kwan Chan ◽  
Sze-Chun Chau ◽  
Sum-Yin Chan ◽  
Chi-Chung Tong ◽  
Ka-On Lam ◽  
...  
Keyword(s):  
Hong Kong ◽  
Nasopharyngeal Carcinoma ◽  
Residential Mobility ◽  
Geographical Area ◽  
Progression Free Survival ◽  
Public Healthcare ◽  
Cancer Specific Survival ◽  
Tertiary Center ◽  
Similar Survival ◽  
Underlying Mechanisms

Background Nasopharyngeal carcinoma (NPC) is endemic in Hong Kong with a skewed geographical and ethnic distribution. We performed an epidemiological study of NPC in Cheung Chau Island, a fishing village with very minimal residential mobility, and compared its demographics and survival with the rest of Hong Kong. Methods NPC data in Cheung Chau and non–Cheung Chau residents between 2006 and 2017 treated in our tertiary center were collected. The incidence, stage distribution, and mortality of Cheung Chau NPC residents were compared with those of their counterparts in the whole Hong Kong obtained from the Hong Kong Cancer Registry. Propensity score matching (PSM) was performed between Cheung Chau and non–Cheung Chau cases in a 1:4 ratio. Overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS) were compared between these two cohorts by product limit estimation and log-rank tests. Results Sixty-one patients residing in Cheung Chau were identified between 2006 and 2017. There was a significantly higher NPC incidence ( P < .001) but an insignificant difference in the mortality rate in Cheung Chau compared to the whole Hong Kong data. After PSM with 237 non–Cheung Chau patients, the Cheung Chau cohort revealed a stronger NPC family history ( P < .001). However, there were no significant differences in OS ( P = .170), PFS ( P = .053), and CSS ( P = .160) between these two cohorts. Conclusion Our results revealed that Cheung Chau had a higher NPC incidence but similar survival outcomes compared to the whole of Hong Kong. Further prospective studies are warranted to verify this finding and to explore the possible underlying mechanisms.

scholarly journals Incidence and Demographics of Nasopharyngeal Carcinoma in Cheung Chau Island of Hong Kong – A Distinct Geographical area with Minimal Residential Mobility and Restricted Public Healthcare Referral Network

2021 ◽  
Author(s):  
Sik-Kwan Chan ◽  
Sze-Chun Chau ◽  
Sum-Yin Chan ◽  
Chi-Chung Tong ◽  
Ka-On Lam ◽  
...  
Keyword(s):  
Hong Kong ◽  
Nasopharyngeal Carcinoma ◽  
Residential Mobility ◽  
Geographical Area ◽  
Progression Free Survival ◽  
Public Healthcare ◽  
Cancer Specific Survival ◽  
Tertiary Center ◽  
Product Limit ◽  
Similar Survival

Abstract Background: Nasopharyngeal carcinoma (NPC) is endemic in Hong Kong with a skewed geographical and ethnic distribution. We performed an epidemiological study of NPC in Cheung Chau Island, a fishing village with very minimal residential mobility, and compared its demographics and survival with the rest of Hong Kong.Methods: NPC data in Cheung Chau and non-Cheung Chau residents between 2006 and 2017 treated in our tertiary center were collected. The incidence, stage distribution and mortality of Cheung Chau NPC residents were compared with those of their counterparts in the whole Hong Kong obtained from the Hong Kong Cancer Registry. Propensity score matching (PSM) was performed between Cheung Chau and non-Cheung Chau cases in a 1:4 ratio. Overall Survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS) were compared between these two cohorts by product limit estimation and log-rank tests.Results: Sixty-one patients residing in Cheung Chau were identified between 2006 and 2017. There was a significantly higher NPC incidence (P<0.001) but insignificant difference in mortality rate in Cheung Chau compared to the whole Hong Kong data. After PSM with 237 non-Cheung Chau patients, Cheung Chau cohort revealed a stronger NPC family history (P<0.001). However, there were no significant differences in OS (P=0.170), PFS (P=0.053), and CSS (P=0.160) between these two cohorts.Conclusion: Our results revealed that Cheung Chau had a higher NPC incidence but similar survival outcomes compared to the whole Hong Kong. Cheung Chau can provide an excellent model for further studies on NPC oncogenesis and screening.

scholarly journals Hospital mortality in patients with rare diseases during pandemics: lessons learnt from the COVID-19 and SARS pandemics

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Claudia Ching Yan Chung ◽  
Wilfred Hing Sang Wong ◽  
Brian Hon Yin Chung
Keyword(s):  
Hong Kong ◽  
General Population ◽  
Hospital Mortality ◽  
Rare Disease ◽  
Rare Diseases ◽  
Resource Scarcity ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Age Related ◽  
Related Mortality

Abstract Background The threat and experience of pandemics occur differently for different groups. The rare disease population is at particular risk of being further marginalised during pandemics. In this study, our objective was to assess the hospital mortality patterns in the rare disease and the general populations during the coronavirus disease of 2019 (COVID-19) and severe acute respiratory syndrome (SARS) pandemics in Hong Kong. Methods All admission records during the COVID-19 pandemic (January 23–August 23, 2020) and SARS pandemic (March 11–June 30, 2003) were extracted from the local public healthcare database. Patients with rare diseases were identified using one or more of the 1084 10th version International Classification of Diseases and Related Health Problems (ICD-10) codes cross-referenced with 467 ORPHAcodes. Hospital mortality patterns were compared in patients with and without COVID-19/SARS infection. Admission records during the same period in 2019 and 2002 were retrieved for comparison. Results During the COVID-19 pandemic, 407,219 patients were admitted to one or more of the 43 public hospitals in Hong Kong, of which, 13,894 were patients with rare diseases (3.4%). A total of 4381 and 77 patients from the general and rare disease populations were infected with COVID-19. Rare disease patients had an adjusted 3.4 times odds of COVID-19-related hospital mortality compared with that of the general population (95% C.I. 1.24–9.41). COVID-19-related mortality was almost exclusively seen in patients ≥ 60 years. While age-related increase in mortality was also observed for the general population during the SARS pandemic, the pattern observed in the rare disease population was significantly different, with a 12.5 times higher SARS-related mortality observed in rare disease patients ≤ 18 years than those in the general population (12.5% vs 1.0%). Patients admitted during the same pandemic periods without coronavirus infection had a significantly higher hospital mortality compared with those admitted one year before the pandemic (p < 0.001). Conclusion This population-based study demonstrated the differential impacts of the COVID-19 and SARS pandemics on the rare disease population. In the era of budget and resource scarcity, this study warrants cautious healthcare planning, with consideration of the rare disease population in healthcare prioritisation.

Sign in / Sign up

Export Citation Format

Share Document