The price of curing cancer

Background Health care systems around the world struggle with high prices for new cancer drugs. The purpose of this study was to conduct a gedankenexperiment and calculate how much health expenditures would change if a cure for cancer through pharmaceutical treatment were made available. The cancer cure was conceived to eliminate both cancer deaths and the underlying morbidity burden of cancer. Furthermore, the cure was hypothesized to arrive in incremental steps but at infinitesimally small time intervals (resulting, effectively, in an immediate cure). Methods The analysis used secondary data and was conducted from the viewpoint of the German social health insurance. As its underlying method, it used a cause-elimination life-table approach. To account for the age distribution of the population, the study weighted age-specific increases in remaining life expectancy by age-specific population sizes. It considered drug acquisition costs as well as savings and life extension costs from eliminating cancer. All cancer drugs that underwent a mandatory early benefit assessment in Germany between 2011 and 2015/16 and were granted an added benefit were included. Data on age- and gender-specific probabilities of survival, population sizes, causes of death, and health expenditures, as well as data on cancer costs were taken from the German Federal Office of Statistics and the German Federal Social Insurance Office. Results Based on the cause-elimination life-table approach and accounting for the age structure of the German population, curing cancer in Germany yields an increase in average remaining life expectancy by 2.66 life years. Based on the current incremental cost-effectiveness ratio of new cancer drugs, which is on average €101,493 per life year gained (€39,751/0.39 life years), the German social health insurance would need to pay €280,497 per insuree to eliminate cancer. Dividing this figure by current average remaining lifetime health expenditures yields a ratio of 2.07, which represents a multiplier of current health expenditures. Conclusions Eliminating cancer at current price levels would more than triple total health expenditures in Germany. As the current price of a cure requires a drastic reduction of non-health consumption, it appears that current prices for cancer drugs already on the market (i.e., small steps towards a cure) need careful reconsideration.

Geographic variation in gender gap among older adults in India and China: Application of a new ageing measure

A continuous rise in the life expectancy of females above that of the males among older adults in India and China may give an impression that the gender gap in health is decreasing. However, given the systemic bias against females in these countries across multiple facets, and the diversity across provinces, a fuller understanding of gender gap calls for (a) understanding the gender gap in multiple dimensions of health, and (b) understanding the variations across provinces. We estimate a multi-dimensional old-age threshold (MOAT) across provinces in India and China, that specifies different old-age thresholds for female and male populations after simultaneously accommodating for multiple dimensions related to their health. These aspects of health include remaining life expectancy, intellectual and functional health. We estimate the gender gap across provinces in these countries by differencing the MOAT of males against that of females. In addition, we also illustrate the gender gap across individual dimensions of health. Our results show that females in almost all the provinces of India and China have a lower MOAT than their male counterparts, showing an earlier advent of ‘old-age’ among females compared to males. The estimates based on remaining life expectancy shows gender gap in favor of females, but the estimates of multi-dimensional gender gap are higher and biased against females. A huge variation is seen across provinces, with Karnataka and Hubei showing lower levels of gender gap and Rajasthan and Yunnan showing higher gender gaps in India in China respectively.

The Great Migration and the Urban-Rural Divide: Lonely Life Expectancy in China

After decades of below replacement fertility, China is now experiencing rapid population aging and the lives of the growing older population are being shaped by massive social and economic change. Of particular importance, is the large-scale migration of working-age adults from rural areas to large cities in search of job opportunities. The departure of migrants from their rural hometowns has resulted in a large population of left-behind older men and women. This distinctively Chinese demographic phenomenon has spurred scholarly interest in the emotional well-being of this older left-behind population, but careful demographic description of aging, migration, grandparenting, and loneliness has yet to be conducted. We bridge this gap by describing the average remaining life spent lonely by older men and women in China. We use Sullivan’s method to calculate lonely life expectancy by urban/rural residence and by the migration status of adult children (as proxied by the presence or absence of coresiding children). We use data from the Harmonized version of the Chinese Health and Retirement Longitudinal Study and focus the analysis on adults aged 55-100. Preliminary results show that, at age 55, women on average spend 9% more of remaining life lonely than men and that rural men and women spend more of their remaining life lonely than their urban counterparts. We will extend these life table analyses by conducting multivariate analyses of the correlates of loneliness in urban and rural China to better understand the role of migration and grandparenting responsibilities.

Preliminary Study on the Remaining Life Estimation Method for Research Reactor Tank Liner

The reactor tank liner is one of the most crucial safety barriers in a research reactor as it retains the radioactive material released from the fuel during the accident condition. It also contains the primary coolant for fission heat removal. The integrity of the tank liner determines the service life of the research reactor. So far, the remaining life estimation of pressure vessels in nuclear power plants is more widely applied and established than that of the research reactor tank liner. Therefore, a study on the remaining life estimation method of the research reactor tank liner is needed to ensure the research reactor operation safety. This paper aims to preliminarily study several methods applied to estimate the remaining life of a research reactor tank liner. The preliminary study consists of a qualitative assessment and a quantitative assessment. The qualitative assessment aims to propose several techniques or methods applied in estimating the remaining life of the reactor tank liner. The quantitative assessment applies one of the remaining life estimation methods discussed in the previous assessment. Generally, the remaining life of the research reactor tank liner can be estimated using the theoretical method and the experimental method. The theoretical methods are applied by calculating the neutron fluence received by the tank liner or by analyzing the fracture mechanics using numerical modeling if the cracks or other defects exist. The calculation of atom displacement number (dpa), as a standard measure of the neutron-induced radiation damage of the materials, can support the neutron fluence calculation. The experimental method is conducted by measuring several parameters of the tank liner material, such as the corrosion rate or the mechanical properties. In the quantitative assessment, the remaining life estimation of the Kartini Reactor tank liner was performed by neutron fluence calculation method using MCNP6 computer code. The result shows that the maximum neutron fluence received by the tank wall is 2.950E+17 n/cm2 for 40 years operating period. By comparing the cumulative neutron fluence received for 40 years to the thermal neutron fluence limit value of 1.18E+23 n/cm2, the Kartini Reactor tank liner can still be used for the next 1.6E+07 operation years. The result of the quantitative assessment implicitly shows that the remaining life estimation of the tank liner needs to: 1) consider all defects experienced by the tank liner and all factors (e.g., thermal, radiation, chemical, cyclic loading) which affect the tank liner material condition, and 2) perform the combination of theoretical and experimental methods. For an open-pool type reactor, corrosion monitoring and corrosion rate measurement are essential to perform the remaining life assessment of the tank liner.

Grandparents in Italy: trends and changes in the demography of grandparenthood from 1998 to 2016

In this article we explore the last two decades of changes in the demography of grandparenthood in Italy, by means of a set of measures: the proportion of men and women becoming grandparents by age and time, the age at transition to grandparenthood and its crossing with a set of life events and the length of grandparenthood. We used data from the four waves of the Survey on Family and Social Subjects carried out by the Italian National Institute of Statistics in 1998, 2003, 2009 and 2016. Overall, the median age at which half of the population over 35 is made up of grandparents moved forward by at least 5 years during the two observed decades. The postponement of grandparenthood is evident in middle age: between 55 and 64 the ratio of grandparents to non-grandparents decreased significantly by about 10 per cent. Overall, among people who had ever had children, the median age at the transition to grandparenthood advanced by three years from 1998 to 2016, both for men (59 to 62) and women (54 to 57). This difference is greater than that observed for age at parenthood and equal to the advantage gained in terms of life expectancy at age 60. Thus, although grandparenthood has been postponed over the last two decades in Italy, the great gains in remaining life expectancy result in grandparent-grandchildren lifetime not being reduced.