According to the analysis of lung cancer treatment policies in the Asia Pacific region published by the Economist Intelligence Unit (EIU), Taiwan needs to improve the NHI reimbursement policies and the access of new drugs for lung cancers. In Taiwan, since the majority of lung cancer patients are in late stage, it increases the difficulty in treatments. In recent years, the effects of new cancer drugs have improved significantly. However, the NHI sets strict reimbursement criteria for new drugs because of the NHI financial strain. Dr Lee Po-Chang, the Director-General of the NHIA, reckoned that there should be a discussion about the co-payment for new cancer drugs in order to solve the NHI financial problems.
According to Dr Yang Chih-Hsin, the Superintendent of the NTU Cancer Center, before the invention of target therapies, the median survival time for patients who received chemotherapy was 9-12 months; and the 5-year median survival rate was 1%-3%. The discovery of target therapies made a major breakthrough in cancer treatment. It has increased the 5-year survival rate to 30%-50%. So far, 7 target therapies have already been approved in Taiwan.
Target therapies are for patients with mutant genes. For those patients without mutant genes, immunotherapy offers an option. Dr Yang pointed out that 4 immunotherapies which target on PD-1 or PD-L1 have been approved in the US; but the authority in Taiwan only provides immunotherapies for patients with high PD-L1 protein expression. Despite the fact that it is an international trend to provide treatments of the combination of immunotherapy and chemotherapy, the NHI has not yet included such a combination use in the NHI Benefit Scheme.
Dr Yang expressed that use immunotherapies as the first line treatment could result in a 5-year survival rate of 32%. Without it, the survival rate could be just 1%-2%. Luckily, the NHI started reimbursing immunotherapies from 2019, though it is a bit later than some countries.
Dr Lai Jun-Liang, the President of Taiwan Clinical Oncology Society, reckoned that new drugs could increase the survival rate; however, it imposes a greater threat to the NHI finance. If the NHI reimbursement policy has not been brought into line with international treatment guidance, patients’ survival rate will become worse in the future.
Dr Chen Li-Tzong, the President of Taiwan Oncology Society, said that, in the future, cancers will become a chronic disease which requires long-term treatments. Whether the government is able to pick up such a big bill is still questionable. Dr Chen and the Hope Foundation, which represents cancer patients, suggested that the government should consider adjusting the co-payment system and introducing commercial insurance policies in order to help cancer patients. Dr Lee Po-Chang stated that it is necessary to have a thorough discussion about the co-payment system.
【2020-12-17 / United Daily】
