By Yang Chih-Hsin, National Taiwan University (NTU) College of Medicine professor, NTU Cancer Center Superintendent

In the beginning of 2021, the National Health Insurance Administration (NHIA) held an expert meeting on next-generation genetic sequencing (NGS) to discuss whether to include the emerging cancer diagnostic technology under the National Health Insurance (NHI) reimbursement scheme. As cancer treatment progresses towards precision medicine, the adoption of NGS will not only aid cancer diagnostics but also preserve Taiwan’s competitiveness in the global pursuit of new cancer drugs. However, due to the high cost of NGS, subsequent challenges will include identifying the specific genes relevant for each type of cancer and determining the most cost-effective methodologies.

At present, NGS testing could cost more than NT$100,000 in out-of-pocket charges for patients, a huge burden for many. Moreover, because genetic testing does not guarantee that viable targeted therapy drugs will be identified, many patients remain reluctant to shoulder the steep upfront costs. Consequently, most NGS are purchased by patients who can afford it, limiting the pool of patients who have access to experimental new drugs. As a result, the lack of access to experimental new drugs among disadvantaged groups has created another aspect of social inequality.

Currently, the penetration rate of genetic testing in Taiwan is lower than that of Japan and South Korea, while 30 to 50 percent of the cost of NGS is covered by the national health insurance reimbursement schemes of the two countries. For cancers that require genetic testing such as lung cancer, the NHI should earmark a budget to subsidize patients who are financially challenged. In addition, a copayment scheme should be considered to allow for more patients to get tested and subsequently gain access to effective checkups and treatments.

[2021-9-20/United Daily News]