Reported by Lee Shu-Jen

The immunotherapies for advanced lung cancer could be the NHI’s next step of reimbursement.  The NHIA held an expert meeting last Friday to discuss the priority of the reimbursement for the immunotherapies for cancers.  The experts listed three cancers in the order of reimbursement priority.  The first priority is given to melanoma, followed by squamous non-small cell lung cancer and EGFR mutation-negative non-small-cell lung cancer.

Dr Chen Yu-Min, President of Taiwan Lung Cancer Society and Director of the General Thoracic Department of the Taipei VGH, expressed that immunotherapy is the last hope of patients with advanced lung cancer; but the treatment is too expensive for any average family.

Dr Chen Yu-Min expressed that the dose of immunotherapy is determined by patient’s weight.  For a female patient of 50 kg in weight, two years treatments will cost about NT$ 5 million.  The cost rises to NT$7~8 million for a patient weighting 70~80 kg.   

The order of immunotherapy reimbursement priority suggested by the experts is as follows:  melanoma for 1st line treatment, squamous non-small cell lung cancer for 2nd line treatment, EGFR mutation-negative non-small-cell lung cancer for 3rd line treatment, Hodgkin's lymphoma for 3rd line treatment, urothelial cancer for 2nd line treatment, and head and neck squamous cell carcinoma.

According to Dr Kao Shang-Jyh, President of Taiwan Clinical Oncology Society, the NHI is going to include the immunotherapy for advanced lung cancer in the next update on the NHI reimbursement plan.  As advanced lung cancer has a very low survival rate and squamous non-small cell lung cancer and EGFR mutation-negative non-small-cell lung cancer are almost incurable, the NHI’s reimbursement for immunotherapy will benefit many patients.

Dr Kao explained that immunotherapy is based on precision medicine.  The principle is to deliver the effective drug to the right patient.  Due to the lack of standardized biomarkers that predict immunotherapy efficacy, the four cancer-related societies suggested adopting a “risk-sharing” scheme.

Dr Kao expressed that as the NHI resources are limited, this year the NHI only has NT$0.8-1 billion left to spend on treatments for lung cancer and other cancers after ring-fencing NT$0.2 billion for the immunotherapy for melanoma.  The NHI has to spend the budget wisely and efficiently.

Dr Kao suggested that the treatment should be provided under a “risk sharing” scheme sponsored by drug companies for patients with advanced cancer for a period of 3 months. If the treatment is effective, the NHI will pay for the treatment for the next 3 months.  The NHI-reimbursed treatment can be continued based on experts’ assessment of the patient’s treatment records.

【2018-09-10/ United Daily News】