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Lessons learned from the reimbursement policy for immune checkpoint inhibitors and real-world data collection in Taiwan

Published online by Cambridge University Press:  21 December 2020

Li Ying Huang Open the ORCID record for Li Ying Huang [Opens in a new window]  and
Churn-Shiouh Gau
Li Ying Huang
Affiliation:
Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
Churn-Shiouh Gau*
Affiliation:
School of Pharmacy, National Taiwan University/Former Chief Executive Director, Center for Drug Evaluation, Rm. 402, No. 33, Linsen S. Rd., Taipei10050, Taiwan
*
Author for correspondence: Churn-Shiouh Gau, E-mail: csg@ntu.edu.tw
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Abstract

This paper describes the reimbursement policy for immune checkpoint inhibitors in Taiwan and provides a perspective to improve the quality, consistency, and transparency of decision making. Global trends for cancer treatment have shifted from chemotherapies to targeted therapies and immuno-oncology (IO) medicine, leading to significant increases in treatment costs. To enhance the accessibility of advanced therapy, the Taiwan National Health Insurance Administration announced two pathways for high-cost medicine: the managed entry agreement and a set of general rules of reimbursement submission for high-cost drugs. To further manage the financial burden on Taiwan's national health insurance system, the policy makers introduced novel inhibitory drugs for cancer immune checkpoints, subject to a maximum annual budget of NT$800 million (≈US$26.7 million). In April 2019, a national registry was established for patients undergoing cancer immunotherapy. Clinical characteristics, treatment duration, toxicity, and the outcome of the postcheckpoint inhibitor treatments were recorded. By analyzing real-world data, we assess the therapeutic effect of IO treatment in Taiwanese patients, thereby enabling payers to adjust payment regulations and rules for reimbursement. The Health Technology Assessment Team plays an important role in drawing upon the evidence to support policy making. Under an implemented cost-management mechanism, Taiwan's high-cost drug policy has enabled patients to access new medicines and maximized patient benefits.

Keywords

Immune checkpoint inhibitorsNational health insuranceHealth technology assessmentReal-world data
Type
Article Commentary
Information
International Journal of Technology Assessment in Health Care , Volume 37 , Issue 1 , 2021 , e26
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Shergold, AL, Millar, R, Nibbs, RJB. Understanding and overcoming the resistance of cancer to PD-1/PD-L1 blockade. Pharmacol Res. 2019;145:1–23.CrossRefGoogle ScholarPubMed
Nishijima, TF, Shachar, SS, Nyrop, KA, Muss, HB. Safety and tolerability of PD-1/PD-L1 inhibitors compared with chemotherapy in patients with advanced cancer: A meta analysis. Oncologist. 2017;22:470–9.CrossRefGoogle ScholarPubMed
Dranitsaris, G, Zhu, X, Adunlin, G, Vincent, MD. Cost effectiveness vs. affordability in the age of immuno-oncology cancer drugs. Expert Rev Pharmacoecon Outcomes Res. 2018;18:351–7.CrossRefGoogle ScholarPubMed
Ministry of Health and Welfare in Taiwan [Internet]. Taiwan's leading causes of death in 2018. 2018 [cited 2020 Jun 28]. Available from: https://www.mohw.gov.tw/cp-4650-50697-2.htmlGoogle Scholar
National Health Insurance Administration [Internet]. Taiwan's top ten costs of cancer treatment in 2018. Ministry of Health and Welfare in Taiwan 2018 [cited 2020 Jun 28]. Available from: https://www.nhi.gov.tw/Content_List.aspx?n=AE8F3C1B6EC35217&topn=23C660CAACAA159DGoogle Scholar
Wu, TY, Majeed, A, Kuo, KN. An overview of the healthcare system in Taiwan. London J Prim Care (Abingdon). 2010;3:115–9.CrossRefGoogle ScholarPubMed
IQVIA Institute [Internet]. Global oncology trends 2019: Therapeutics, clinical development and health system implications. 2019 May 30 [cited 2020 Mar 2]. Available from: https://www.iqvia.com/insights/the-iqvia-institute/reports/global-oncology-trends-2019Google Scholar
National Health Insurance Administration [Internet]. Taiwan's top ten costs of cancer treatment in 2014. Ministry of Health and Welfare in Taiwan 2014 [cited 2020 Jun 28]. Available from: https://www.nhi.gov.tw/Content_List.aspx?n=AE8F3C1B6EC35217&topn=23C660CAACAA159DGoogle Scholar
National Health Insurance Administration [Internet]. PBRS meeting minutes for medicine. Ministry of Health and Welfare in Taiwan 2019 January 24 [cited 2020 Jun 28]. Available from: https://www.Nhi.Gov.Tw/content_list.Aspx?N=33afe41ad952dd32&topn=5fe8c9feae863b46Google Scholar
Ministry of Health and Welfare in Taiwan [Internet]. National Health Insurance Administration. 2018 June 4 [cited 2020 Mar 2]. Available from: http://gtma.org.tw/upload/file/1/15311900430.pdfGoogle Scholar
Kao, K-L, Huang, L-Y, Wu, Y-H, Gau, C-S. Outcomes and impacts of 10-year HTA implementation in Taiwan. Int J Technol Assess Health Care. 2019;35:441–5.CrossRefGoogle ScholarPubMed
The International Network of Agencies for Health Technology Assessment (INAHTA) [Internet]. INAHTA Listserv questions and responses. C2020. Available from: http://www.Inahta.Org/listserv/#2017Google Scholar
Hasan, SS, Lu, CY, Babar, ZUD. Access to high cost medicines: An overview. In: Babar, ZUD, editor. Equitable access to high-cost pharmaceuticals. London: Academic Press; 2018. p. 1–10.Google Scholar
National Health Insurance Administration [Internet]. The addition of relevant regulations of the Managed Entry Agreement (MEA). Ministry of Health and Welfare in Taiwan 2018 September 17 [cited 2020 Mar 2]. Available from: https://www.nhi.gov.tw/News_Content.aspx?n=FC05EB85BD57C709&s=FCE5D1753D1BF7C2Google Scholar
National Health Insurance Administration [Internet]. Questions and answers on the payment of the immuno-oncology. Ministry of Health and Welfare in Taiwan 2019 [cited 2020 Mar 20]. Available from: https://www.nhi.gov.tw/content_list.Aspx?N=7157a9a3e2a3b110&topn=3fc7d09599d25979Google Scholar
National Health Insurance Administration [Internet]. The reimbursement policy of immune checkpoint inhibitors. Ministry of Health and Welfare in Taiwan 2019 [cited 2020 Mar 20]. Available from: https://www.nhi.gov.tw/content_list.Aspx?N=7157a9a3e2a3b110&topn=3fc7d09599d25979Google Scholar
National Health Insurance Administration [Internet]. The executive summary of immune checkpoint inhibitors real world data. Ministry of Health and Welfare in Taiwan 2019 [cited 2020 Mar 20]. Available from: https://www.nhi.gov.tw/content_list.Aspx?N=7157a9a3e2a3b110&topn=3fc7d09599d25979Google Scholar
Pasello, G, Pavan, A, Attili, I, Bortolami, A, Bonanno, L, Menis, J, et al. Real world data in the era of immune checkpoint inhibitors (ICIs): Increasing evidence and future applications in lung cancer. Cancer Treat Rev. 2020;87:102031.CrossRefGoogle ScholarPubMed
Oliva, M, Spreafico, A, Taberna, M, Alemany, L, Coburn, B, Mesia, R, et al. Immune biomarkers of response to immune-checkpoint inhibitors in head and neck squamous cell carcinoma. Ann Oncol. 2019;30:57–67.CrossRefGoogle ScholarPubMed
Jommi, C. Managed entry agreements and high cost medicines (European perspective). In: Babar, ZUD, editor. Equitable access to high-cost pharmaceuticals. London: Academic Press; 2018. p. 35–50.CrossRefGoogle Scholar
Aggarwal, A, Fojo, T, Chamberlain, C, Davis, C, Sullivan, R. Do patient access schemes for high-cost cancer drugs deliver value to society? Lessons from the NHS Cancer Drugs Fund. Ann Oncol. 2017;28:1738–50.CrossRefGoogle ScholarPubMed
Ferrario, A, Kanavos, P [Internet]. Managed entry agreements for pharmaceuticals: The European experience. Brussels, Belgium: EMiNet; 2013 [cited 2020 Oct 2]. Available from: http://eprints.lse.ac.uk/50513/Google Scholar
O'Rourke, B, Oortwijn, W, Schuller, T, International Joint Task Group. The new definition of health technology assessment: A milestone in international collaboration. Int J Technol Assess Health Care. 2020;36(3):187–90.CrossRefGoogle ScholarPubMed
Bullement, A, Podkonjak, T, Robinson, MJ, Benson, E, Selby, R, Hatswell, A, et al. Real-world evidence use in assessments of cancer drugs by NICE. Int J Technol Assess Health Care. 2020;36(4):388–94.CrossRefGoogle Scholar
Wenzl, M, Chapman, S [Internet]. Performance-based managed entry agreements for new medicines in OECD countries and EU member states: How they work and possible improvements going forward, OECD Health Working Papers, No. 115. Paris: OECD Publishing; 2019 [cited 2020 Mar 20]. Available from: https://doi.org/10.1787/6e5e4c0f-enCrossRefGoogle Scholar
Weale, A, Kieslich, K, Littlejohns, P, Tugendhaft, A, Tumilty, E, Weerasuriya, K, et al. Introduction: Priority setting, equitable access and public involvement in health care. J Health Organ Manag. 2016;30:736–50.CrossRefGoogle ScholarPubMed