Background: In December 2022, the Taiwan National Health Insurance Administration (NHIA) announced the reimbursement of three dosages of pemigatinib 4.5 mg, 9 mg, and 13.5 mg for treating advanced intrahepatic cholangiocarcinoma (ICC) with fibroblast growth factor receptor 2 (FGFR2) fusions/rearrangements and set the reimbursement price for pemigatinib 4.5 mg at NT$6600. This study aims to analyze the cost-effectiveness of pemigatinib 13.5 mg as a second-line treatment compared to mFOLFOX and 5-FU chemotherapy for advanced ICC patients with FGFR2 fusions/rearrangements from the perspective of Taiwan’s NHIA. Methods: This study used a 3-state partitioned survival model to analyze the 5 year cost-effectiveness of pemigatinib as a second-line treatment for advanced ICC patients in whom first-line gemcitabine-based chemotherapy failed and to compare the results with those for the mFOLFOX and 5-FU chemotherapy regimens. Overall survival and progression-free survival were estimated from the FIGHT-202 trial (pemigatinib), ABC-06 trial (mFOLFOX), and NIFTY trial (5-FU). The price of pemigatinib 13.5 mg was set at the potentially highest listing price (NT$17,820). Other parameters of utility, disutility, and costs related to advanced ICC were obtained from the published literature. The willingness-to-pay threshold was three times the forecasted gross domestic product per capita in 2022 (NT$2,928,570). A 3% discount rate was applied to quality-adjusted life-years (QALYs) and costs. Several scenario analyses were performed, including a gradual price reduction for pemigatinib. Deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA), and value of information were performed to assess uncertainty. Results: Pemigatinib was not cost-effective compared to mFOLFOX or 5-FU in the base-case analysis. When the price of pemigatinib was reduced by 50% or more, pemigatinib gained a positive net monetary benefit (mFOLFOX: NT$55,374; 5-FU: NT$92,437) and a 72% (mFOLFOX) and 77.1% (5-FU) probability of being cost-effective. Most of the uncertainty came from the medication cost of pemigatinib, health state utility, and the overall survival associated with pemigatinib. Conclusions: According to the NCCN guidelines, the daily use of pemigatinib 13.5 mg at the hypothesized NHIA price of NT$17,820/13.5 mg was not cost-effective compared to mFOLFOX or 5-FU. The price reduction scenario suggested a 50% price reduction, NT$8910 per 13.5 mg, for advanced ICC patients with FGFR2 fusions/rearrangements.

Care retention and medication adherence are crucial for individuals living with human immunodeficiency virus (HIV). Discrepancies exist between real-world evidence and randomized trials regarding early antiretroviral therapy (ART) initiation and care retention. We investigated the effects of same-day ART initiation on care and medication discontinuation in new patients with acquired immunodeficiency syndrome (AIDS) and those newly infected with HIV. The two groups commenced ART from January 2017 to December 2021 in Taiwan. Data were collected from the National Health Insurance claims database. We defined care discontinuation as having no clinical visits for over 90 days since the last clinical visit and medication discontinuation as failing to pick up medication 30 days after the expected medication pick-up date. We used a doubly robust weighted Cox regression model to estimate the average hazard ratio for same-day ART initiation compared to rapid ART initiation within 7 days over a 12-month care- and medication-discontinuation risk horizon. Among the 1528 HIV- and 5373 AIDS-group individuals, 1329 and 4494 initiated same-day ART, respectively. Same-day ART initiation did not impact care or medication discontinuation among HIV-infected patients. However, it was associated with a significantly lower hazard of care discontinuation (adjusted average hazard ratio [aAHR] = 0.86, 95 % CI: 0.74-0.99) and a higher, though not significant, hazard of medication discontinuation (aAHR = 1.14, 95 % CI: 0.86-1.52) among patients with AIDS. Same-day ART initiation demonstrates varying impacts on care and medication continuation. While it improves care retention, caution is advised regarding medication discontinuation among patients with AIDS.

Background/Objectives: Sugemalimab demonstrated clinical efficacy in the GEMSTONE-303 trial, but its cost-effectiveness remains unclear. This study aims to evaluate the cost-effectiveness of sugemalimab in combination with chemotherapy (CAPOX) as a first-line treatment for patients with advanced or metastatic gastric or gastroesophageal junction (G/GEJ) adenocarcinoma, compared to chemotherapy alone, from the perspective of Taiwan’s healthcare payer. Methods: A partitioned survival model was developed to simulate outcomes over a 40-year time horizon, and model parameters were derived from GEMSTONE-303 and the wider literature. Health benefits were measured in quality-adjusted life-years (QALYs), and only direct medical costs were included, with both discounted at an annual rate of 3%. The willingness-to-pay threshold was set at three times the 2024 GDP per capita. Deterministic and probabilistic sensitivity analyses were conducted alongside scenario analyses. Results: Compared to capecitabine and oxaliplatin (CAPOX) alone, adding sugemalimab yielded an incremental gain of 0.39 QALYs at an additional cost of USD 47,020, resulting in an incremental net monetary benefit of −USD 7478. Conclusions: Sugemalimab plus CAPOX is not cost-effective for advanced or metastatic G/GEJ adenocarcinoma from the Taiwan payer’s perspective. Achieving cost-effectiveness would require a 20–30% price reduction for sugemalimab (to USD 1204–USD 1376 per 600 mg), assuming first-line therapy is administered for the median treatment duration observed in the GEMSTONE-303 trial. If reimbursement continued until disease progression, a reduction of approximately 68% would be required (USD 550 per 600 mg).

Background: In this study, using Taiwan's National Health Insurance (NHI) as an example of a single-payer system, we examined the extent of pharmaceutical procurement profits (PPP) and evaluated their impact on the financial performance of healthcare institutions. Methods: We extracted data from financial statements and healthcare service declarations of NHI-contracted hospitals from 2015 to 2021. Financial data concerning PPP, health service profits (HSP), and total operating profits (TOP) from each hospital were analyzed. The impact of PPP on hospitals with positive and negative HSP was further investigated. Results: The total PPP across all hospitals studied gradually increased from NT$30.6 billion in 2015 to NT$47.0 billion in 2021. In 2021, 28.1% of all hospitals reported a deficit in HSP. PPP appeared to have a significantly positive impact on the financial performance of these hospitals. It not only enhanced positive profits, but also helped mitigate or completely offset the negative profits from HSP. The effect of PPP seems to be more pronounced for hospitals with larger HSP values, suggesting that larger hospitals benefit more from PPP in absolute terms. Discussion: Average PPP increased during the study period, increasingly affecting hospitals' financial stability across all strata. The gap between TOP and HSP in medical centers has gradually widened, suggesting an increase in non-health service profits. In this study, we propose a payment policy reform that fosters sustainability of the healthcare and financing system under universal health coverage and corrects the potential distortions caused by PPP.

Aims: Predetermined treatment duration limits (PTDLs) are often used by Taiwan's National Health Insurance Administration to contain healthcare costs, but they may compromise patient outcomes. Therefore, we studied Taiwan's 2017 extension of the bevacizumab PTDL from 24 to 36 weeks in metastatic colorectal cancer (mCRC) to evaluate whether prolonged treatment duration improves clinical outcomes, specifically treatment continuity, therapy duration and survival. Methods: We identified two cohorts based on initial bevacizumab prescription dates from the Taiwan Health and Welfare Database: PTDL‐24 weeks (1 April 2013–31 March 2016; n = 2051) and PTDL‐36 weeks (1 April 2017–31 March 2020; n = 2484). We assessed overall survival (OS), progression‐free survival (PFS) and time on treatment (ToT) for first‐line therapy over 2 years. A doubly robust approach was applied, including inverse probability of treatment weighting (IPTW) to balance covariates and Cox proportional hazards models adjusted for calendar year. A two‐stage residual inclusion (2‐SRI) model estimated the impact of the policy on bevacizumab duration and subsequent survival outcomes. Results: After IPTW adjustment, baseline characteristics were well‐balanced. The 36‐week PTDL policy was associated with improved PFS (adjusted hazard ratio: 0.814 [95% confidence interval: 0.691–0.959]) and ToT (0.821 [0.703–0.959]), but not OS (0.926 [0.751–1.142]). The 2‐SRI analysis showed the policy extended bevacizumab treatment by approximately 8 weeks and was associated with improvements in OS (0.912 [0.89–0.934]), PFS (0.941 [0.923–0.959]) and ToT (0.966 [0.95–0.984]). Conclusions: Relaxing the PTDL can extend bevacizumab treatment exposure, improving PFS and ToT.