Breast Cancer Reimbursement Policy in Taiwan Mao-Ting Sheen Director Bureau of National Health...
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Transcript of Breast Cancer Reimbursement Policy in Taiwan Mao-Ting Sheen Director Bureau of National Health...
Breast Cancer Reimbursement Policy
in Taiwan
Mao-Ting SheenDirector
Bureau of National Health Insurance
Department of Health, Executive Yuan
November 10, 20111
Outline
• Current Status of Breast Cancer in Taiwan
• Medical Expenditures of Breast Cancer
• Reimbursement of Target-therapy Drugs
• The Breast Cancer Pay for Performance Pilot Program
2
Current Status of Breast Cancer in Taiwan
• The 2008 Cancer Registry Report published by the Department of Health in Taiwan indicated that breast cancer still had the highest incidence rate among all female cancers and appeared a gradually year-by-year rising tendency.
• The incidence rate and death rate of breast cancer in Taiwan took the 2nd rank in Asian countries.
• The prevalence of breast cancer has become a global trend. In recent years, it has an obvious trend that the patient’s age has been dropping in Asian countries.
The Long-term Trend in the Incidence of Female Breast Cancer in Taiwan
4
Source : Taiwan Cancer Registry http://tcr.cph.ntu.edu.tw/main.php?Page=A5B2
0
10
20
30
40
50
60
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
The
age
-adj
uste
d in
cide
nce
rate
per
hun
dred
th
ousa
nd
Year
The Age-specific Incidence Rate of Taiwan’s Female Breast Cancer (1981 ~
2005)
Source : Taiwan Cancer Registry http://tcr.cph.ntu.edu.tw/main.php?Page=A5B35
6
Inpatient Medical Expenses of Breast Cancer in Taiwan
Source: Medical claims database of BNHI
In-patient 2006 2007 2008 2009 2010
(million) (%) (million) (%) (million) (%) (million) (%) (million) (%)
Total Exp. 1,600 100.0% 1,745 100.0% 1,961 100.0% 2,052 100.0% 2,219 100.0%
Drug Fees 658 41.1% 714 40.9% 759 38.7% 803 39.1% 930 41.9%
Diagnosis Fees 60 3.8% 66 3.8% 75 3.8% 83 4.0% 89 4.0%
Inpatient Surgical Fees 192 12.0% 208 11.9% 233 11.9% 245 11.9% 256 11.6%
Ward Fees 190 11.8% 211 12.1% 235 12.0% 255 12.4% 271 12.2%
Inpatient Laboratory Fees
131 8.2% 143 8.2% 166 8.5% 182 8.9% 206 9.3%
Inpatient X-ray Fees 117 7.3% 130 7.5% 144 7.4% 162 7.9% 173 7.8%
Inpatient Therapeutic Procedure Fees &
Medical Devices Fees113 7.1% 127 7.3% 151 7.7% 156 7.6% 162 7.3%
Others 138 8.7% 145 8.3% 198 10.1% 167 8.1% 133 6.0%
Number of patients 11,715 12,966 14,388 15,620 16,659 Avg. admissions per patient
2.8 2.9 2.9 3.0 3.0 Avg. length of stay per patient
14.0 13.8 13.6 13.3 13.3
7
Outpatient Medical Expenses of Breast Cancer in Taiwan
Source: Medical claims database of BNHI
Out-patient 2006 2007 2008 2009 2010
(million) (%) (million) (%) (million) (%) (million) (%) (million) (%)
Total Exp. 2,642 100.0% 3,000 100.0% 3,447 100.0% 3,808 100.0% 4,649 100.0%
Drug Fees 1,381 52.3% 1,637 54.5% 1,839 53.4% 1,988 52.2% 2,577 55.4%
Diagnosis Fees 130 4.9% 140 4.7% 157 4.5% 176 4.6% 193 4.2%
Laboratory & Treatment Fees
1,067 40.4% 1,215 40.5% 1,434 41.6% 1,613 42.4% 1,830 39.4%
Others 64 2.4% 9 0.3% 18 0.5% 30 0.8% 48 1.0%
Number of patients 48,394 53,288 58,173 63,680 68,864
Avg. number of visits per patient
12.4 12.3 12.7 12.5 12.6
Reimbursement of Target-therapy Drugs for Breast Cancer
Trastuzumab ( Ex: Herceptin ) coverage• 2002/4/1 covered by NHI - used for metastatic breast cancer
(MBC) patients– Use alone : HER2 excessive expression(IHC 3+ 或 FISH+) and
received at least one time of chemotherapy(C/T) MBC patients
– Use combined with paclitaxel or docetaxel: HER2 excessive expression(IHC 3+ 或 FISH+) and has never received C/T MBC patients
– MBC and HER2excessive expression patients who has never used trastuzumab.
• 2010/1/1 expanded coverage to early breast ca. patients– Post surgery and C/T, early breast ca. patients with HER2 excessive
expression (IHC 3+ or FISH+), used as adjuvant therapy, and confined its use for less than one year.
9
Reimbursement of Target-therapy Drugs for Breast Cancer
Lapatinib ( Ex: Tykerb ): not covered yet
• Reason: due to high uncertainty in the
effectiveness of increasing survival rate and the
total budget impact, this drug has not been
covered till date.
10
The Drug Expenses of Trastuzumab
11
Note: Use rate is defined as the rate of the patients who has ever used trastuzumab among the total number of breast cancer patients.
Year
Patient who has ever
used Trastuzumab
Use rateTrastuzumab drug
expenses(million)
Share of all medical cost
Share of all drug cost
2006 771 1.6% 282 6.7% 13.8%
2007 1038 1.9% 397 8.4% 16.9%
2008 1169 2.0% 481 8.9% 18.5%
2009 1403 2.2% 617 10.5% 22.1%
2010 2829 4.1% 1,372 20.0% 39.1%
Pay for Performance Pilot Program
12
Requirement in ProcessParticipation rate of casesCompletion rate of disease management for new patientsCompletion rate of disease management for old patientsAnnual assessment of disease management completion rateThe degree of adherence to the treatment guidelines
Requirement in OutcomeExtra payment based on the performance of quality indicatorsDisease free survival rate, Overall survival rate
Payment Incentives for P4P ProgramPayment Incentives:Fee for Service + Performance Bonus
Performance Bonus calculation:1.The bonus depends on the performance of the disease free survival rates in the stage 0 to 3 and the overall survival rate in the stage 4 in 5 years after treatment as indicated in the table.2. It is paid annually in percentage of the annual total payment amount calculated based on FFS if the required standard is met.
13
Pathological stage First yr. Second yr. Third yr. Fourth yr. Fifth yr.
Stage 0(Disease free survival rate) 97% 94% 93% 93% 93%
Stage 1(Disease free survival rate) 97% 93% 89% 88% 86%
Stage 2(Disease free survival rate) 95% 86% 80% 78% 75%
Stage 3(Disease free survival rate) 85% 70% 50% 45% 40%
Stage 4(Overall survival rate) 64% 33% 23% 18% 10%
Extra bonus on top of FFS 2% 3% 4% 6% 7%
Participation of P4P Program
14
2005 2006 2007 2008 2009 2010
Number of cases
5,852 6,927 8,438 9,807 10,743 11,678
Participation rate
12.09% 12.98% 13.60% 14.64% 14.50% 14.62%
Note: Since the requirement and calculation of performance bonus was quite complicated, hospitals were not willing to partake.
Results of P4P Program
15
Use Kaplan-Meier or life table to calculate survival rate as of 2010
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4
99% 98% 95% 87% 71%
5-year disease free survival rate
Results of P4P Program
16
Local recurrence rate after breast cancer surgery
This indicator is defined as the rate of the number of cases
occurred local recurrence (including supraclavicular lymph
nodes) among the total number of patients who performed
either partial or whole breast mastectomy. According to the
results of the hospitals which joined the pilot project, the
local recurrence rate was less than 2% annually , and five-
year local recurrence rate was less than 10%.
Results of P4P Program
17
Re-treatment rate of breast cancer after surgery
This indicator refers to the rate of the number of cases who
received repeated chemotherapy or radiation therapy after
partial or whole breast mastectomy among the total number of
patients who performed either partial or whole breast
mastectomy. According to the results of the hospitals which
joined the pilot project, the re-treatment rate within 18 months,
24 months and 30 months were less than 10%, 15% and 20%,
respectively.
Conclusions
18
The incidence of breast cancer in Taiwan has increased year
by year. And there’s a tendency that the patient age has been
obviously dropping in recent years.
The government has made promotion and provided funding for
early screening.
The National Health Insurance has also put helpful drugs,
exams and treatment items into coverage.
Strong activities of private society involved.
I believe with the joint efforts of government, medical
providers and private support groups, the prevention and
treatment of breast cancer will generate more effective results.