Presentation (CTI)

Problem Statement: Taiwan faced deep uncertainty in 2016 when committing to national DAA reimbursement for hepatitis C, with budget projections reaching NTD 600-800 billion at prevailing prices. The MOHW established a dedicated National Hepatitis C Program Office to operationalize the Minister’s 2025 elimination mandate, translating political commitment into evidence-based plans, implementation strategies, and outcome monitoring through sustained HEOR capacity across the full policy cycle.
Description: HEOR informed every phase of Taiwan's elimination program. At the planning stage, epidemiological modeling estimated 400,000 chronic HCV patients and projected treatment need; a natural history Markov model compared DAA, interferon, and no-treatment scenarios, projecting that reaching 250,000 treated patients by 2025 would reduce HCC cases by 24,000 and liver-related deaths by 54,000 by 2040. Budget impact analysis estimated NTD 45.7 billion in treatment and testing costs, offset by NTD 37.6 billion in avoided complication costs through 2040. At implementation, a national patient registry for all 173,747 reimbursed patients captured fibrosis stage, age, and SVR12 outcomes, enabling pharmaceutical risk-sharing agreements in 2017-2018. A real-time elimination monitoring network (TWNHCP-MIN) integrated NHI claims, screening, and seven subpopulation databases to generate monthly care cascade reports, identifying gaps and guiding adaptive policy adjustments. Retrospectively, a Markov-based ROI analysis valued 614,980 discounted QALYs at NTD 672 billion against NTD 28.7 billion in NHI spending, yielding an ROI of 22.4. By June 2025, Taiwan had achieved WHO Path to Elimination Gold Tier programmatic targets, with 90.2% of chronic HCV patients diagnosed and 92.6% of those diagnosed treated.
Lessons Learned: Four lessons emerged. First, front-loading HEOR investment at the policy design stage, through disease modeling and budget impact analysis, enabled credible target-setting and multi-year budget commitment under uncertainty. Second, registry-based risk-sharing reduced financial exposure while generating real-world effectiveness data. Third, integrated real-time monitoring with subpopulation disaggregation enabled adaptive management rather than static implementation. Fourth, retrospective ROI analysis reframes treatment expenditure as public investment, strengthening the evidence base for sustained universal access.
Stakeholder Perspective: Government (MOHW and NHIA, Taiwan)