Exploring the Determinants of Pharmaceutical Expenditure Growth: The Case of Cancer Drugs UNDER a Single-Payer System
Author(s)
Lin YS1, Cheng SH2
1Taipei Veterans General Hospital, Taipei, TPE, Taiwan, 2National Taiwan University, Taipei, Taiwan
OBJECTIVES: In light of population ageing and health technology innovation, cancer drug is one of the major contributors for pharmaceutical expenditure growth in many countries. This study aims to explore the determinants of cancer drug cost expansion in recent two decades and review the drug pricing policies of the single-payer system in Taiwan. METHODS: Data of fiscal year 2001, 2006, 2011 and 2016 of the Taiwanese National Health Insurance (NHI) Scheme was selected as study source and was obtained from the NHI Research Database. Two established methods for decomposition were employed in light of methodological advantages: the Fisher Ideal Index decomposition method (Morgan, 2004) and the decomposing formula developed by Patented Medicine Prices Review Board of Canada at 2013. Considering the defined daily doses established by WHO are generally unavailable for cancer drugs, the authors set uniformed daily dosage for each ingredient based on product information and/or clinical consensus to estimate drug volume in a more delicate way. Policies were reviewed from the prospective of NHI. RESULTS: The total expenditure of cancer drugs increased from USD$ 77.1 million in 2001 to USD $ 646.5 million in 2016. The contribution of novel agents, such as monoclonal antibodies and protein kinase inhibitors, surged from 29.0% to 83.6%. The decomposing analysis revealed that price effects were negative to drug expenditure growth (Period 1[2001-2006], 1.01; Period 2 [2006-2011], 0.79; Period 3 [2011-2016], 0.74). By contrast, therapeutic choices and volume effects had positive impacts, yet the degrees of effects were decreasing (Volume effects/Therapeutic choices: Period 1, 1.63/1.56; Period 2, 1.45/1.28; Period 3, 1.30/1.17). CONCLUSIONS: Patient volume was the major driver of cancer drug expense in Taiwan, followed by therapeutic choices. This finding may be associated with the established health technology assessment for insurance coverage and effective price control strategy under the single-payer scheme.
Conference/Value in Health Info
2020-09, ISPOR Asia Pacific 2020, Seoul, South Korea
Value in Health Regional, Volume 22S (September 2020)
Code
PDG23
Topic
Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Drugs, Oncology