OBJECTIVES: The expenditure of National Health Insurance (NHI) on cancer treatment has been growing significantly. However, doubts have been raised about whether the cancer treatments demonstrate ‘value for money’. This study aims to compare life years gained and medical costs increased between patients diagnosed with breast cancer in different periods, and to estimate the incremental cost per life year gained.

METHODS: Patients diagnosed with breast cancer during 2002-2009 and 2010-2013, were identified from Taiwan Cancer Registry, respectively. First, Cox proportional regression adjusted survival curve was assessed with death events identified from the Death Registry. Second, breast cancer related inpatient and outpatient claims for 5 years from initial diagnosis were retrieved from the NHI claims database and expenditures per year survived were calculated using generalized linear Gamma models by application of the Kaplan-Meier sample average (KMSA) method. Finally, medical costs and life expectancy for the two patient cohorts were compared. Two-sided 95%-confidence intervals were constructed using 1000 non-parametric bootstrap replications.

RESULTS: Cumulative survival for patients with breast cancer in 2002-2009 and 2010-2013 was 4 and 4.144 years as following through 5 years. The medical expenditure per case was NT$409,338 and NT$650,189 for 2002-2009 and 20010-2013 patient cohort, respectively. Average life expectancy rose by 0.144 years, and medical costs increased by NT$74,387-$240,851. Overall, costs per life-year gained was estimated to be NT$0.52-$1.67 million.

CONCLUSIONS: The cost of treating patients with breast cancer has risen considerably, yet the survival has improved simultaneously. Results of this study highlight the importance of considering outcomes and overall costs when assessing the value of new cancer drug treatment.