Disparities in medical expenditure on advanced cancer care in Taiwan

Cancer imposes a substantial financial burden. Notably, the National Health Insurance (NHI) program of Taiwan does not cover all indicated treatments for cancer. This study explored differences in medical expenditure across various cancer types.

From the National Health Insurance Research Database and Taiwan Cancer Registry, we identified patients with a new diagnosis of advanced cancer of nine major types, namely breast, colorectal, cervical, esophageal, gastric, hepatocellular, lung, head and neck, and prostate cancer, between January 1, 2013, and December 31, 2017. We calculated their expenditure from diagnosis to death and compared the expenditure across cancer types.

Our analysis included 72,915 patients. Within the first 3 years after cancer diagnosis, patients with advanced breast cancer and colorectal cancer (CRC) had the highest mean total medical costs (US$49,243·3 and US$41,466·2 per person, respectively), whereas patients with esophageal cancer and gastric cancer had the lowest mean total medical costs (US$20,802·9 and US$21,954·1 per person, respectively). Additionally, within the first 3 years after diagnosis, patients with advanced breast cancer and CRC had the highest anticancer drug costs (US$26,062·6 and US$17,386·1 per person, respectively), whereas patients with esophageal cancer and cervical cancer had the lowest anticancer drug costs (US$702·0 and US$1742·6 per person, respectively). The highest and lowest survival-adjusted lifetime medical and anticancer drug costs were those for breast cancer and esophageal cancer, respectively.

Substantial disparity exists in the resource allocation for different cancer types in the NHI program. The reimbursement policy should be improved.

Policymakers should strengthen Taiwan's NHI reimbursement framework by applying explicit and consistent HTA criteria across cancer types, including clinical benefit, cost-effectiveness, budget impact, disease burden, and unmet medical need. Routine monitoring of cancer-specific expenditure, reimbursement coverage, and patient out-of-pocket burden may help identify under-resourced cancers and guide equitable yet sustainable resource allocation.