This cohort study compares the risks of venous thromboembolism (VTE) recurrence in patients receiving non–vitamin K antagonist oral anticoagulants (NOACs) vs low-molecular-weight heparin in Asian individuals with cancer.

Purpose. Lung cancer has been the top-ranking cause of cancer deaths in Taiwan for decades. Limited data were available in global cancer surveillance regarding lung cancer epidemiology in Taiwan, and previous reports are outdated. Patients and Methods. This population-based cohort study extracted data of patients with lung cancer from the Taiwan National Health Insurance database and determined the lung cancer incidence and prevalence during 2002–2014. Histological subtypes were retrieved from the Taiwan Cancer Registry database; survival rates were gathered from the National Death Registry. Average annual percentage changes (APCs) of prevalence, incidence, and overall survival were estimated by joinpoint regression analysis. Results. Age-standardized incidence of lung cancer increased from 45.04 per 100,000 person-years in 2002 to 49.86 per 100,000 person-years in 2014, with an average APC of 0.7 (95% CI = 0.3–1.1; 0.2 in males, 2.0 in females). Lung cancer was more prevalent in male patients, but this increase gradually slowed down. Socioeconomic analysis showed that lung cancer has higher prevalence in patients with higher income level and urban residency. Adenocarcinoma was the most abundant histological subtype in Taiwan (adenocarcinoma-to-squamous cell carcinoma ratio = 4.16 in 2014), with a 2.4-fold increase of incident cases during 2002–2014 (from 43.47% to 64.89% of all lung cancer cases). The 5-year survival rate of lung cancer patients in 2010 was 17.34% (12.60% in male, 25.40% in female), with an average APC of 9.3 (6.3 in male, 11.8 in female) during 2002–2010. Conclusion. Average APCs of prevalence and incidence of lung cancer were 3.1 and 0.7, respectively, during 2002–2014 in Taiwan. The number of female patients and number of patients with adenocarcinoma have increased the most, with incident cases doubling in these years. Facing this fatal malignancy, it is imperative to improve risk stratification, encourage early surveillance, and develop effective therapeutics for lung cancer patients in Taiwan.

Background: Cancer patients with atrial fibrillation (AF) were excluded in the major clinical trials. We therefore investigated the efficacy and safety of novel oral anticoagulant (NOAC) versus warfarin in these patients. Methods: Data were retrieved from Taiwan National Health Insurance Research Database during 2010-2017 for patients with AF, excluding those without cancer or >1 cancer, not using anticoagulant, switching of agents, patients age <18, and cancer and AF diagnosed >1 month apart. Primary outcomes are ischemic stroke (IS)/systemic embolism (SE), GI bleeding, major bleeding, intracranial hemorrhage (ICH), acute myocardial infarction (AMI), and death from any cause at 6 months and 1 year. Results: After exclusion criteria and propensity score matching, there were 336 patients in each group. Patients on NOAC had significantly reduced IS/SE (HR=0.45, 95% CI=0.25-0.82), major bleeding (HR=0.21, 95% CI=0.05-0.96), and no ICH at 6 months. In addition, IS/SE (HR=0.42, 95% CI=0.24-0.74), major bleeding (HR=0.26, 95% CI=0.09-0.76), and no ICH at 1 year compared to patients on warfarin. There was no difference on GI bleeding, AMI, and death from any cause at 6 months and at 1 year. Conclusion: In cancer patients with AF, NOAC were associated with significant reduced IS/SE, major bleeding, and ICH compared to warfarin.

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Objective: To examine temporal trends of OOP expenses, total payments, facility fees, and professional fees for outpatient surgery. Summary Background Data: Approximately 48 million outpatient surgeries are performed annually with a limited financial understanding of these procedures. High OOP expenses may influence treatment decisions, delay care, and cause financial burden for patients. Methods: We conducted a retrospective cohort study of patients with employer-sponsored insurance undergoing common outpatient surgical procedures (cholecystectomy, cataract surgery, meniscectomy, muscle/tendon procedures, and joint procedures) from 2011 to 2017. Total payments for surgical encounters paid by the insurer/employer and patient OOP expenses were calculated. We used multivariable linear regression to predict total payments and OOP expenses, with costs adjusted to the 2017 US dollar. Results: We evaluated 5,261,295 outpatient surgeries (2011–2017). Total payments increased by 29%, with a 53% increase in facility fees and no change in professional fees. OOP expenses grew by 50%. After controlling for procedure type, procedures performed in ambulatory surgery centers conferred an additional $2019 in predicted total payments (95%CI:$2002–$2036) and $324 in OOP expenses (95%CI:$319–$328) compared to predicted cost for office-based procedures. Hospital-based procedures cost an additional $2649 in predicted total payments (95%CI:$2632–$2667) and $302 in predicted OOP expenses (95%CI:$297–$306) compared to office procedures. Conclusion: Increases in outpatient surgery total payments were driven primarily by facility fees and OOP expenses. OOP expenses are rising faster than total payments, highlighting the transition of costs to patients. Healthcare cost reduction policies should consider the largest areas of spending growth such as facility fees and OOP expenses to minimize the financial burden placed on patients.