Geographic Variations and Time Trends in Cancer Treatments in Taiwan

Abstract

BackgroundTargeted therapies have become important treatment options for cancer care in many countries. This study aimed to examine recent trends in utilization of antineoplastic drugs, particularly the use of targeted therapies for treatment of cancer, by geographic region in Taiwan (northern, midwestern, southern, and eastern regions and the outer islands).MethodsThis was a retrospective observational study of antineoplastic agents using 2009-2012 quarterly claims data from Taiwan’s National Health Insurance Research Database. Yearly market shares by prescription volume and costs for targeted therapies among total antineoplastic agents by region were estimated. We used multivariate regression model and ANOVA to examine variations in utilization of targeted therapies between geographic regions and used ARIMA models to estimate longitudinal trends.ResultsPopulation-adjusted use and costs of antineoplastic drugs (including targeted therapies) were highest in the southern region of Taiwan and lowest in the outer islands. We found a 4-fold difference in use of antineoplastic drugs and a 49-fold difference in use of targeted therapies between regions if the outer islands were included. There were minimal differences in use of antineoplastic drugs between other regions with about a 2-fold difference in use of targeted therapies. Without considering the outer islands, the market share by prescription volume and costs of targeted therapies increased almost 2-fold (1.84-1.90) and 1.5-fold (1.26-1.61) respectively between 2009 and 2012. Furthermore, region was not significantly associated with use of antineoplastic agents or use of targeted therapies after adjusting for confounders. Region was associated with costs of antineoplastic agents but it was not associated with costs of targeted therapies after confounding adjustments.ConclusionsUse of antineoplastic drugs overall and use of targeted therapies for treatment of cancer varied somewhat between regions in Taiwan; use was notably low in the outer islands. Strategies might be needed to ensure access to cancer care in each region as economic burden of cancer care increase due to growing use of targeted therapies.

Association between variations in the number of hospital beds and inpatient chemo/radiotherapy for breast cancer: a study using a large claim database

“…This study aimed to take the first step towards identifying the capacity for saving health resources in oncology care. To our knowledge, this is the first study to determine the association between the proportion of hospitalisation for inpatient chemo/radiotherapy treatment and staffed hospital beds per capita [17]. While a previous study described the regional variation in the proportion of chemotherapy cases in Taiwan, it did not examine the association between the proportion of chemo/radiotherapy cases and health resources [17].…”

“…To our knowledge, this is the first study to determine the association between the proportion of hospitalisation for inpatient chemo/radiotherapy treatment and staffed hospital beds per capita [17]. While a previous study described the regional variation in the proportion of chemotherapy cases in Taiwan, it did not examine the association between the proportion of chemo/radiotherapy cases and health resources [17]. Consistent with previous studies in other fields [9], our study revealed a positive association between the number of hospital beds and the proportion of hospitalisation for inpatient chemo/radiotherapy treatment for breast cancer, which extends the findings of the Taiwanese chemotherapy study.…”