Estimation of the financial burden to the national health insurance for patients with major cancers in Taiwan

Background/Purpose: Almost all countries that have national health insurance schemes face financial challenges. A better understanding of the financial burden that cancer places on Taiwan's National Health Insurance (NHI) is important for helping policy makers to plan tinder scarce healthcare resources. This study attempts to estimate lifetime health expenditure for patients with 17 types of major cancers. Methods: A total of 425,294 patients, each of whom was registered in Taiwan during 1990 to 2001 as having one of 17 major types of cancers, were included. All of them were followed until the end of 2004. Monte Carlo simulation was used to extrapolate survival for up to 600 months to derive the life expectancy or lifetime survival function after diagnosis for different cancers. The average annual health expenditure per case for each cancer type was calculated by using data from the NHI's reimbursement database. The lifetime health expenditure per case was estimated by multiplying the monthly survival probability by the average monthly health expenditure, adjusting for the annual discount rate and the medical care inflation rate. By incorporating the number of annual incidence cases, the total lifetime health expenditure can also be estimated. Results: Of the 17 cancers studied, it was found that leukemia had the highest average annual health expenditure per case (207,000 TWD) as well as the highest lifetime health expenditure per case (2,404,000 TWD, without discounting adjustment). Breast cancer had the highest total lifetime health expenditure (5046 million TWD) because of the longer life expectancy and chronic morbidity. Furthermore, colorectal cancer had the second highest total lifetime health expenditure (4995 million TWD) due to its high incidence. Conclusion: The proposed method is a feasible way of estimating lifetime health expenditure for cancer patients even under high censoring rates. This would be helpful for cost-effectiveness assessment of cancer prevention programs and for policy planning.