Real-world results of immune checkpoint inhibitors from the Taiwan National Health Insurance Registration System

• Published in: European review for medical and pharmacological sciences Vol. 25; no. 21; p. 6548
• Main Authors: Hsieh, S-T, Ho, H-F, Tai, H-Y, Chien, L-C, Chang, H-R, Chang, H-P, Huang, Y-W, Huang, J-J, Lien, H-J, Huang, L-Y, Lee, P-C
• Format: Journal Article
• Language: English
• Published: Italy 01.11.2021
• Subjects: Aged; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Databases, Factual; Female; Humans; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; Kaplan-Meier Estimate; Male; Middle Aged; National Health Programs; Neoplasms - drug therapy; Neoplasms - mortality; Nivolumab - adverse effects; Nivolumab - therapeutic use; Registries; Retrospective Studies; Taiwan; Treatment Outcome; Taiwan
• ISSN: 2284-0729
• DOI: 10.26355/eurrev_202111_27097

Immune checkpoint inhibitors (ICIs) are a major advance in cancer treatment, but their payment benefits are unclear, resulting in financial risk. In Taiwan, the National Health Insurance Administration (NHIA) has adapted risk-sharing mechanisms to cover ICIs by collecting and assessing real-world evidence, such as case registration data, to adjust benefit packages for each medication, increase payment benefits of ICIs, and enable national health insurance sustainability. This nationwide, multicenter, retrospective cohort study assessed the real-world use, effectiveness, and safety of ICIs reimbursed by the NHIA for treating multiple advanced cancers in Taiwan. We obtained data mainly from the NHIA Immune Checkpoint Inhibitor Registry Database. Between April 1, 2019, and March 31, 2020, 1644 patients received at least one dose of ICIs. The overall response rate (RR) was 29.1%. The metastatic urothelial carcinoma of patients ineligible for chemotherapy showed the highest RR. The estimated median progression-free survival (PFS) was 2.8 months (95% confidence interval [CI]=2.7-3 months), and renal cell carcinoma showed the longest PFS. The median PFS was reached in patients with most cancers except classic Hodgkin's lymphoma, which had a small sample size. The estimated survival probability was 50%. Under the national registration tracking system, Taiwan's high-cost drug policy has enabled access to new medicines and maximized patient benefits.