According to the 2005 Cause-of-Death Statistics and the 2003 Cancer Registry Annual Report published by the Department of Health, the number of people suffering from malignant renal tumors accounted for 1% (i.e. 628) of all malignant tumor cases, with the number of deaths being 459, about 1.3% of all cancer deaths. Of all malignant renal tumors, 90% were renal cell carcinoma (kidney cancer).
Drug treatments for cancer include chemotherapy, hormone therapy and immunotherapy. These drugs mainly act by interfering with cancer cell division and growth. Most tumors require new blood vessels to supply the need for growth. Therefore, if angiogenesis can be inhibited, cancer cell growth may be suppressed. Currently, there are various anti-cancer target drugs that can extend patients’ lives by 6 months to 1 year on average. Advanced renal cell carcinoma is a difficult-to-treat disease that usually does not respond to chemotherapy/hormone therapy and has poor treatment outcomes after surgical resection; hence immunotherapy will be considered to increase patients’ immune responses to tumors.
Nexavar®, a target drug used for renal cell carcinoma, is the first of its kind to be covered by National Health Insurance; its active mechanism is inhibition of tumor growth and angiogenesis. In a multi-country, multi-center, randomized, Phase III clinical trial for advanced renal cell carcinoma, analysis showed that the average median progression-free survival was 5.5 months. The Department of Health has currently approved Nexavar® for use only in treatment of advanced renal cell carcinoma, with the approved indications being “patients with advanced renal cell carcinoma not responding to treatment with interferon-alpha or interleukin-2, or not fit for treatment with these two drugs”. Therefore, when patients with advanced renal cell carcinoma fail to respond to the two types of immunotherapies noted above or are not suitable for these two, Nexavar® may be used once the contracted medical care institutions have applied to the Bureau of National Health Insurance for review and received approval. This offers a glimmer of hope to patients with advanced renal cell carcinoma seeking second-line treatment. Nexavar®, an oral tablet, is administered at a dosage of 400 mg (2×200-mg tablet) twice daily. Given that the estimated average treatment period is 23 weeks per patient and the drug costs NT$1,092 per tablet, the total drug expenditure for each patient will be about NT$700,000. In order to ensure patients’ rights to receive medication and alleviate their family’s economic stress, the Bureau of National Health Insurance (BNHI) has convened a meeting of medical and pharmaceutical experts and approved insurance payments for Nexavar® at a cost of about NT$60,000,000 a year.
The BNHI Drug Price Standards provides that drugs covered by National Health Insurance will only be reimbursed on the condition that they have been approved and registered by central health authorities and have acquired drug licenses, and drug usage has to comply with drug licenses and indications and the "Guidelines for Drug Benefits Under National Health Insurance" formulated by the insurer. As a result, National Health Insurance only covers Nexavar® when used in treatment of advanced renal cell carcinoma; other cancers have yet to be included.