Changes in Utilization of Antiretroviral Therapy and Outcomes of AIDS Patients in Taiwan Before and

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Changes in Utilization of Antiretroviral Therapy
and Outcomes of AIDS Patients in Taiwan Before
and after the New AIDS Therapy Reimbursement
Scheme
ICIUM, Chiang Mai, Thailand, March 30-April 2,
2004

• Hong-jen Chang, MD, MPH, MS
• CEO and President
• Bureau of National Health Insurance
• Taipei, Taiwan

www.nhi.gov.tw
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Contents

• A brief introduction to Taiwans
• Profile of Taiwan
• National Health Insurance
• Utilization of Antiretroviral Therapy and
  Outcomes of AIDS Patients

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(No Transcript)
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Health Indices, 2002

• Crude Birth Rate 11.02 0/00
• Crude Death Rate 5.73 0/00
• Natural Increase Rate 5.29 0/00
• Infant Mortality Rate 5.35 0/00
• Maternal Mortality Rate 7.68 0/0000
• Life Expectancy 73.03 Male
• 78.82 Female

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National Health Expenditures as in GDP 1983-2002
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• "The average citizen pays 20 U.S. dollars per
  person, per month."
• "They can go to any doctor, any hospital they
  want. They pay, on the average, two U.S. dollars
  and a maximum of about 10 U.S. dollars each
  visit. And we don't have a waiting list."
• Hong-jen Chang, ABC News October 25, 2003

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Taiwan AIDS Utilization Study TAU Study
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HIV/AIDS cases by year of diagnosis, 1984-2003
NHI Scheme for AIDS medical care
Combination therapy for all clinically indicated
patients
Mandatory testing for all donated blood
AIDS Act
1st AIDS case
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Study Design

• Longitudinal Follow-up Design
• Data set
• NHI claims data
• CDC HIV/AIDS registry data
• National Death Certificate
• Measurement
• Survival and mortality rate
• Inpatient utilization
• OPD Adherence
• Incidence Trends of 7 major AIDS defining OI

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Study time line
Observation Period
Pre-HAART 19901996
Early-HAART 19971998
Late-HAART 19992001
Subject Enrollment Grouping by HAART era
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OPD Adherence Definition

• Background under NHI Scheme
• No. of visits in regular OPD follow up 8 times
  per year
• Definition of OPD Adherence
• None no OPD visit record
• Poor 1-2 times / year
• Fair 3-4 times / year
• Good 5 times / year

8 times per year
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Proportion of AIDS by year of diagnosis
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Proportion of Risk Factors by year of diagnosis
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Sex Ratio by year of diagnosis
Year
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Survival after AIDS-defining OI Diagnosis
by HAART era
Late 1999-2002 (n687)
Early 1997-1998 (n286)
Pre 1990-1996(n399)
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OPD Adherence Pattern, by HAART Era
1990-1996
1997-1999
2000-2002
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Mortality trends, HIV/AIDS
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Antiretroviral Therapy Drug Cost
(thousands USD)
(millions USD)
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Changes in Length of Stay, HIV/AIDS
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Changes in Length of Stay, HIV/AIDS
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Disease incidence of 7 major AIDS defining OI
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Conclusions (1)

• Survival time improved after AIDS diagnosis from
  1990 to 2002 in TAU study
• Patients in Late HAART era had the better
  survival outcome.
• More than 25 of AIDS patients died within 6
  months of diagnosis, survival patterns
  persisting from 1990 to 2002
• The clinical spectrum of AIDS in TAU study is
  changing
• The proportion of AIDS patients presenting with
  AIDS-defining illnesses, AIDS-related length of
  stay and number of admissions were decreasing
  with each study year.
• Non-AIDS defining diseases might arise more
  frequently in the future

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Conclusions (2)

• National Health Insurance claim data, without
  selection bias issue, is effective in exploring
  the relationship between the HIV/AIDS adherence
  behavior and the health outcome.
• The whole clinical spectrum of HIV/AIDS,
  including the infectious complications, cancers,
  possible adverse events associated with
  antiretroviral therapy, and mental health
  conditions, are not recorded in a standardized
  fashion. While improving the current reporting
  system, National Health Insurance dataset will
  provide better quality data for HIV/AIDS research.

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ICIUM, Chiang Mai, Thailand, March 30-April 2,
2004
Thank you
Hong-jen Chang, MD, MPH, MS Bureau of National
Health Insurance Ian Jen, MD, MS National Yang
Ming University Taipei, Taiwan