Disease and economic burden for rare diseases in Taiwan: A longitudinal study using Taiwan's National Health Insurance Research Database.

Jason C Hsu,Huai-Chueh Wu,Edward Chia-Cheng Lai,Wen-Chia Feng,Chih-Ho Chou,Christine Y Lu,Der-Chong Tsai

doi:10.1371/journal.pone.0204206

Abstract

BackgroundHigh-cost orphan drugs are becoming increasingly available to treat rare diseases that affect a relatively small population. Little attention has been given to the prevalence of rare diseases and their health-related economic burden in Taiwan.ObjectivesThis study examined the national trends in the prevalence of rare diseases and their health-related economic burden (including medication costs) in Taiwan.MethodsRare disease-related claims data from 2003–2014 (12 years) from the National Health Insurance Research Database were used in this study. We used a time series analysis to assess trends in the yearly rates of treated patients with rare diseases, overall healthcare use, and expenditures, including drugs.ResultsDuring the 12-year study period, the estimated prevalence of rare diseases increased from 10.57 to 33.21 per 100,000 population, an average rate of a 19.46% increase per year. Total health expenditures for treatment of rare diseases increased from US$18.65 million to US$137.44 million between 2003 and 2014, accounting for 0.68% of the total national health expenditures in 2014. Drug expenditures for treatment of rare diseases increased from US$13.24 million to US$121.98 million between 2003 and 2014, which accounted for 71.00% and 88.75% of the health expenditures for patients with rare diseases in 2003 and 2014, respectively. In 2014, we found a 20.43-fold difference in average health expenditures and a 69.46-fold difference in average drug expenditures between patients with rare diseases and the overall population.ConclusionsThe prevalence of rare diseases and the related economic burden have grown substantially in Taiwan over the past 12 years, and these trends are likely to continue. Drug expenditures accounted for almost 90% of health expenditures for rare diseases. Further analyses are underway to examine the economic burden of individual rare diseases.

Highlights

The ice bucket challenge that has spread globally since 2014 is an activity involving dumping a bucket of ice water on a person’s head to promote awareness of amyotrophic lateral sclerosis, a rare disease, to encourage donations to research
This study examined the national trends in the prevalence of rare diseases and their healthrelated economic burden in Taiwan
Drug expenditures for treatment of rare diseases increased from US $13.24 million to US$121.98 million between 2003 and 2014, which accounted for 71.00% and 88.75% of the health expenditures for patients with rare diseases in 2003 and 2014, respectively

Summary

Introduction

The ice bucket challenge that has spread globally since 2014 is an activity involving dumping a bucket of ice water on a person’s head to promote awareness of amyotrophic lateral sclerosis, a rare disease, to encourage donations to research. Most countries define rare diseases based on disease prevalence, but the criteria vary from country to country. In the United States and Japan, a rare disease is one with a prevalence fewer than 200,000 persons and 50,000, respectively [2, 3]. The EU defines rare diseases as fewer than 5 per 10,000 persons. [3,4,5] Compared to the criteria in other countries, the general definition of a rare disease in Taiwan (< 1/10,000 persons) [2] is stricter. [7, 8] only 330 and 220 rare diseases have been defined in Japan and in Taiwan [9], respectively.

Objectives

Results

Conclusion