Retinoblastoma in Taiwan: The Effect of a Government-Sponsored National Health Insurance Program on the Treatment and Survival of Patients With Retinoblastoma

Abstract

To assess the effect of a government-sponsored national health insurance program that was implemented in Taiwan in March 1995 on the diagnosis and survival of patients with retinoblastoma. A retrospective chart review of 108 retinoblastoma patients who were treated at the Chang-Gung Medical Center, Taipei, Taiwan, from 1978 to 2003 was performed. Patients diagnosed and treated before March 1995 were compared with those treated after March 1995 in terms of annual number of cases, gender, laterality, age at onset, presenting signs, treatment modalities, and survival rate. The average annual number of cases doubled from 3.3 to 6.5 after the implementation of the national health insurance program, and the age at diagnosis decreased from 29 to 21 months (P = .03). The most common presenting sign was leukocoria in both groups. The Kaplan-Meier survival rate at 5 years increased from 67% to 72%, an effect that was obvious in unilateral cases (70% to 83%) but not in bilateral cases (50% for both time periods). The establishment of a government-sponsored national health insurance program in Taiwan allowed retinoblastoma to be diagnosed earlier, resulting in better survival rates, especially in unilateral cases.