Respiratory Syncytial Virus (RSV) remains a major cause of respiratory tract infections among older adults, especially among the elderly and those with comorbidities. This study investigated the incidence and disease burden of RSV-related hospitalization in Taiwanese adults. Our retrospective study was conducted among adults aged ≥ 18 years utilizing the National Health Insurance Research Database between July 2017-December 2021. Cases were defined as having ≥ 1 RSV-related hospitalization via the corresponding ICD-10 disease codes. The incidence, severity, risk factors, and medical costs related to RSV hospitalizations were examined. Among 226 RSV-related hospitalizations, 66.8% occurred in older adults aged ≥ 60 years. Of these, 39.4% were aged ≥ 75 years. There was a 4-fold increase in the incidence of RSV-related hospitalizations in Q4 2020 (0.20 per 100,000 population) compared to 2017-2019 (0.05-0.07). Mean of hospitalization was 32 days, with 63.3% of cases requiring oxygen supplementation, 26.5% with intensive care unit (ICU) admission, and 23.0% with ventilator use. Among comorbid patients, congestive heart failure (CHF)/coronary artery disease (CAD)/stroke and chronic kidney disease were 2 times more reported to be admitted into the ICU (odds ratio, OR: 2.50; p=0.01 and 2.28; p=0.04 respectively). Risk factors for infection severity included being adults aged ≥ 50 years (ref: age 18-49 years; OR: 3.14-8.90, p< 0.05), having asthma/chronic obstructive pulmonary disease (COPD) (3.69; p< 0.05), and CHF/CAD/stroke (3.20; p< 0.05). Patients aged ≥ 75 years were the highest risk group for CHF/CAD/stroke (55.7%) and asthma/COPD (45.5%) for RSV-related hospitalizations. Mean medical costs were 9,209 USD for hospitalization, 4,786 USD for ICU admission, 2,720 USD for outpatient visit, and 259 USD for emergency room visits. Our study reveals the underestimated burden of RSV-related hospitalizations among Taiwanese adults, particularly those aged ≥ 50 and with comorbidities. The findings underscore the importance of RSV-vaccination and early intervention, especially among high-risk groups. Efforts should prioritize reducing the clinical and financial burden of RSV. Wei-Ting Chen, MD, MSD Taiwan: Employment Kai-Ting Chen, PhD, MSD Taiwan: Employment

Influenza carries a high risk of severe complications and mortality among individuals aged ≥65 years. Advanced influenza vaccines, such as MF59®-adjuvanted influenza vaccine (aQIV) and high-dose influenza vaccine (HD-QIV), offer enhanced protection for older adults compared to standard-dose vaccines (SD-QIV). This study evaluated the cost-effectiveness of vaccination strategies using aQIV compared to SD-QIV and HD-QIV in South Korea and Taiwan for individuals ≥65 years from healthcare payer and societal perspectives, using a static decision tree model to estimate economic and clinical outcomes. Compared to SD-QIV, aQIV was estimated to prevent an additional 71,352 and 13,530 symptomatic influenza infections, 5,443 and 819 hospitalizations due to influenza-related complications, and 1,275 and 140 deaths per influenza season in South Korea and Taiwan, respectively. From a healthcare payer perspective, the incremental cost per quality-adjusted life year (QALY) gained with aQIV versus SD-QIV was 2,200 USD per QALY in South Korea and 6,798 USD per QALY in Taiwan, both of which fall below the respective willingness-to-pay thresholds in these countries based on the vaccine price ratios and relative vaccine effectiveness estimates incorporated in the model. Under the same parameters, and assuming both vaccines were available, aQIV was found to be a cost-saving strategy compared to HD-QIV in both countries from payer and societal perspectives. As official price data for HD-QIV and aQIV were not publicly available, expert-informed estimates were applied, which may introduce residual uncertainty. Our results imply that introducing aQIV for the ≥65 population might significantly reduce the clinical and economic burden of influenza in these countries. These findings support the benefits of aQIV as an enhanced influenza vaccine in national immunization programs targeting ≥65 year olds.

STUDY OBJECTIVES:We investigated the prevalence and incidence of narcolepsy (types 1 and 2) and idiopathic hypersomnia (IH) in Taiwan using the National Health Insurance Research Database (NHIRD), and compared disease impact with patients identified from a "gold-standard" hospital database. METHODS:This study employed retrospective cohort and cross-sectional designs to analyze data from the NHIRD and the hospital database cohort between 2009 and 2019. Analyses comprised prevalence and incidence of narcolepsy and IH, with diagnoses validated against the hospital database, and comparison of demographics, prescriptions, comorbidities, healthcare utilization, and costs with a control cohort. Categorical variables were analyzed using the chi-squared test; continuous variables were assessed via analysis of variance or Kruskal-Wallis tests. RESULTS:From both databases, 24 317 patients were identified as having narcolepsy or IH. The diagnosed prevalence of narcolepsy was 9.98 per 100 000 individuals. Annual increases in prevalence and incidence were observed, particularly in young adults (aged 21-30 years). Patients with narcolepsy and IH exhibited higher rates of comorbidities and received more psychotropics compared with controls. However, fewer patients from the NHIRD received treatment for hypersomnolence than those from the hospital cohort. Healthcare utilization and costs were higher among patients with narcolepsy and IH compared with controls. CONCLUSIONS:Increased narcolepsy prevalence over time was observed, particularly among young adults, but the overall prevalence in Taiwan appears to be lower than in other countries, potentially indicating underdiagnosis or inadequate treatment. High comorbidity rates and healthcare utilization underscore the substantial disease impact in patients with central hypersomnia.

Background: To examine the application of quantitative 2-dimensional phase-contrast magnetic resonance imaging (2D PC-MRI) for treating patients with pelvic congestion syndrome (PCS). Materials and methods: We conducted a retrospective cross-sectional analysis by using quantitative 2D PC-MRI data enrolled between April 2017 and Sep 2023. In addition, 32 healthy female controls (HCs) were included. Results: Most patients with PCS presented with chronic pelvic pain and more than half had extra-pelvic venous symptoms (80/81, 98% and 45/81, 56%, respectively). Quantitative 2D PC-MRI analyzed the 81 patients with PCS, 239 patients without PCS, and 32 HCs. The patients with PCS had higher stroke volume (SV), absolute SV (ASV), and mean flux (MF) in the calf region (interstitial pixel shift) than did the HCs. In the left gonadal vein, the patients with PCS had higher SV, backward flow volume (BFV), ASV, and MF and lower forward flow volume (FFV), stroke distance (SD), and mean velocity (MV) than did the HCs. However, the patients with PCS had lower SV, FFV, MF, SD, and MV in the great saphenous veins. Quantitative 2D PC-MRI analysis revealed that the PCS group had higher SV, FFV, BFV, ASV, and MF in the calf region than did the non-PCS group. The variables that most strongly differentiated the patients with PCS from the HCs were SV in the great saphenous veins, SD in the great saphenous veins and left gonadal vein, and MV in the great saphenous veins and left gonadal vein. Caudal flow in the left gonadal vein was identified in half of the patients with PCS (39/81, 48.1%); 14 of them received embolization for left gonadal vein. Conclusions: In additional to providing an objective 3-dimensional morphology of the pelvic veins and extra-pelvic leaks, quantitative 2D PC-MRI analysis reveals distinct hemodynamic profiles between patients with PCS, those without PCS, and HCs, especially in the gonadal veins and regional perfusion of the calves.

Immune checkpoint inhibitors (ICI) represent new anticancer agents and have been used worldwide. However, ICI can potentially induce life-threatening severe cutaneous adverse reaction (SCAR), such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), hindering continuous ICI therapy. We examine 6 cohorts including 25 ICI-induced SJS/TEN patients and conduct single-cell RNA sequencing (scRNA-seq) analysis, which shows overexpression of macrophage-derived CXCL10 that recruits CXCR3+ cytotoxic T lymphocytes (CTL) in blister cells from ICI-SJS/TEN skin lesions. ScRNA expression profiles and ex vivo blocking studies further identify TNF signaling as a pathway responsible for macrophage-derived CXCL10 and CTL activation. Based on the trajectory analysis, ICI-activated T cells from whole blood are proposed to serve as the initial cells involved in inflammation, that lead to monocytes differentiating into macrophages and increasing their susceptibility to migrate to the lesion sites. Compared with systemic corticosteroids treatment, ICI-induced SJS/TEN patients treated with biologic TNF blockade showed a significantly rapid recovery and no recurrence of SCAR with continuous ICI therapy. Our findings identify that macrophage-eliciting CTL contribute to the pathogenesis of ICI-induced epidermal necrolysis and provide potential therapeutic targets for the management and prevention of SCAR induced by ICI therapy.

BACKGROUND:To examine the application of quantitative 2-dimensional phase-contrast MRI (2D PC-MRI) for treating patients with pelvic congestion syndrome (PCS). MATERIALS AND METHODS:The authors conducted a retrospective cross-sectional analysis by using quantitative 2D PC-MRI data enrolled between April 2017 and September 2023. In addition, 32 healthy female controls (HCs) were included. RESULTS:Most patients with PCS presented with chronic pelvic pain and more than half had extrapelvic venous symptoms (80/81, 98% and 45/81, 56%, respectively). Quantitative 2D PC-MRI analyzed the 81 patients with PCS, 239 patients without PCS, and 32 HCs. The patients with PCS had higher stroke volume (SV), absolute SV (ASV), and mean flux (MF) in the calf region (interstitial pixel shift) than did the HCs. In the left gonadal vein, the patients with PCS had higher SV, backward flow volume (BFV), ASV, and MF and lower forward flow volume (FFV), stroke distance (SD), and mean velocity (MV) than did the HCs. However, the patients with PCS had lower SV, FFV, MF, SD, and MV in the great saphenous veins. Quantitative 2D PC-MRI analysis revealed that the PCS group had higher SV, FFV, BFV, ASV, and MF in the calf region than did the non-PCS group. The variables that most strongly differentiated the patients with PCS from the HCs were SV in the great saphenous veins, SD in the great saphenous veins and left gonadal vein, and MV in the great saphenous veins and left gonadal vein. Caudal flow in the left gonadal vein was identified in half of the patients with PCS (39/81, 48.1%); 14 of them received embolization for left gonadal vein. CONCLUSIONS:In additional to providing an objective 3-dimensional morphology of the pelvic veins and extrapelvic leaks, quantitative 2D PC-MRI analysis reveals distinct hemodynamic profiles between patients with PCS, those without PCS, and HCs, especially in the gonadal veins and regional perfusion of the calves.

Study Objectives: To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED. Methods: This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer's test, lacking tear break-up time values, or with a history of refractive surgery, Sjogren's syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared. Results: In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 +/- 23.4, patients without DED: 17.9 +/- 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47-10.49, P = 0.006). Conclusion: OSA severity is associated with DED and might be attributed to the use of CPAP.

Objectives: Given the lack of a value framework for assessing health technologies in Asian settings, a value framework incorporating multiple-criteria decision analysis for new drugs under universal healthcare coverage in Taiwan was established. Methods: The development process included (1) the adoption of 5 value domains (ie, Overall clinical benefit, Disease burden, Alignment with patient concerns, Economic value, and Feasibility of adoption into the health system) and 26 corresponding indicators, derived from the literature and expert discussions; (2) the creation of separate weighting schemes for 3 drug types-new oncology, new orphan, and other new drugs-based on inputs from multiple stakeholders (n = 86) using various weighting methods; and (3) the application of the value framework to cases of new oncology drugs. Results: Overall clinical benefit had the highest preference weight, irrespective of drug type, (ie, mean values [95% CIs] for new oncology, new orphan, and other new drugs: 32.5 [30.4-34.6], 30.6 [28.1-33.1], and 30.6 [28.7-32.6], respectively), weighting method, and stakeholder type. The 5 domain-derived weights (from the point allocation method) were comparable to the 26 indicator- derived weights (from the direct rating method), suggesting that the value framework with a short-form (domain-derived) weighting scheme is sufficient to support decision making under time and resource constraints. Conclusions: A country-specific value framework incorporating multiple-criteria decision analysis for new drugs was developed in an Asian setting under universal healthcare coverage. It allows multiple stakeholders to systematically appraise all drug value attributes and provides a structured process for adapting and refining value assessments.

There are scanty population-based studies investigating the incidence and prevalence rates of inflammatory bowel disease (IBD) in Taiwan. This study aimed to estimate the nationwide prevalence and incidence of IBD and identify its noticeable trends in Taiwan between 2016 and 2020. A retrospective study by analyzing the data from the National Health Insurance Research Database of Taiwan. A total of 2595 patients with catastrophic IBD illness were registered from 2016 to 2020 in Taiwan (CD, 880; UC, 1715). The male-to-female ratio in the study sample was 1.83:1 for CD and 1.69:1 for UC. The median age of those registered with CD and UC was 37 and 47 years, respectively. The incidence rate of CD was 0.65 per 100,000 persons in 2016 and it was increased to 0.81 per 100,000 persons in 2020. The incidence rate of UC was 1.16 per 100,000 persons in 2016 and it was increased to 1.53 in 2020. Overall, the incidence of IBD was increase from 1.81 per 100,000 persons to 2.34 per 100,000 persons between 2016 and 2020. Overall, the prevalence rates of IBD was increase from 14.95 per 100,000 persons to 20.02 per 100,000 persons between 2016 and 2020. The epidemiological stages of IBD in Taiwan was considered in the acceleration in incidence stage, during which incidence rises and prevalence is relatively low. Understanding these geographical differences is important for the rising global burden of IBD.

Background: Head and neck cancers (HNC) are increasingly recognized as important human papillomavirus (HPV)-related malignancies in addition to cervical cancer (CC). However, data on the socioeconomic impact of HNC and CC in Taiwan are limited. Methods: A retrospective cohort study was conducted to estimate the total direct medical cost and indirect productivity loss from CC and HNC between 2014 and 2015. Patient data from the Taiwan National Cancer Registry were analyzed, with matched non-cancer controls from the Taiwan National Healthcare Reimbursement Database. Indirect costs due to premature deaths were calculated using public data from Taiwanese government reports. Results: In the direct cost analysis, 2083 patients with newly diagnosed CC and 11,078 with newly diagnosed HNC (10,036 males) were identified between 2014 and 2015 and followed up through the end of 2016 or until death. The total direct medical costs incurred in 2014 and 2015 due to HNC were 11.54 times higher in males than in females, and 4.55 times higher than CC. Indirect cost analysis showed the total annual productivity loss was New Taiwan Dollar (NTD) $12 billion in 2019, and 79.99% was attributed to male HNC. Conclusion: In Taiwan, the socioeconomic burden associated with male HNC is high and greater than that seen with CC. While not all HNCs are attributable to HPV infection, prevention of HNC through HPV vaccination should be considered for both sexes.

Hepatic angiosarcoma (HAS) is an aggressive mesenchymal malignancy that remains underexplored with respect to its etiology and mutational landscapes. To clarify the association between HAS and end‐stage renal disease (ESRD), we used nationwide data of the National Health Insurance Research Database (NHIRD) in Taiwan, covering ~99% of the population, from 2001 to 2016. To investigate molecular signatures, we performed whole‐exome sequencing (WES) in 27 surgical specimens, including nine ESRD‐associated cases. The NHIRD analysis demonstrated that HAS ranked second among all angiosarcomas in Taiwan, with the incidence rates of HAS being 0.08, 2.49, and 5.71 per 100,000 person‐years in the general population, chronic kidney disease (CKD), and ESRD patients, respectively. The standardized incidence ratios of HAS in CKD and ESRD patients were 29.99 and 68.77, respectively. In comparison with nonhepatic angiosarcoma, the multivariate regression analysis of our institutional cohort confirmed CKD/ESRD as an independent risk factor for HAS (odds ratio: 9.521, 95% confidence interval: 2.995–30.261, p < 0.001). WES identified a high tumor mutation burden (TMB; median: 8.66 variants per megabase) and dominant A:T‐to‐T:A transversion in HAS with frequent TP53 (81%) and ATRX (41%) mutations, KDR amplifications/gains (56%), and CDKN2A/B deletions (48%). Notably, ESRD‐associated HAS had a significantly higher TMB (17.62 variants per megabase, p = 0.01) and enriched mutational signatures of aristolochic acid exposure (COSMIC SBS22, p < 0.001). In summary, a significant proportion of HAS in Taiwan is associated with ESRD and harbors a distinctive mutational signature, which concomitantly links nephrotoxicity and mutagenesis resulting from exposure to aristolochic acid or related compounds. A high TMB may support the eligibility for immunotherapy in treating ESRD‐associated HAS. © 2023 The Pathological Society of Great Britain and Ireland.

Background:Compared to antibiotic treatment, fecal microbiota transplantation (FMT) is a more effective treatment for refractory or recurrent CDI (rCDI). Patients with inflammatory bowel disease (IBD) have a higher incidence of CDI and worse outcomes. There has been no study from Asia to evaluate the cost-effectiveness of FMT for overall rCDI patients and rCDI patients with IBD.Methods:We applied a Markov model with deterministic and probabilistic sensitivity analyses to evaluate the cost and effectiveness of different treatments for rCDI patients with a time horizon of 1 year from the payer's perspective. We compared the cost and clinical outcomes of FMT through colonoscopy to two antibiotics (vancomycin and fidaxomicin) using data from Chang Gung Memorial Hospital, Taoyuan, Taiwan.Results:Compared to vancomycin, FMT was cost-effective in overall rCDI patients as well as IBD patients with rCDI [USD 39356 (NT$1,101,971.98)/quality-adjusted life year (QALY) gained in overall patients; USD65490 (NT$1,833,719.14)/QALY gained in IBD patients]. Compared to fidaxomicin, FMT was only cost-effective in overall rCDI patients [USD20255 (NT$567,133.45)/QALY gained] but slightly increased QALY (0.0018 QALY gained) in IBD patients with rCDI.Conclusion:FMT is cost-effective, compared to vancomycin or fidaxomicin, for the treatment of rCDI in most scenarios from the payers' perspective in Taiwan.

Objectives: The concept of precision oncology using genetic testing has become popular for cancer treatment in recent years. This research aimed to evaluate the financial impact of comprehensive genomic profiling (CGP) in patients with advanced non-small cell lung cancer before receiving any systemic treatments, compared with current practice using single-gene testing, in the hope that the findings can inform the National Health Insurance Administration the decision regarding CGP reimbursement.Methods: A budget impact analysis model was developed comparing the sum of gene testing costs, the first-line and subsequent systemic treatment costs, and other medical costs between the current practice of traditional molecular testing and the new test strategy of CGP. The evaluation time horizon is 5 years from the perspective of the National Health Insurance Administration. Outcome endpoints were incremental budget impact and life-year gained.Results: This research indicated CGP reimbursement would benefit 1072 to 1318 more patients receiving target therapies than the current practice and consequently had incremental 232 to 1844 life-years gained from 2022 to 2026. The new test strategy also led to higher gene testing cost and systemic treatment cost. Nevertheless, less medical resource utilization and better patient outcome were demonstrated. The incremental budget impact ranged from US dollar 19 to US dollar 27 million in the 5-year period.Conclusion: This research shows that CGP could pave the way for personalized healthcare with moderate increase of National Health Insurance budget.

OBJECTIVES:This study aimed to estimate the epidemiologic and economic impact of a nonavalent human papillomavirus (HPV) vaccination program for 13- to 14-year-old females compared with that of the bivalent vaccine in Taiwan.METHODS:A previously developed dynamic transmission model for the nonavalent HPV vaccine was adapted to the Taiwan setting. The natural history of cervical cancer and genital warts was simulated by the HPV model assuming an 80% vaccination coverage rate in girls aged 13 to 14 years of age with a 2-dose schedule for the nonavalent and bivalent HPV vaccines. A lifetime duration of vaccine protection was assumed for the HPV vaccine types.RESULTS:The model estimated that the nonavalent HPV vaccine would prevent an additional 15 951 cervical cancer cases, 6600 cervical cancer-related deaths, 176 702 grade 2 or grade 3 cervical intraepithelial neoplasia cases, 103 959 grade 1 cervical intraepithelial neoplasia cases, and 1 115 317 genital warts cases compared with the bivalent HPV vaccine. The nonavalent HPV vaccination program was projected to cost an additional New Taiwan dollars (NTD) 675.21 per person and to produce an additional 0.00271 quality-adjusted life-year per person over 100 years compared with the bivalent HPV vaccine. Thus, the incremental cost-effectiveness ratio of the nonavalent HPV vaccine versus the bivalent HPV vaccine was NTD 249 462/quality-adjusted life-year.CONCLUSIONS:A nonavalent HPV vaccination program for 13- to 14-year-old girls would have additional public health and economic impacts and would be highly cost-effective compared with the bivalent HPV vaccine, relative to per capita gross domestic product, which is estimated at NTD 746 526 for Taiwan.

Objectives: We investigated whether the use of adjuvant traditional Chinese medicine (TCM) therapy, a form of complementary and alternative medicine, is associated with long-term mortality after stroke.Study design: We conducted a retrospective cohort study and used claims data from Taiwan's National Health Insurance program linked to the National Registry of Death. The cohort included patients aged & GE;18 years who were hospitalized for their first stroke event between January 1, 2006, and December 31, 2013. Adjuvant TCM therapy was defined as additional treatments with TCM, which included acupuncture, Chinese herbal medicine, and Tuina, during hospitalization for up to six months.Main outcome measure: The mortality rate was measured through to December 31, 2014.Results: Of 321,157 patients with stroke, 14,579 received adjuvant TCM therapy. Propensity score matching resulted in 13,918 matched pairs of patients who did and did not receive adjuvant TCM care. Both multivariableadjusted Cox proportional hazards models (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.64-0.69) and propensity score-matching analysis (HR, 0.65; 95% CI, 0.60-0.66) revealed a reduced mortality risk associated with the use of adjuvant TCM therapy, as compared with routine inpatient care only. Acupuncture was the most commonly used TCM therapy. Patients treated with acupuncture only, which accounted for 41.3% of TCM users, had a reduced risk of mortality compared with those treated with routine inpatient care.Conclusions: The use of TCM therapy adjuvant to Western inpatient care in the acute and subacute stages of stroke recovery is associated with a reduced risk of long-term mortality.

Background Depression is common among patients with head and neck cancer, thereby affecting their survival rate. However, whether close monitoring of depression affects the survival outcomes of these patients is unknown. Therefore, this study aimed to determine whether depression treatment continuity after the diagnosis of cancer affects the survival of these patients. Methods A total of 55,069 patients diagnosed with head and neck cancer in the Cancer Registration System database in Taiwan were enrolled. This cohort was followed from January 1, 2007 to December 31, 2017. Furthermore, the patients were divided into four groups, namely, “no depression,” “pre-cancer only,” “post-cancer only,” and “both before and after cancer,” on the basis of the diagnosis of depression and the duration of the follow-up period in the psychiatric clinic. Further, the Cox proportional hazard model was applied to estimate the hazard of death for the four groups. Results A total of 6,345 (11.52%) patients were diagnosed with depression in this cohort. The “pre-cancer only” group had a lower overall survival (HR = 1.18; 95% CI = 1.11–1.25) compared with the “no depression” group. Moreover, the “post-cancer only” group had better overall survival (HR = 0.88; 95% CI = 0.83–0.94) compared with the “no depression” group, especially in advanced-stage patients. Patients who were diagnosed with depression before cancer and had continuous depression treatments after the cancer diagnosis had better overall survival (HR = 0.78; 95% CI = 0.71–0.86) compared with patients who had treatment interruptions. Conclusion Patients with pre-cancer depression had poorer survival outcomes, especially those who did not receive psychiatric clinic visits after their cancer diagnosis. Nonetheless, in patients with advanced-stage cancer, depression treatment may improve overall survival.

Individuals diagnosed with metastatic triple-negative breast cancer (mTNBC) suffer worse survival rates than their metastatic non-TNBC counterparts. There is little information on survival, treatment patterns, and medical costs of mTNBC patients in Asia. Therefore, this study aimed to examine 5-year survival, regimens of first-line systemic therapy, and healthcare costs of mTNBC patients in Taiwan. Adult females newly diagnosed with TNBC and non-TNBC as well as their survival data, treatment regimens and costs of health services were identified and retrieved from the Cancer Registry database, Death Registry database, and National Health Insurance (NHI) claims database. A total of 9691 (19.27%) women were identified as TNBC among overall BC. The 5-year overall survival rate of TNBC and non-TNBC was 81.28% and 86.50%, respectively, and that of mTNBC and metastatic non-TNBC was 10.81% and 33.46%, respectively. The majority of mTNBC patients received combination therapy as their first-line treatment (78.14%). The 5-year total cost in patients with metastatic non-TNBC and with mTNBC was NTD1,808,693 and NTD803,445, respectively. Higher CCI scores were associated with an increased risk of death and lower probability of receiving combination chemotherapy. Older age was associated with lower 5-year medical costs. In sum, mTNBC patients suffered from poorer survival and incurred lower medical costs than their metastatic non-TNBC counterparts. Future research will be needed when there are more treatment options available for mTNBC patients.