Investing in health: Policy lessons from reimbursing direct-acting antivirals for hepatitis C in Taiwan

This report examines the development and implementation of Taiwan's direct-acting antiviral (DAA) reimbursement policy and evaluates outcomes using a return-on-investment (ROI) framework. Aggregating model-based estimates across 173,747 reimbursed patients, we project 614,980 discounted quality-adjusted life years (QALYs) and 1,085,742 undiscounted QALYs. Valuing discounted QALYs at a threshold equal to Gross Domestic Product (GDP) per capita yields an economic value of about NTD672 billion. Against National Health Insurance (NHI) DAA spending of NTD28.74 billion (2017-2024), the ROI is 22.4; using undiscounted QALYs, the value is about NTD1.187 trillion and the ROI is about 40.3. These findings indicate a high-return public investment, with gains from extended life expectancy and improved quality of life rather than short-term budget savings. Achievements reflect concerted efforts by clinicians, policymakers, administrators, and other stakeholders. Key lessons include the importance of early treatment access, dedicated funds with proactive financial risk management, use of a national patient registry for outcome tracking, and periodic professional monitoring to guide adaptive policy adjustments within a comprehensive elimination strategy.