(SLB-031) Disparities in the Utilization of Nirmatrelvir-Ritonavir in Taiwan: An Analysis Within a Universal Healthcare System During the COVID-19 Pandemic

Background: Although nirmatrelvir-ritonavir has demonstrated real-world effectiveness in reducing COVID-19 severity, disparities in its utilization within a universal healthcare system and where the cost of the drug was paid by government funding remain underexplored.

Objectives: This study examines patient- and provider-level factors influencing the prescription of nirmatrelvir-ritonavir in Taiwan.

Methods: This study utilizes data from the Taiwan National Health Insurance database to assess the association between nirmatrelvir-ritonavir prescribing patterns and various patient characteristics—including age, income level, comorbidities, prior healthcare utilization, and vaccination status—as well as provider attributes such as geographic location, urban versus rural practice settings, and healthcare facility type. The study population includes 2,300,130 patients diagnosed with COVID-19 who had at least one risk factor qualifying them for nirmatrelvir-ritonavir treatment between January 1, 2022, and December 31, 2022.

Results: Among eligible patients, 530,806 (23.1%) received nirmatrelvir-ritonavir on the day of diagnosis. Logistic regression analysis, adjusted for comorbidities, revealed that male patients (OR: 1.135), individuals residing outside northern Taiwan (OR: 1.026–1.362), patients aged 60 and above (OR: 1.364–8.252), and those with a higher frequency of outpatient visits in the previous year (OR: 1.298–1.508) were more likely to receive the medication. Notably, higher-income patients were less likely to receive the medication than their lower-income counterparts (OR: 0.688–0.771). Vaccination status was also associated with prescribing patterns, with patients receiving two (OR: 0.954) or three (OR: 0.979) vaccine doses being less likely to receive the drug than unvaccinated patients.
Provider-related factors also influenced prescribing trends. Compared to patients diagnosed at medical centers, those diagnosed at community hospitals (OR: 1.175) and clinics (OR: 1.148) were more likely to receive nirmatrelvir-ritonavir. Patients diagnosed in urban areas were more likely to receive the medication (OR: 1.261–1.403) than those in rural settings.

Conclusions: This study identifies significant disparities in the prescription of nirmatrelvir-ritonavir based on geographic, provider, and patient-related factors. Interestingly, lower-income patients were more likely to receive the medication, which may be attributed to Taiwan's universal healthcare system and the public funding of this treatment. The findings suggest that universal healthcare systems may help mitigate financial barriers to accessing critical medications during public health emergencies.