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Current knowledge on this topic is largely limited to studies conducted upon reimbursement of new drugs. We investigated how endogenous factors (e.g., changed reimbursement criteria, such as an expanded indication) and exogenous factors (e.g., competing drugs) affect the level and trends of innovative oncology drug utilization in the Taiwan National Health Insurance (NHI) system, both upon reimbursement and afterward. This retrospective longitudinal study analyzed monthly data (January 2009 to December 2014) from the NHI Research Database on the consumption (prescribing volume) of 15 innovative oncology drugs reimbursed by the NHI between 2007 and 2013. Effects of endogenous and exogenous factors on drug utilization were evaluated using interrupted time series analyses. In segmented regression analyses, changed drug prescribing volume after the indication expanded (endogenous factor) was statistically significant; however, drug volume did not change significantly after prescription restrictions changed. First\u2010competitors and non\u2010first\u2010competitors (exogenous factors) were significantly associated with drug prescription levels or utilization rates. Taking sorafenib as an example, the post\u2010reimbursement drug prescribing volume did not change significantly after its therapy line changed (endogenous factor), whereas the reimbursement of first\u2010competitors (exogenous factor) was significantly associated with a lower level or usage rate of sorafenib. Utilization of innovative oncology drugs in Taiwan changed dramatically after NHI reimbursement, driven largely by expanded indications and new competitors. Drug utilization evaluations should investigate both endogenous and exogenous factors.<\/jats:p>","DOI":"10.1111\/cts.12829","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T10:21:00Z","timestamp":1593080460000},"page":"1288-1297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Factors Affecting Usage Levels and Trends of Innovative Oncology Drugs Upon and After Reimbursement Under Taiwan National Health Insurance: Interrupted Time Series Analysis"],"prefix":"10.1111","volume":"13","author":[{"given":"Kai\u2010Hsin","family":"Liao","sequence":"first","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy College of Medicine National Taiwan University Taipei Taiwan"},{"name":"Department of Pharmacy National Taiwan University Hospital Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7965-7579","authenticated-orcid":false,"given":"Bor\u2010Sheng","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Hematology Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan"},{"name":"Department of Hematological Oncology National Taiwan University Cancer Center Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang\u2010Kung","family":"Chen","sequence":"additional","affiliation":[{"name":"Aging and Health Research Center National Yang Ming University Taipei Taiwan"},{"name":"Center for Geriatrics and Gerontology Taipei Veterans General Hospital Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1660-9120","authenticated-orcid":false,"given":"Fei\u2010Yuan","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy College of Medicine National Taiwan University Taipei Taiwan"},{"name":"Department of Pharmacy National Taiwan University Hospital Taipei Taiwan"},{"name":"School of Pharmacy College of Medicine National Taiwan University Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,16]]},"reference":[{"key":"e_1_2_11_1_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-10-0437"},{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21262"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2015.10.011"},{"key":"e_1_2_11_4_1","volume-title":"Global Oncology Trend Report: A Review of 2015 and Outlook to 2020","author":"Aitken M.","year":"2016"},{"key":"e_1_2_11_5_1","first-page":"123","article-title":"Payers' management of oncology drugs: opportunities and challenges","volume":"7","author":"Kenney J.T.","year":"2014","journal-title":"Am. 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