Balance needed between allowing liberal use of cancer drugs and affordability

We refer to senior health correspondent Salma Khalik's commentary, "Rules on cancer treatment financing can be improved" (June 13).

Cancer is a major cause of death in Singapore. Although cancer patients account for about 2 per cent of all patients, cancer drugs constitute 35 per cent of public sector drug spending.

For the five-year period from 2017 to 2021, this spending increased by 90 per cent to $275 million, while overall national age-adjusted cancer mortality improved by 2.1 per cent.

On average, about 50 per cent of new cancer drugs or indications potentially entered the market without evidence of benefits on survival or quality of life.

Many others may show survival benefit of a few weeks or months, or may show improvement in cancer markers but no prolongation of life. There are, of course, exceptions.

Exceptions aside, the general picture is one of rapidly escalating drug costs, with marginal improvement in clinical outcomes, and will significantly drive up health insurance premiums and reduce affordability, especially for lower-income individuals.

A balance must therefore be struck between allowing liberal use of cancer drugs, and keeping the regime affordable through greater use of cost-effective drugs.

The Agency for Care Effectiveness (ACE) is the national health technology assessment (HTA) agency established to demonstrate the impact and value of health technologies through scientific and economic assessments.

ACE supported the Ministry of Health (MOH) in developing the new Cancer Drug List using internationally standardised HTA methodologies to target funding to drugs that optimise health benefits within finite resources.

The evaluations provided by ACE were then deliberated by the MOH Drug Advisory Committee, a panel of senior public sector clinicians and pharmacists.

Separately, we sought feedback from more than 60 oncologists in the public and private sectors.

We also worked with various patient groups including Singapore Cancer Society and SingHealth Patient Advocacy Network to better help patients understand the benefits, risks and costs of their treatments.

Most countries do not subsidise or reimburse off-label use of cancer drugs, given the uncertainty over the clinical benefit and the risk of side effects.

There are situations in which off-label use is justified and MOH allows it, provided certain criteria, such as those on clinical and cost effectiveness, are met.

To ensure that patients have better access to new oncology drugs, companies and clinicians are encouraged to submit their evidence to ACE in time to ensure their drugs are evaluated close to the point of market entry.

Daphne Khoo (Dr)
Executive Director
Agency for Care Effectiveness
Ministry of Health