Subsidy of chemotherapy drugs Benefits

17 Oct 2005

Question No:  198  

Question

Name of the Person: Mr Chiam See Tong, Member of Parliament for Potong Pasir

To ask the Minister for Health what are the chemotherapy drugs that are not subsidized in the C class wards and why are they not subsidized?

Reply

Reply From MOH

Mr Chiam has asked why chemotherapy drugs are not subsidised in the C class wards. Let me state at the onset that chemotherapy drugs are subsidised in the C class wards just as they are in the other subsidised wards and that the same chemotherapy drugs are used in the treatment of C class patients as B class patients. 

Cancer is of concern to Singaporeans. This is not surprising as it is the leading cause of death in Singapore, accounting for 27% of deaths in 2004. The Ministry of Health has been working to alleviate the burden that cancer places on its patients. Our efforts have contributed to a decrease in the number of premature deaths from cancer, from 124 deaths per 100,000 population aged 35-64 years in 1997, to 119 deaths per 100,000 population in 2004. 

Our public hospitals provide high quality subsidised treatment for B2 and C class patients. Specifically for chemotherapy, my Ministry subsidises a total of 30 chemotherapy drugs, comprising essential first-line drugs and some alternatives. Most patients can be treated with these first-line drugs with good results. The drugs include Doxorubicin, Cyclophosphamide, Carboplatin and Fluorouracil. These drugs are available to all subsidised patients at heavily subsidised rates. 

Sometimes cancer recurs after standard treatment has been given. Often experimental treatments are then tried. Within the international community of oncologists, and even within our own domestic community, there are many different opinions on what treatment strategies are "effective" after the standard treatment has been given. For example the experimental treatment available at the Mayo Clinic, the MD Anderson Cancer Centre at the University of Texas and at our public hospitals may not be the same. Experimental treatments are essentially unproven treatments and are usually part of a clinical trial to see if the treatment works. Many of the experimental treatments use drugs that are not on the Standard drug list. 

For this reason, non-standard drugs are not automatically subsidised, but are subject to review. The Drug Advisory Committee (DAC) is an expert committee which periodically reviews new drugs and recommends effective drugs for inclusion in the Standard Drug List. The last review was done in 2002 and the next review would be in 2007. 

However, there may be cases where patients need drugs that are not on the Standard drug list. MOH has given a budget to the hospitals to help cover the cost of non standard drugs that are considered necessary in specific cases. The decisions on when to use which drug is left to the oncologist. 

Cancer is best managed at a level closest to the patient, that is, based on the professional judgement of the attending doctor. The doctor has a responsibility to ensure that the therapy he prescribes is clinically effective in treating the patient and that his care of the patient meets the standards set by his peers.