Purpose Previous reports cite high costs of clinical cancer genetic testing as main barriers to patient's willingness to test. We report findings of a pilot study that evaluates how different subsidy schemes impact genetic testing uptake and total cost of cancer management.
Methods We included all patients who attended the Cancer Genetics Service at the National Cancer Centre Singapore (January 2014–May 2016). Two subsidy schemes, the blanket scheme (100% subsidy to all eligible patients), and the varied scheme (patients received 50%–100% subsidy dependent on financial status) were compared. We estimated total spending on cancer management from government's perspective using a decision model.
Results 445 patients were included. Contrasting against the blanket scheme, the varied scheme observed a higher attendance of patients (34 vs 8 patients per month), of which a higher proportion underwent genetic testing (5% vs 38%), while lowering subsidy spending per person (S$1098 vs S$1161). The varied scheme may potentially save cost by reducing unnecessary cancer surveillance when first-degree relatives uptake rate is above 36%.
Findings Provision of subsidy leads to a considerable increase in genetic testing uptake rate. From the government's perspective, subsidising genetic testing may potentially reduce total costs on cancer management.
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S-TL and JY contributed equally.
Contributors S-TL was responsible for drafting of the manuscript, data interpretation and statistical analysis of data. JY assisted in the acquisition and interpretation of data, drafting of the manuscript and provided administrative and material support for the study. KZ contributed in the interpretation of data, statistical analysis and provided his critical revision of the manuscript for important intellectual content. JCA was involved in the statistical analysis, interpretation of the data and gave his critical review of the manuscript for important intellectual content. NDBI was responsible for the acquisition of data, providing administrative and technical support and also gave her critical review of the manuscript for important intellectual content. YC was involved in the acquisition of data, providing technical and material support and also gave her critical review of the manuscript for important intellectual content. YPT contributed in the interpretation of data, obtaining funding and provided her critical review of the manuscript for important intellectual content. MM-D contributed in conception, design and data acquisition of the study. She provided her critical review of the manuscript for important intellectual content. SHC was involved conception and design of the study. She provided technical and material support, and provided her critical review of the manuscript for important intellectual content. STL and KCS was involved in conception and design of the study, obtaining study funding and gave his critical review of the manuscript for important intellectual content. JN was involved in conception, design, data acquisition and interpretation of the study, statistical analysis, obtaining study funding and drafting of the manuscript to include insightful intellectual content.
Funding This project was sponsored by generous donations made by the Lee foundation to the Lee Kong Chian NCCS Cancer Genetics Service (LKCNCCS) fund.
Competing interests None declared.
Ethics approval SingHealth Centralised Institutional Review Board (Singapore).
Provenance and peer review Not commissioned; externally peer reviewed.
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