Impact of subsidies on cancer genetic testing uptake in Singapore.
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.



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.



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%.



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.
Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Shao-Tzu
ST
Li
Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Jeanette
J
Yuen
Health Sciences and Services Research, Duke-NUS Graduate Medical School, Singapore, Singapore.
Ke
K
Zhou
Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Nur Diana
ND
Binte Ishak
Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.|Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Yanni
Y
Chen
Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Marie
M
Met-Domestici
Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Sock Hoai
SH
Chan
Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Yee Pin
YP
Tan
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
John Carson
JC
Allen
Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
Soon Thye
ST
Lim
Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.|Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
Khee Chee
KC
Soo
Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.|Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.|Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Joanne
J
Ngeow
D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000235:genetics / Q000628:therapy; D010865:Pilot Projects; D012846:Singapore
Cancer genetics; Genetic screening/counselling; subsidy