Impact of Subsidy on the Use of Personalized Medicine in Breast Cancer.

Abstract

OBJECTIVES:

Advances in adjuvant therapy have led to increased survival rates after cancer prognosis. Herceptin, a targeted therapy, had first been introduced to Singapore in 2006. We aimed to assess whether subsidies for Herceptin from 2012 will lead to changes in uptake among HER2-positive patients by socioeconomic groups.

METHODS:

Random-intercept logistic regression was used to model diagnostic test and Herceptin uptake using the Singapore Breast Cancer Cohort from 2006 to 2018, adjusting for covariates such as education, housing type, and marital status before and after subsidies. Interrupted time series analysis was used to evaluate the impact of Herceptin subsidy on treatment uptake. Concentration index was also computed by ethnicity and education to measure inequality in uptake.

RESULTS:

We found that the odds of diagnostic testing were not associated with socioeconomic factors. Nevertheless, before subsidies, highest education attained (odds ratio 4.57; 95% confidence interval 1.90-11.02; P<.01) significantly increased the odds of Herceptin uptake. These odds were leveled after the introduction of subsidies to Herceptin treatment from 2012. After subsidy, we also found that Herceptin uptake increased significantly by 11.4% (95% confidence interval 3.47-19.4; P=.016). In addition, inequality of Herceptin use decreased especially among the Indians, where at least 40% were used in the higher educated group before subsidy.

CONCLUSIONS:

Subsidies have lowered the barriers to Herceptin uptake for marginalized individuals. Having targeted subsidies for socioeconomically disadvantaged groups may work more efficiently in providing ease of access than a blanket subsidy in Herceptin.

• Authors: Jue Tao Lim, Jemima Jia En Koh, Peh Joo Ho, Jenny Liu, Swee Ho Lim, Ern Yu Tan, Benita Kiat Tee Tan, Veronique Kiak Mien Tan, Su Ming Tan, Wei Sean Yong, Mikael Hartman, Cynthia Chen
• Journal: Value in health regional issues (Value Health Reg Issues) Vol. 29 Pg. 108-115 (May 2022) ISSN: 2212-1102 [Electronic] United States
• PMID: 35104748 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.

Chemical References

• Trastuzumab

Topics

• Breast Neoplasms (drug therapy)
• Cohort Studies
• Female
• Humans
• Precision Medicine
• Singapore
• Trastuzumab (therapeutic use)