Proton beam therapy for cancer in Singapore is being heralded as an advanced radiation treatment.
Unlike conventional radiation, proton beam therapy for cancer in Singapore minimises damage to healthy cells. Dr Michael Wang, chair of radiation oncology at the National Cancer Centre Singapore (NCCS), highlighted that proton beam therapy for cancer in Singapore reduces radiation exposure to nearby healthy tissues and organs, potentially lowering the risk of secondary cancers.
Introduction of Proton Beam Therapy in Singapore
Since mid-2023, Singapore has offered proton beam therapy for cancer at three locations. Mount Elizabeth Novena, the Singapore Institute of Advanced Medicine Holdings (SAM) at Biopolis, and the National Cancer Centre Singapore (NCCS) are equipped to provide this advanced treatment. Mount Elizabeth Novena and SAM each have one treatment gantry, while NCCS boasts four, making it the largest PBT facility in the country.
Each treatment gantry, the rotating arm of the PBT machine, is housed in a separate room to ensure precise targeting of tumours. These gantries are essential for delivering the proton beams accurately to the cancer cells while sparing the surrounding healthy tissues.
Despite the advanced capabilities, only about 300 patients have received PBT since its introduction, compared to the thousands who undergo conventional radiation therapy each year. The limited number of patients treated with PBT highlights the selective use of this technology, often due to its high cost and specific application criteria.
High Costs and Limited Access to Proton Beam Therapy in Singapore
The high cost of proton beam therapy for cancer in Singapore remains a significant barrier to its widespread use. PBT treatment is 2.5 to three times more expensive than conventional radiation therapy, with costs ranging from $20,000 to $90,000. While PBT may have fewer side effects, it has not been proven to significantly improve survival rates for most cancers compared to traditional radiation therapy.
To manage these high costs, the Ministry of Health (MOH) has implemented strict guidelines on the use of PBT. Only specific cancers and conditions qualify for PBT under insurance coverage. This policy is in line with the Cancer Drug List (CDL) introduced in 2022, which limits MediShield Life, Integrated Shield Plans (IP), and MediSave coverage to proven cancer therapies.
MOH Guidelines and Insurance Coverage
MOH’s guidelines for proton beam therapy for cancer in Singapore align with the principles of the CDL. The aim is to prevent excessive healthcare spending on expensive, unproven treatments. Health Minister Ong Ye Kung explained that rising cancer treatment costs could significantly increase insurance premiums, affecting affordability. Consequently, PBT is restricted to specific cancers and conditions that demonstrate clear benefits.
Coverage under Integrated Shield Plans (IPs) varies, with private hospital IPs covering between $30,000 and $100,000 per year and B1 class IPs ranging from $15,000 to $100,000 per year. MediShield Life and MediSave also offer limited coverage, with caps based on the type of treatment. For instance, MediSave withdrawal ranges from $80 to $2,800, while MediShield Life claims range from $300 to $2,800 per treatment. For PBT used in the central and peripheral nervous systems, the limits are $7,500 for MediSave and $10,000 for MediShield Life per treatment course.
Patient Demographics and Financial Support
Proton beam therapy for cancer in Singapore is primarily accessible to those with comprehensive Integrated Shield Plans (IPs). While 70% of the population has IPs, the coverage provided varies significantly. Private hospital IPs cover between $30,000 and $100,000 per year, while those pegged to B1 class wards range from $15,000 to $100,000 annually.
Despite these provisions, many patients still face high out-of-pocket costs. MediShield Life and MediSave offer some financial support. However, the caps on these schemes often leave a substantial portion of the bill unpaid. For example, MediSave withdrawals for PBT can range from $80 to $2,800. MediShield Life claims vary from $300 to $2,800 per treatment. The higher limits for central and peripheral nervous system treatments are $7,500 for MediSave and $10,000 for MediShield Life per treatment course. These limits reflect the increased costs associated with these complex cases.
This financial structure means that PBT is beyond the reach of 30% of the population who only have basic MediShield Life insurance. Even if their cancer qualifies for PBT under MOH guidelines, these patients would need to qualify for and receive MediFund coverage. MediFund acts as a safety net for those unable to afford their medical treatments.
Under-Utilisation and Future Considerations
With six proton beam therapy gantries in Singapore, the treatment of only 300 patients annually highlights a significant under-utilisation of these costly machines. Each PBT machine costs between $80 million and $100 million, emphasising the need for a more efficient use of resources.
MOH could consider a two-tier system to increase access to PBT without significantly raising healthcare costs. The first tier would maintain the current list of PBT-approved cancers covered by insurance. The second tier could include all cancers, with coverage capped at conventional radiation rates. Patients opting for PBT would pay the difference out-of-pocket, ensuring insurance premiums remain stable.
A two-tier system would allow more patients to choose PBT while controlling insurance costs. It could also attract more international patients, helping institutions recover equipment costs faster. This model mirrors the CDL, where MediShield Life sets coverage caps, and IPs cover a multiple of those amounts, ensuring cost control while offering patients more treatment options.
By adopting a flexible, two-tier system, Singapore could balance patient choice with cost control, benefiting both local and international patients. This approach could optimise the use of advanced PBT technology and improve overall healthcare outcomes.
Potential for Broader Access and Future Benefits
Expanding the availability of proton beam therapy for cancer in Singapore could significantly enhance patient outcomes. By adopting a flexible, two-tier system, Singapore could ensure that more patients benefit from this advanced treatment without substantially increasing healthcare costs.
This approach would also attract international patients, contributing to the sustainability of PBT facilities and potentially leading to reduced treatment costs over time. As more data on the effectiveness of PBT emerges, there may be opportunities to further refine guidelines and make this cutting-edge therapy accessible to a broader population.
Image credit: National Cancer Centre Singapore
References
- More than 300 in Singapore have received proton beam therapy for cancer. (n.d.). https://www.healthxchange.sg/news/more-than-300-in-singapore-have-received-proton-beam-therapy-for-cancer#:~:text=Since%20the%20launch%20of%20PBT,below%20the%20age%20of%2025.
- Proton beam: Possible to ease grip on cancers it can be used for, without pushing up healthcare costs for all. (n.d.). https://www.singhealthdukenus.com.sg/news/patient-care/proton-beam-possible-to-ease-grip-on-cancers-it-can-be-used-for-without-pushing-up-healthcare-costs-for-all
