The government maintains a Standard Drug List (SDL) of subsidized drugs. However, there are some issues of transparency concerning the List and decision-making processes.
First, is the SDL public information? It is not easy to find the SDL and even doctors I spoke to were uncertain. In comparison, it is easy to locate the Essential Drugs Lists maintained by World Health Organisation and several other countries online.
Secondly, there is little information about how our Drug Advisory Committee weighs up various factors before deciding if a drug should be on the list or not. The Committee reportedly takes into account factors including the cost-effectiveness of each drug, but what exactly does this mean? For instance, how are the findings of Pharmaco-economic research used in this decision-making process?
I understand that at the Health Sciences Authority, there is a unit called the Pharmacoeconomics and Drug Utilisation Unit (PEDU). PEDU assists the Drug Advisory Committee to assess the cost-effectiveness of such drugs and the financial impact to the governmental drug budget.
In 2008, there was an analytical study entitled “Healthcare Systems and Pharmaco-economic Research in the Asia-Pacific region” published in the journal Value In Health. The authors were of the opinion that the Singapore system involved “a simplified cost-effectiveness evaluation” which was in fact “a trade-off”, considering the available staff level at our Pharmaco-economics and Drug Utilization Unit, and how far the Drug Advisory Committee understood and accepted pharmaco-economic concepts.
Can the Singapore decision-making process be more transparent? Australia and Canada both devote entire websites to inform the public of the process of decision-making and the rationale for decisions. The information includes reasons why a drug is not included, with clinical data to back up their conclusions.
As we are talking about potential life-saving drugs, more transparency would go a long way towards building public trust.