Forum: Set up national body to decide quickly on medical treatment in exceptional cases

I was alarmed to read the article, "Cancer patient dealt another blow - insurer refuses to pay for drug" (April 21). A patient was diagnosed with a rare cancer, and after poor response to the standard therapies, her oncologist treated her with a cocktail of medicines including a drug approved in Singapore for treating another cancer. She responded well but the insurer declined the claim for this drug, citing its lack of approval by the Health Sciences Authority for the cancer she had. There are important policy implications arising from this case.

Healthcare resources are finite, and doctors and patients cannot be given carte blanche to choose from all therapies - all of us suffer when health premiums skyrocket, and they will if healthcare costs are not managed well.

However, practice guidelines are developed typically for more common conditions and even then, for the more usual forms of treatment. When patients have exhausted these forms of treatment, or when there are no guidelines, it cannot be that no further treatment can be offered because of reimbursement restrictions.

All of us will, as medicine advances, be eventually found to be unique and benefit from "precision medicine" approaches based on a person's genes.

If population-level guidelines are not appropriate for specific cases because of particular genetic or other traits, how can we cater to this group of patients?

There will also always be exceptional cases for whom standard guidelines and policies would be a poor fit, and time-sensitive decisions with substantial financial impact would have to be made. Who should make these decisions and how can the process be efficient, consistent, fair and timely?

A national "clearing house" for such clinical decisions is needed. The relevant experts could then be mobilised quickly to decide on the appropriateness of a high-cost, non-standard treatment that is prescribed.

Escalating healthcare costs are a concern but all of us should be just as concerned about inappropriate denial of care.

Jeremy Lim (Dr)

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