WHAT DRIVES SUBSIDY SUCCESS IN SINGAPORE? KEY DETERMINANTS OF HTA DECISION-MAKING BY THE AGENCY FOR CARE EFFECTIVENESS (ACE)
Author(s)
Jian Yi Choy, MSc, Janis Lim, BSc, Xuenan Liu, MSc, Amrita Viswambaram, MSc.
Costello Medical, Singapore, Singapore.
Costello Medical, Singapore, Singapore.
OBJECTIVES: In 2021, ACE introduced a company-led submission (CLS) process in oncology, enabling subsidy decisions to be made close to regulatory approval. Non-oncology drugs continue to undergo the physician-led pathway, although some are selected for the CLS process.
This research aims to evaluate ACE’s decision-making factors and subsidy outcomes across a range of HTA appraisals (covering cancer/non-cancer, rare diseases, vaccines and gene therapies).
METHODS: ACE appraisals published between January 2024-April 2026 were identified. Indication reviews, withdrawn appraisals and documents not reporting committee discussion were excluded. Included appraisals were reviewed for decision-making factors (clinical need, clinical value, economic value, budget impact), and subsidy outcomes.
RESULTS: 54 HTA appraisals evaluated 77 regimens (69 drugs/5 gene therapies/3 vaccines); over half were cancer (31; all CLS) and rare disease (15) regimens. 29/77 regimens were recommended for subsidy-listing (15 on first assessment, including 5 for rare diseases; 14 more upon pricing revision, including 1 for rare disease). Fewer cancer vs non-cancer regimens were recommended on first assessment (1 vs 14; 10 vs 4 more upon pricing revision). Among 16 regimens considered cost-effective, 3 had acceptable ICERs of S$15,000-45,000 per QALY, while ICERs were not reported for the remaining regimens.
Amongst the 48 regimens not recommended, 4 were judged to have low clinical need for the regimen, 21 were deemed to have uncertain clinical evidence (commonly due to data immaturity), none were cost-effective, and all had uncertain/unreasonably high budget impact. Nonetheless, uncertain clinical evidence did not preclude subsidy-listing (2 regimens with uncertain clinical evidence received subsidy recommendation); none of the regimens with low clinical need, unreasonably high budget impact or those that were not cost-effective were recommended for subsidy listing on first application.
CONCLUSIONS: Singapore HTA subsidy decisions are driven by clinical need, clinical- and cost-effectiveness, and budget certainty. Pricing resubmissions improved recommendation outcomes, particularly for cancer regimens.
This research aims to evaluate ACE’s decision-making factors and subsidy outcomes across a range of HTA appraisals (covering cancer/non-cancer, rare diseases, vaccines and gene therapies).
METHODS: ACE appraisals published between January 2024-April 2026 were identified. Indication reviews, withdrawn appraisals and documents not reporting committee discussion were excluded. Included appraisals were reviewed for decision-making factors (clinical need, clinical value, economic value, budget impact), and subsidy outcomes.
RESULTS: 54 HTA appraisals evaluated 77 regimens (69 drugs/5 gene therapies/3 vaccines); over half were cancer (31; all CLS) and rare disease (15) regimens. 29/77 regimens were recommended for subsidy-listing (15 on first assessment, including 5 for rare diseases; 14 more upon pricing revision, including 1 for rare disease). Fewer cancer vs non-cancer regimens were recommended on first assessment (1 vs 14; 10 vs 4 more upon pricing revision). Among 16 regimens considered cost-effective, 3 had acceptable ICERs of S$15,000-45,000 per QALY, while ICERs were not reported for the remaining regimens.
Amongst the 48 regimens not recommended, 4 were judged to have low clinical need for the regimen, 21 were deemed to have uncertain clinical evidence (commonly due to data immaturity), none were cost-effective, and all had uncertain/unreasonably high budget impact. Nonetheless, uncertain clinical evidence did not preclude subsidy-listing (2 regimens with uncertain clinical evidence received subsidy recommendation); none of the regimens with low clinical need, unreasonably high budget impact or those that were not cost-effective were recommended for subsidy listing on first application.
CONCLUSIONS: Singapore HTA subsidy decisions are driven by clinical need, clinical- and cost-effectiveness, and budget certainty. Pricing resubmissions improved recommendation outcomes, particularly for cancer regimens.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HTA27
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas