Presentation (CTI)

OBJECTIVES: In Singapore, cancer treatments listed on the Cancer Drug List receive funding coverage. New cancer treatments are evaluated through company-led submissions to the Agency for Care Effectiveness (ACE), which conducts health technology assessments to inform national funding decisions. This review examines the evidence quality of company-led submissions and identifies common factors contributing to clinical assessment uncertainty.
METHODS: We reviewed cancer drug submissions received by ACE between March 2023 and June 2025. Submissions with published technology guidance were included. Information was extracted from publicly available guidance documents on evidence type, maturity of survival outcomes, appropriateness of selected comparators, and overall robustness of clinical evidence. Identified evidence limitations were categorised using a predefined framework. Descriptive statistical methods were applied to summarise factors contributing to uncertainty in clinical and comparative effectiveness.
RESULTS: Of 31 cancer drug submissions reviewed, 22 had published guidances and were included. Several evidence limitations were observed. Fourteen submissions (64 percent) did not demonstrate overall survival benefit, and ten (45 percent) contained immature survival data. Eleven submissions (50 percent) relied on indirect comparative evidence with transitivity concerns. Eight (36 percent) included claims of superiority that were not fully supported by submitted clinical data. Seven (32 percent) nominated comparators not aligned with local standard of care, limiting relevance of the evidence.
CONCLUSIONS: Cancer drug submissions demonstrated evidence gaps, including lack of survival benefits, reliance on indirect comparisons, and inappropriate comparator selection that misaligned with local practice. These factors contribute to uncertainty in funding decision-making. Strengthening submission standards may support more robust evaluations to inform resource allocation decisions in Singapore’s healthcare system.