Preliminary Report of System Dynamics Modeling of a Co-Payment Mechanism for Breast Cancer Patients in Malaysia
Author(s)
Jing Sheng Lim, MPhil1, Weng Hong Fun, Degrees BPharm, M.Sc (BioE), PhD2, Kenneth Kwing Chin Lee, Degrees BSc (Pharm), MPhil, PhD (Health Economics)3, Renukha Sellappans, MPharm, PhD1.
1School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia, 2Centre for Health Outcomes, Institute for Health Systems Research, Shah Alam, Selangor, Malaysia, 3School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
1School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia, 2Centre for Health Outcomes, Institute for Health Systems Research, Shah Alam, Selangor, Malaysia, 3School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
OBJECTIVES: Malaysia’s tax-funded public healthcare system, operating on a finite budget, provides equitable and affordable cancer care but is often associated with longer waiting times and limited patient access to innovative therapies. Consequently, some uninsured breast cancer patients may seek innovative therapies in the costlier private sector, exposing them to financial toxicity. To provide more value-based options, the Ministry of Health (MOH) is developing a co-payment model, “Rakan KKM” in public hospitals to offer affordable “premium economy” access, while reinvesting the generated revenue to improve public healthcare services. This study evaluates its potential financial impact from both the MOH and patient perspectives.
METHODS: A system dynamics model was developed to simulate annual breast cancer incidence by stage using data from the Malaysia National Cancer Registry. It incorporated the disease progression and patient flow to public, private, or no treatment pathways. Based on an earlier study, the scenario analysis assumed 66.7% of private-sector patients shifting to Rakan KKM due to financial toxicity over the period of 2026-2035. Costs were limited to drug costs for chemo-, endocrine, and anti-HER2 therapies. All costs and financial outcomes, including Rakan KKM profit and patient out-of-pocket savings, were discounted at 3% annually.
RESULTS: The patient shift could generate RM 38,063,229 (USD8,458,495, 1USD=RM4.50) cumulative profit for MOH over ten years. Patients who switch to Rakan KKM may save an average of RM 26,285 (USD5,841) in out-of-pocket costs, a 59.2% reduction compared to private cancer care cost. From a health system perspective, the simulated scenario (private + Rakan KKM) could potentially save RM 428,215,819 (USD95,159,070) over ten years, compared to the base case (private only).
CONCLUSIONS: Rakan KKM has the potential to be a cost-saving co-payment model for breast cancer treatment access. It potentially offers substantial savings for patients, contributes to MOH sustainability, and reduces system-wide healthcare costs.
METHODS: A system dynamics model was developed to simulate annual breast cancer incidence by stage using data from the Malaysia National Cancer Registry. It incorporated the disease progression and patient flow to public, private, or no treatment pathways. Based on an earlier study, the scenario analysis assumed 66.7% of private-sector patients shifting to Rakan KKM due to financial toxicity over the period of 2026-2035. Costs were limited to drug costs for chemo-, endocrine, and anti-HER2 therapies. All costs and financial outcomes, including Rakan KKM profit and patient out-of-pocket savings, were discounted at 3% annually.
RESULTS: The patient shift could generate RM 38,063,229 (USD8,458,495, 1USD=RM4.50) cumulative profit for MOH over ten years. Patients who switch to Rakan KKM may save an average of RM 26,285 (USD5,841) in out-of-pocket costs, a 59.2% reduction compared to private cancer care cost. From a health system perspective, the simulated scenario (private + Rakan KKM) could potentially save RM 428,215,819 (USD95,159,070) over ten years, compared to the base case (private only).
CONCLUSIONS: Rakan KKM has the potential to be a cost-saving co-payment model for breast cancer treatment access. It potentially offers substantial savings for patients, contributes to MOH sustainability, and reduces system-wide healthcare costs.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD86
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology