OBJECTIVES :

Human papillomavirus (HPV) immunisation is recommended under the Singapore National Adult Immunisation Scheme (NAIS) for individuals between 9 – 26 years of age. The bivalent (2vHPV) and quadrivalent (4vHPV) vaccines, which are available in the KKH formulary, have been claimable under the national medical savings system (Medisave) for this age group since 2010. The recent availability of a nonavalent (9vHPV) vaccine increases the overall prevention of cervical cancer from 70% to 90%, but it is currently not covered under Medisave. The impact of including 9vHPV vaccine in the formulary, and its influence on patient and physician preferences was reviewed.

METHODS :

The age, billing records and number of patients prescribed with the HPV vaccines were retrieved from the electronic medical and health records. Cost comparison and physicians’ input were also considered during the review of the vaccines.

RESULTS

There were 375 patients prescribed with HPV vaccines over a 6-month period, of which 53 patients (14%) was eligible for Medisave claims – however, only 15/53 (28%) used Medisave. Majority (74%) selected the 9vHPV vaccine, although it was 170% and 43% more expensive than 2vHPV and 4vHPV vaccines, respectively. Overall, only 15/375 (4%) utilized Medisave, which showed that it had minimal impact on KKH’s patient population because they are willing to pay out-of-pocket for the more efficacious vaccine. Furthermore, physicians shared that they preferred recommending 9vHPV vaccine, due to its better efficacy.

CONCLUSIONS :

The 4vHPV vaccine was removed from the formulary while the 9vHPV and 2vHPV vaccines were retained, the latter for those who prefer using Medisave. While the formulary decision-making process takes into account recommendations of national subsidies and saving schemes, other factors such as patient and physician preferences also play a vital role in the Singapore healthcare system, where patients are expected to pay all or part of the treatment costs.