Impact of the cancer drug list on out-of-pocket expenses and financial toxicity of patients undergoing outpatient chemotherapy in Singapore

BackgroundThe Ministry of Health, Singapore instituted the Cancer Drug List (CDL) on 1st September 2022 to keep cancer treatments and insurance premiums affordable. This study assessed the impact of CDL on out-of-pocket expenses (OOPE) and patient-reported financial toxicity (FT) in cancer patients undergoing outpatient chemotherapy.MethodsA cross-sectional study was conducted at the National Cancer Centre Singapore involving two cohorts. Impact on OOPE was determined by reviewing chemotherapy bills between June-November 2022 (Cohort A). Impact on FT was assessed using the COmprehensive Score for financial Toxicity (COST) tool through patient surveys conducted May-June 2023 (Cohort B). Factors associated with increased OOPE or FT were analysed.ResultsAnalysis of 1674 patients' bills showed most patients (68.1%) did not experience increased OOPE following CDL implementation. Median change in OOPE was $0.00 (IQR: $0.00-$3.17). Factors significantly associated with increased OOPE included subsidised patients, primary gastrointestinal tumours, using non-subsidised or non-CDL agents, and chemotherapy regimen changes. Among surveyed participants, 60.7% reported high FT, particularly those with <$2000 monthly income.ConclusionMost patients did not experience increased OOPE following CDL implementation, indicating stable objective financial burden. However, subjective financial distress remained concerning. Patient education and improved health literacy may empower patients to seek financial assistance. The study identified vulnerable patients who may benefit from targeted interventions such as enhanced subsidy schemes and safety nets.