Assessing the financial impact of cancer drug list (CDL) implementation on patients receiving chemotherapy in an ambulatory cancer centre in Singapore

On 1st September 2022, the Cancer Drug List (CDL) was implemented to ensure the long-term affordability of chemotherapy and insurance premiums. This project aimed to determine the financial impact of CDL on out-of-pocket expenses (OOPE), acceptability and financial toxicity (FT) after CDL implementation. A cross-sectional study was conducted at National Cancer Center Singapore. We analyzed OOPE before and after implementation of CDL by reviewing billing transactions in Aug-Sept 2022. Acceptability and FT were determined using theoretical framework of acceptability (TFA) and COmprehensive Score for financial Toxicity (COST) tool respectively via survey. Of the 314 patients finalized bills examined, majority (68.8%) experienced no change in their OOPE, and 69.1% had no OOPE. Most patients (72.6%) were unaware of implementation of CDL. Among patients aware of CDL, majority (61.9%) were accepting, but unsure on how it benefits them. FT was reported as low (mean COST score = 22.4 ± 9.9), and patients ≥65 years old or have at least pre-university education were less likely to experience FT. Despite best efforts from policymakers, it is challenging to achieve a one-size fits funding or subsidy framework that can cater to the needs of all patients. Some groups of patients would inevitably still experience high OOPE and FT due to their personal or clinical circumstances. Patients can be better empowered to seek financial assistance or resources.