Table 2.
Current PM adoption in four focus SEA countries based on six key themes
| Key themes | Indicators | Indonesia | Malaysia | Singapore | Thailand |
|---|---|---|---|---|---|
| Healthcare system | General | ||||
| GDP per capita (Current USD) | 3500 | 11,306 | 56,007 | 5970 | |
| Healthcare financing system | Social health insurance | Tax-funded | Mixture from tax revenue, insurer and patient | Social health insurance | |
| Healthcare expenditure per capita (USD) | 99 | 456 | 2752 | 360 | |
| THE (% of GDP, 2014) | 2.8 | 4.2 | 4.9 | 6.5 | |
| Health coverage (%) | 48 | 100 | 100 | 98 | |
| OOP health expenditure (% of THE, 2014) | 46.9 | 35.3 | 54.8 | 7.9 | |
| PM-specific | |||||
| Presence of PM-related healthcare service delivery | |||||
| 1. Targeted oncology therapy | Yes | Yes | Yes | Yes | |
| 2. PGx testing | Noa | Noa | Yesb | Yesc | |
| 3. Newborn screening | Yes (congenital hypothyroidism) | Yes (congenital hypothyroidism, G6PD) | Yes (congenital hypothyroidism, G6PD, inherited metabolic disorders) | Yes (congenital hypothyroidism, thalassemia, phenylketonuria) | |
| 4. Cancer risk screening | Noa | Yesd | Yesd | Noa | |
| 5. Advance genome sequencing | No | No | Yese | Yese | |
| Presence of PM-related healthcare workforce | |||||
| 1. Medical geneticist | Yes (NR) | Yes (9) | Yes (6 + 2 cancer geneticist) | Yes (11) | |
| 2. Genetic counsellors | Yes (NR) | Yes (2) | Yes (≈10) | No | |
| Financing mechanism | |||||
| 1. Capacity-building | NR | NR | NR | NR | |
| 2. Infrastructure | NR | NR | NR | NR | |
| 3. Research | Cyclic grants from government, university, international collaborators | Cyclic, one-off grant from government, university | Funding from A*STAR | Cyclic, one-off grant from government, university | |
| Governance | National strategy/plan | No | No | National PM initiative (in progress) | No |
| Comprehensive PM legislation/guideline | No | Nof | Nof | No | |
| Ethical, social, legal framework on PM provision | No | No | PM-specific provision standard is in progress | No | |
| Ethical, social, legal framework for genetic data | No | Yes, but no laws related to genetic discrimination by insurance companies | PM-specific standard is in progressg | Yes, but no laws related to genetic discrimination by insurance companies | |
| National PM research centre or large-scale research initiative | No | No | GIS; POLARIS; SAPhIRE; PRISM |
PGx projects by TCELS | |
| Direct to consumer test legislation or code of conduct | No | No | Bioethics Advisory Committee recommendations | Existing consumer law | |
| PM working group with multiple stakeholders | No | No | Yes | Yes | |
| Access | HTA body | Yes Major hospitals |
Yes National |
Yes National |
Yes National |
| PM-specific HTA framework | No | No | Noh | No | |
| Multi-stakeholder decision-making group | Yes | Yes | Yes | Yes | |
| Awareness | Patient support/advocacy groups | No | Yes | Yes, but not specific | Yes, but not specific |
| Efforts to increase public awareness | Yes | Yes | Yes | Yes | |
| Patient involvement in healthcare and/or research | Low in research | Low in research | Moderate in research | High in research | |
| Implementation | Centre of excellence/leading institute in PM service | Dr Cipto Mangunkusumo Hospital; Center for Biomedical Research in Diponegoro University | Institute of Medical Research | PRISM | Ramathibodi Hospital; Khon Kaen University Hospital; Siriraj Hospital |
| Education and training for PM and non-PM specialized healthcare workforce including medical school | Yes | Yes | Yes | Yes | |
| Data | EHR | No | No | Yes | Yes |
| Biobank | Hospital-level biobanks | Malaysian Cohort Biobank; UKMMC-UMBI Biobank | SingHealth Tissue Repository; National University Health System Tissue Repository |
Hospital-level biobanks | |
| Database | Indonesian National Genetic Database | Malaysian Human Variome Project | Singapore Genome Variation Project database; Singapore Human Mutation/ Polymorphism Database; Singapore PGx Portal |
Thailand Mutation and Variation database | |
| Patient registry with genetic/genomic data | No | Thalassemia Registry | Singapore Polyposis Registry; Thalassemia Registry; National Birth Defect Registry | No | |
Notes
a Available through special request
b HLA-B*15:02 screening is mandatory in Singapore. UGT1A*6 and UGT1A1*28 testing are available in National Cancer Centre
c HLA-B*15:02 screening is routinely practised in major hospitals. A variety of other PGx testings are available as service in several university hospitals
d BRCA screening is available in a few national/university/ specialised hospitals: University Malaya Medical Centre, Hospital Kuala Lumpur in Malaysia; National Cancer Centre Singapore, National University Hospital in Singapore
e Next-generation sequencing is available in leading hospital: SingHealth-POLARIS in Singapore; Ramathibodi Hospital in Thailand
f Some degree of ethical oversights are governed under the existing national medical genetics service and/or genetic testing guideline
g Includes informed consent, security and confidentiality of information, and disclosure of test results to third parties outside direct healthcare providers
h Genetic test is evaluated as medical device
Abbreviations
A*STAR Agency for Science and Technology Research, EHR electronic health record, GDP gross domestic product, GIS Genome Institute of Singapore, HTA health technology assessment, NR not reported or insufficient information, OOP out-of-pocket, PGx pharmacogenomics, PM personalized medicine, POLARIS Personalized OMIC Lattice for Advanced Research and Improving Stratification, PRISM SingHealth Duke-NUS Institute of Precision Medicine, SAPhIRE Surveillance and Pharmacogenomics Initiative for Adverse Drug Reactions, TCELS Thailand Centre of Excellence Life Sciences, THE total health expenditure, UKMMC University Kebangsaan Malaysia Medical Centre, UMBI UKM Medical Biology Institute, USD United States dollar