Current situation in control strategies and HealthSystems in AsiaSINGAPORE                                                ...
Demography              (2010)                        (2010)    Land area                    712.4 km2    Temperature     ...
Demography                    (2010)                              (2010)    Annual Birth Rate    A      l Bi th R t       ...
Health System – Public/Government (1)   Affordable, Good Quality Healthcare  Hospitals     • 5 general hospital     • 1 wo...
Health System – Public/Government (2)   • Medisave Medishield ElderShield and     Medisave, Medishield,     Medifund schem...
Health System – Private   16 Hospitals       • 20 – 505 beds   ~2000 Private Clinics   Medisave, Medishield, ElderShield a...
Diagnostic ServicesPopulation Screening    • National Thalassaemia Registry    • Cascade screening – first degree relative...
National Thalassaemia Registry (NTR)  Established:1992年  Location:KK Women’s and Children’s Hospital  Aim :    • Register ...
Screening                Full blood count     Hb electrophoresis   (HbH inclusion bodies)               Mutation analysis
Prenatal screening                                   FBC of couple  MCV < 80 for one or both                              ...
Thalassaemia carrier rate       2000 unrelated individuals:        Thalassaemia                2.91 %        Thalassaemi...
Number of allele screened                      No of alleles   No of mutation    - thalassaemia       4971             26...
NUMBER OF NTR REGISTRANTS2010   • Number of Registrants 43,471   • Number Screened 24,989   • Number of Carrier 30,679    ...
Type of thalassaemia2010  -thalassaemia carrier                  14129 (45.97%)  -thalassaemia   thalassaemia carrier  ...
Number of -thalassaemia majors born 30 25 20 15 10  5  0Before Year   1971-1975   1976-1980   1981-1985   1986-1990   199...
-thalassaemia majors     Chinese      66.3%                                      Malay                                   ...
-thalassaemia minors   Chinese                               Malay    77.5%    77 5%                               14.3% ...
HbE Carriers     Malay     M l     75.5%                          Indian                          I di                    ...
HbE -thalassaemia       Malay       74.3%                                  Indian                                   4.0% ...
-thalassaemia minors    Chinese     82.8%                                    Malay                                    8.2...
 and -thalassaemia carriers                                   Malay  Chinese                          8.5%   79.5%      ...
HbH Disease     Chinese      86.2%                          Malay                           7.1%                     India...
TreatmentBlood transfusion   • Non-remunerated   • US$21 27 (RCC) or US$52.22 (Washed Cells)     US$21.27            US$52...
Monitor Cardiac and other complicationsCardiac   • T2* Technology available at National Heart CentreOther complications   ...
Conclusion • The strategy of screening family members of index   cases has been effective in identifying new carriers. • T...
Thank you      y                          < single image >                           4.3cm x 5.5cmThis presentation contai...
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Singapore - Current Situation in Control Strategies and Health Systems in Asia

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Current situation in control strategies and Health Systems in SINGAPORE by Law Hai Yang Deputy, Director, National Thalassaemia Registry

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Singapore - Current Situation in Control Strategies and Health Systems in Asia

  1. 1. Current situation in control strategies and HealthSystems in AsiaSINGAPORE 8 February2012 < single image > g g 4.3cm x 5.5cm Law Hai Yang Deputy Director Natiional Thalassaemia Reigistry
  2. 2. Demography (2010) (2010) Land area 712.4 km2 Temperature 24.9 – 31.9 OC Total Population 5,076,700 076, Resident Population 3,771,700 3,771, Density 7,126/km2 Ethnic Groups Chinese 74.1% Malay 13.4% Indian 9.2% Others 3.3%2
  3. 3. Demography (2010) (2010) Annual Birth Rate A l Bi th R t 9.3/1 000 3/1,000 3/1 1,000 Total Live-Births Live- 37,967 Infant Mortality Rate 2.0 /1000 Live-Birth Live- Life Expectancy at Birth 81.8 Years Doctor per 1,000 Population 1.7 Average Income* g $4,800 (US$3,713) ( , ) Total Health Budget* $4.1 (US$3.17) billion Subsidies for medical care* $2.2 (US$1.7) billion ( ) *$1 (USD) = $1.2926 (SGD) 16 Jan 20123
  4. 4. Health System – Public/Government (1) Affordable, Good Quality Healthcare Hospitals • 5 general hospital • 1 women’s and children’s hospital • 1 psychiatry hospital 6 Specialty Centres • Cancer, cardiac, eye, skin, neuroscience and dental care Total 185 – 2064 beds 18 polyclinics l li i
  5. 5. Health System – Public/Government (2) • Medisave Medishield ElderShield and Medisave, Medishield, Medifund schemes exist to help Singaporeans “co-pay” their medical expenses. • $20 million allocated to Medication Assistance Fund to help needy patients with high cost drugs. g g • No special policy on Hb disorders.
  6. 6. Health System – Private 16 Hospitals • 20 – 505 beds ~2000 Private Clinics Medisave, Medishield, ElderShield and Medifund not applicable
  7. 7. Diagnostic ServicesPopulation Screening • National Thalassaemia Registry • Cascade screening – first degree relatives •GGenetic C i Counseling liClinical laboratory y • Full blood count, Hb electrophoresis • All major hospitals and private labs j p p • Outpatient and prenatal screeningMolecular Diagnostic Lab (Carrier & Prenatal testing) • KK Women’s and Children’s Hospital • National University Hospital
  8. 8. National Thalassaemia Registry (NTR) Established:1992年 Location:KK Women’s and Children’s Hospital Aim : • Register all thalassaemia carriers • Free counseling • Subsidized screening Referral :• Government and private hospitals, Clinics • Consent • Self referral Effective in identifying carriers
  9. 9. Screening Full blood count Hb electrophoresis (HbH inclusion bodies) Mutation analysis
  10. 10. Prenatal screening FBC of couple MCV < 80 for one or both MCV > 80 for both MCH < 26 for one or both MCH > 26 for both Hb electrophoresis for No further action HbH inclusion body both HbE +ve HbA2  HbH +ve HbH -ve & both MCV < 80 HbE trait -thal trait -thal trait If spouse is If spouse is -thal trait -thal trait Consider -thalassaemia minor - Do DNA and family studies
  11. 11. Thalassaemia carrier rate 2000 unrelated individuals:  Thalassaemia 2.91 %  Thalassaemia 0.93 0 93 % HbE 0.64 % Total 4.49 %
  12. 12. Number of allele screened No of alleles No of mutation - thalassaemia 4971 26 -th l thalassaemia i 3105 53
  13. 13. NUMBER OF NTR REGISTRANTS2010 • Number of Registrants 43,471 • Number Screened 24,989 • Number of Carrier 30,679 NTR Population p Chinese 72.6% 74.1% Malay 17.6% 13.4% Indian 4.8% 4 8% 9.2% 9 2% Others 5.1% 3.3%
  14. 14. Type of thalassaemia2010 -thalassaemia carrier 14129 (45.97%) -thalassaemia  thalassaemia carrier 11550 (37 58%) (37.58%) HbE 3652 (11.88%) HbH disease 521 (1.70%) Concurrent -thalassaemia carrier  thalassaemia 352 (1.15%) (1 15%) HbE with -thalassaemia 101 (0.33%) -thalassaemia 89 (0.29%) major
  15. 15. Number of -thalassaemia majors born 30 25 20 15 10 5 0Before Year 1971-1975 1976-1980 1981-1985 1986-1990 1991-1995 1996-2000 2001-2005 2006-2010 1970 19 0
  16. 16. -thalassaemia majors Chinese 66.3% Malay 23.6% Indian Others 4.5% 5.6% n = 89
  17. 17. -thalassaemia minors Chinese Malay 77.5% 77 5% 14.3% Indian 5.2% Others 3.0% n = 11550
  18. 18. HbE Carriers Malay M l 75.5% Indian I di 2.2% Others 12.7% Chinese 9.6% n = 36 2 3652
  19. 19. HbE -thalassaemia Malay 74.3% Indian 4.0% Others 4.0% Chinese 17.8% n =101
  20. 20. -thalassaemia minors Chinese 82.8% Malay 8.2% Indian 4.1% Others h 5.0% n = 14129
  21. 21.  and -thalassaemia carriers Malay Chinese 8.5% 79.5% Indian 6.5% Others 5.4% n = 352
  22. 22. HbH Disease Chinese 86.2% Malay 7.1% Indian Others 0.8% 6.0% n = 521
  23. 23. TreatmentBlood transfusion • Non-remunerated • US$21 27 (RCC) or US$52.22 (Washed Cells) US$21.27 US$52 22 • Average 4 weekly transfusion • Target at Hb Level of 9 g/dL Iron chelation •Deferroxamine (Desferal) D f i (D f l) •Deferiprone (L1) •Deferasirox (Exjade) •Combination therapy (Desferal & L1)• Bone marrow transplant
  24. 24. Monitor Cardiac and other complicationsCardiac • T2* Technology available at National Heart CentreOther complications • Singapore General Hospital • National University Hospital
  25. 25. Conclusion • The strategy of screening family members of index cases has been effective in identifying new carriers. • The incidence of the major form of the disease has decreased significantly with effective screening and preventive strategies in place. • The reduction in the number of affected homozygotes has allowed expensive optimal treatment to be available to nearly all those afflicted with the major form of the disease.
  26. 26. Thank you y < single image > 4.3cm x 5.5cmThis presentation contains information which is confidential and/or legally privileged. No part of this presentation may be disseminated, distributed, copied, reproduced or relied upon without the expressed authorisation of SingHealth.

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