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

1. Current situation in control strategies and Health
Systems in Asia
SINGAPORE
8 February2012
< single image >
g g
4.3cm x 5.5cm
Law Hai Yang
Deputy Director
Natiional Thalassaemia Reigistry

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. 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 2012
3

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. 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. Health System – Private
16 Hospitals
• 20 – 505 beds
~2000 Private Clinics
Medisave, Medishield, ElderShield and
Medifund not applicable

7. Diagnostic Services
Population Screening
• National Thalassaemia Registry
• Cascade screening – first degree relatives
•GGenetic C
i Counseling
li
Clinical laboratory
y
• Full blood count, Hb electrophoresis
• All major hospitals and private labs
j p p
• Outpatient and prenatal screening
Molecular Diagnostic Lab (Carrier & Prenatal testing)
• KK Women’s and Children’s Hospital
• National University Hospital

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. Screening
Full blood count
Hb electrophoresis (HbH inclusion bodies)
Mutation analysis

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. Thalassaemia carrier rate
2000 unrelated individuals:
 Thalassaemia 2.91 %
 Thalassaemia 0.93
0 93 %
HbE 0.64 %
Total 4.49 %

12. Number of allele screened
No of alleles No of mutation
- thalassaemia 4971 26
-th l
thalassaemia
i 3105 53

13. NUMBER OF NTR REGISTRANTS
2010
• 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. Type of thalassaemia
2010
-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. Number of -thalassaemia majors born
30
25
20
15
10
5
0
Before Year 1971-1975 1976-1980 1981-1985 1986-1990 1991-1995 1996-2000 2001-2005 2006-2010
1970
19 0

16. -thalassaemia majors
Chinese
66.3%
Malay
23.6%
Indian
Others
4.5%
5.6%
n = 89

17. -thalassaemia minors
Chinese
Malay
77.5%
77 5%
14.3%
Indian
5.2%
Others
3.0%
n = 11550

18. HbE Carriers
Malay
M l
75.5%
Indian
I di
2.2%
Others
12.7%
Chinese
9.6%
n = 36 2
3652

19. HbE -thalassaemia
Malay
74.3%
Indian
4.0%
Others
4.0%
Chinese
17.8%
n =101

20. -thalassaemia minors
Chinese
82.8%
Malay
8.2%
Indian
4.1%
Others
h
5.0%
n = 14129

21.  and -thalassaemia carriers
Malay
Chinese 8.5%
79.5%
Indian
6.5%
Others
5.4%
n = 352

22. HbH Disease
Chinese
86.2%
Malay
7.1%
Indian
Others 0.8%
6.0%
n = 521

23. Treatment
Blood 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. Monitor Cardiac and other complications
Cardiac
• T2* Technology available at National Heart Centre
Other complications
• Singapore General Hospital
• National University Hospital

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. Thank you
y
< single image >
4.3cm x 5.5cm
This 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.