Singapore launches national genetic testing programme for inherited cholesterol condition
SINGAPORE: Singapore will on Jun 30 start a national genetic testing programme for an inherited cholesterol condition, the Ministry of Health (MOH) said on Thursday (Jun 19).
The programme aims to identify individuals with familial hypercholesterolaemia (FH) early and reduce the risk of premature heart disease for these individuals with timely interventions.
An estimated 20,000 people in Singapore have FH, a condition that affects the body's ability to process cholesterol.
People with FH face a "significantly higher risk" – up to 20 times more – of experiencing heart attacks at a younger age compared with the general population. It is a hereditary condition.
MOH plans to open three Genomic Assessment Centres (GAC) within each of the three healthcare clusters.
The first, operated by SingHealth, will be located at the National Heart Centre. It will start accepting referrals from Jun 30.
Two other centres, operated by the National Healthcare Group and National University Health System, will be opened subsequently.
Individuals referred to these centres will undergo pre-test genetic counselling to understand potential outcomes and benefits before the test, the drawing of blood and the test.
They will also get post-test genetic counselling to understand the implications of the results.
WHO QUALIFIES?
Singaporeans and permanent residents with "abnormally high" cholesterol levels may be referred by their doctors to the GAC for FH genetic testing. Abnormally high levels refer to LDL-C levels of more than or equal to 5.5mmol/L or 212mg/dL.
If a person tests positive for FH, their immediate family members – parents, siblings and children – will be at risk and are encouraged to undergo genetic testing.
This process is known as cascade screening and enables early detection of FH within families.
"In turn, it allows for timelier intervention and treatment, such as advising them to adopt healthier lifestyles and starting them on cholesterol-lowering therapies, if necessary, to reduce their risk of premature heart disease," said MOH.
In a Facebook post on Thursday, Health Minister Ong Ye Kung said: "We want to expand preventive care based on genetic testing to more diseases, beyond FH.
"It is part of our longer-term effort to develop predictive preventive care under Healthier SG."
HOW MUCH WILL IT COST?
The costs for FH genetic testing include the drawing of blood, tests, as well as pre-test and post-test counselling.
At the GACs, eligible Singaporeans and permanent residents can get means-tested subsidies of up to 70 per cent for these costs.
Seniors from the Pioneer Generation and Merdeka Generation are eligible for additional subsidies.
After subsidies, patients who are referred to do FH testing can expect to pay between S$117 (US$91) and S$575.
Eligible immediate family members of those who have tested positive for FH can expect to pay between S$53 and S$253 after subsidies.
MediSave500/700 can be used to further offset the cost of the genetic test after subsidies. Patients who are 60 and above may also use Flexi-MediSave to further defray out-of-pocket costs.
Most patients who test positive for FH will require a combination of medication and lifestyle modifications, such as dietary changes and physical activity, to achieve a healthy cholesterol level and prevent premature heart disease, MOH said.
"Patients are advised to follow up with a primary care provider at the polyclinics or general practitioner (GP) clinics, or with their family doctor if they are enrolled in Healthier SG for continued management. Subsidies are available for selected chronic medications," it added.
INSURANCE
A moratorium on genetic testing and insurance was introduced by MOH and the Life Insurance Association Singapore (LIA) in October 2021.
Under this agreement, life insurers in Singapore are not allowed to use predictive genetic test results in assessing or deciding the outcome of insurance applications, unless certain criteria are satisfied.
Insurers are also not allowed to use genetic test results from biomedical research or direct-to-consumer genetic test results
MOH has worked with the LIA to amend the moratorium to disallow life insurers in Singapore from using the results of all genetic tests - both predictive and diagnostic - conducted under the national FH genetic testing programme.
"As with standard insurance underwriting practice, they may however request individuals to disclose existing diagnosed conditions (including FH) and family history.
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