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(a)
(b)
(c)

(d)

(e)
(f)
(g)
(h)
(i)
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4
Costing Template
Introduction
This workbook should be completed in addition to the company evidence submission template for full evaluations
presented to ACE within the agreed timelines for the technology evaluation. This workbook does not need to be co
for topics which are subject to expedited evaluation.

The spreadsheets are designed to assist the user calculate the net cost of the technology under evaluation over a
period. Figures will inform ACE's technology evaluation and budget impact analyses, as well as subsidy deliberatio
the MOH Drug Advisory Committee.

Guidance points
Please follow the guidance points below when completing the costing template:
Costs and other information inserted in the template must be consistent with the information provided in the evidence subm
Unless clearly indicated, data are required to be on a per annum basis, e.g. treatment costs per annum.
All costs should exclude GST.
Point estimates of costs, patient numbers and other data should reflect the local context. Where Singapore-specific data are
available, justification for using overseas estimates (including justification for the country selected) as a proxy should be pro
Opportunity costs (e.g. increase or decrease in inpatient days due to the technology under evaluation) are not accounted fo
Estimates are required covering a 5 year period from subsidy implementation of the technology under evaluation.
Full year costs must be calculated, even if the new technology is introduced part way through a year.
Only cells shaded yellow should be completed where appropriate.
Review the final numbers as a sense check.
Where the technology is being evaluated for several indications, a separate template is required for each indication.

More detailed explanations

Explanatory notes are provided within each worksheet which explain in detail how to complete each part of the template.
Hyperlinks to notes are provided and indicated by underscored numbers on the left-hand side of the text.

This costing template is made up of the following worksheets:

Click on any of the worksheet names below to go directly to that worksheet.

Annual treated patient numbers

This spreadsheet calculates the estimated numbers of patients in public healthcare institutions that will be treated with the
technology under evaluation in Singapore. It is important to capture the total patient population that could be clinically eligib
treatment, rather than the proportion of patients who are eligible for subsidy. The latter will be undertaken by ACE as part of
evaluation.
It is important to show sources of information and bases of calculations to justify assumptions. In order to facilitate this, a fr
spreadsheet is also provided ('derivation of patient numbers') that can be completed with tables, calculations, graphs and re
sources.

Derivation of patient numbers

This worksheet should be used to provide detailed workings to explain how the numbers of eligible patients and the number
patients to be treated have been estimated.
Use the details from this spreadsheet to populate the tables in the 'annual treated patient numbers' worksheet.
Treatment costs
This worksheet estimates the cost price of the technology under evaluation.
The cost must be consistent with information in the evidence submission and should be the cost price to public healthcare
institutions only (no margins applied). If a price discount is proposed in the evidence submission (contingent on a subsidy lis
prepare 2 separate analyses, one at the current price and one at the discounted price.

Summary

Budget impact
The budget impact section of the summary sheet is populated automatically from the detailed spreadsheets.
After completing the detailed spreadsheets you are advised to review the summary sheet to sense check the results in orde
identify any errors.
 Costing Template
Annual treated patient numbers

Indication: PLEASE ADD

Patient numbers should be calculated on a treated per annum basis in Singapore.

The tables below are provided as an aid for the estimation process.

Number
1 Singapore resident population
3,933,600

2 Prevalence and incidence Year 1 Year 2 Year 3

Prevalence
3
Incidence
Estimated number of patients with the
0 0 0
condition
Mortality Year 1 Year 2 Year 3
4 Mortality rate of patient cohort with the
condition (annual percentage).
Registration - eligible patient
5
population
Percentage of patient cohort with the
condition treatable under the registered
indication (eligible patients) (%)
6 Sub-population
Sub-population of eligible patient cohort
(%) in line with proposed clinical criteria
defined in Section 2.6 of evidence
submission
Year 1 Year 2 Year 3
Percentage of eligible patients treated
7
with technology under evaluation (%)

8 Treatment discontinuation

Discontinuation rate (%)

Summary
Year 1 Year 2 Year 3
Estimated number of patients with the 0 0 0
condition

Mortality rate of patient cohort with the 0.00% 0.00% 0.00%

condition

Net number of patients with the condition 0 0 0

Percentage of patient cohort with the

condition treatable under the registered 0.00% 0.00% 0.00%
indication (eligible patients) (%)
 Potential number of eligible patients
treated each year in the registered 0 0 0
indication

Sub-population of eligible patient cohort

(%) in line with proposed clinical criteria 0.00% 0.00% 0.00%
defined in Section 2.6 of evidence
submission

Potential number of eligible patients 0 0 0

treated each year in sub-set

Percentage of eligible patients treated 0.00% 0.00% 0.00%

with technology under evaluation (%)

Number of patients treated in each 0 0 0

9
year

Notes Description

1 Singapore resident population

The total population of Singapore citizens and permanent residents has been provided according to the latest av
more detailed information about the Singapore population see the website http://www.singstat.gov.sg/statistics.

2 Prevalence and incidence

Estimate and insert the prevalence and incidence of the total number of patients with the condition under evaluat
of the 5 years. These should be entered as patient numbers.
It is important to show how these estimates have been calculated and the sources of information used, including
local clinicians. Please provide a brief description to explain any sources or assumptions.

3 PrevalenceEstimate the total number of patients with the condition in Singapore. Show your reference so

4 Mortality
The cohort of patients with the condition may have significant mortality over the 5 year period due to age or other
Insert the estimated mortality rate as a percent per annum of the patient cohort with the condition.
It is important not to double count mortality if this has been taken into account in calculation of prevalence and in
If the mortality rate is not known or is not significant, leave blank.

5 Registration - eligible patient population

Treatments often have licences that restrict their use to a particular group within the disease area as a whole.
Insert the estimated proportion of the disease area that will be treatable under the registered indication as a perc
It is important not to double count if this has been taken into account previously in the calculation of the patient p
condition.
6 Sub-population
Based on the proposed position of the technology in the existing clinical treatment pathway for the condition unde
section 2.5 in evidence submission), some technologies are often positioned for a specific sub-population of patie
covered by the registered indication. This serves to target the use of the technology to patients who are most like
treatment and in whom the technology is most likely to be cost-effective.
In line with the clinical criteria defined in Section 2.6 of the evidence submission template (proposed MAF listing
estimate the propotion of the eligible patient population that will be treatable under these specific criteria.
Insert estimates as a percentage for each year.
It is important not to double count if this has been taken into account previously in the calculation of the eligible p

7 Percentage of eligible patients treated with technology under evaluation

It is unlikely that all patients will be treated with the technology under evaluation due to competing products/mark
change of established clinical practice.
Insert your estimate of the share of eligible patients that will be treated with the technology as a percentage for e
switching is anticipated, clearly justify assumptions.

8 Treatment discontinuation
Insert the expected discontinuation rate as a percentage of patients treated with the technology under evaluation
Discontinuation rates due to lack of tolerance, cure or other reasons should be considered and justified.
If the discontinuation rate is not known or is not significant, leave blank.
These cells are not used to derive total patient numbers, but are used by the ACE technical team to validate inpu
analysis.

9 Sense check
Review the final patient numbers to ensure that these appear reasonable.
.

Number Reference/Sources
Singapore Government Department of Statistics. 2016
933,600 resident population estimate.

Year 4 Year 5

0 0

Year 4 Year 5

Year 4 Year 5

Year 4 Year 5
0 0

0.00% 0.00%

0 0

0.00% 0.00%
 0 0

0.00% 0.00%

0 0

0.00% 0.00%

0 0

according to the latest available estimates. For

ingstat.gov.sg/statistics.

e condition under evaluation per annum for each

formation used, including expert testimony from

s.

Show your reference sources and describe your assumptions and calculations in sufficient detail to allow the ACE technical t

period due to age or other conditions.

condition.
ation of prevalence and incidence above.

ease area as a whole.

tered indication as a percentage for each year.
alculation of the patient population with the
way for the condition under evaluation (as per
ific sub-population of patients narrower than that
patients who are most likely to benefit from

te (proposed MAF listing eligibility criteria),

e specific criteria.

alculation of the eligible population.

competing products/market penetration and rate of

ogy as a percentage for each year. If treatment

hnology under evaluation for each year.

red and justified.

nical team to validate inputs in their budget impact

Use this sheet to provide your detailed workings to explain how you have estimated the num
and the number of patients to be treated.

Use the details from this spreadsheet to populate the tables in the "annual treated patient numbers" worksheet

This is a free-form spreadsheet and you should expand and change the sheet as necessary to set out your calculation
information such as tables, graphs and reference sources, etc.

A series of prompts is set out below to assist you in providing the information required by the ACE technical team:

a) Current prevalence

Estimate the total number of patients in Singapore who have the condition relating to the indication under evaluation (current pr
course of estimated numbers.
(insert additional rows below was required)

b) Yearly incidence

Estimate the number of newly diagnosed patients each year over the first five years after subsidy is recommended (yearly incid
source of estimated numbers.
(insert additional rows below as required)

c) Net number of patients

Estimate the net number of patients treated in a public healthcare institution in each of the first five years after subsidy is recom
of patients who may or may not be eligible for subsidy. This will be done by ACE.
(net number = prevalent cases plus incident cases less those who recover or die)
(insert additional rows below as required)

d) Number of patients likely to be prescribed the technology

Estimate the number of patients likely to be prescribed the treatment in line with eligibility criteria defined in Section 2.6 of the e
for the calculation.
(insert additional rows below as required)
gs to explain how you have estimated the number of eligible patients

he "annual treated patient numbers" worksheet

change the sheet as necessary to set out your calculations and any other relevant
etc.

e information required by the ACE technical team:

e condition relating to the indication under evaluation (current prevalence) and an indication of the

er the first five years after subsidy is recommended (yearly incidence) and an indication of the

e institution in each of the first five years after subsidy is recommended. Do not adjust for number
be done by ACE.
ho recover or die)

ment in line with eligibility criteria defined in Section 2.6 of the evidence submission, with the basis
 Costing Template
Technology cost

1 Value Based Pricing - Price Discounts

Is a price discount contingent on subsidy listing proposed in this evidence submission?
Does this version of the template adjust for the price discount?

Cost price per annum per patient

2
Total estimated cost of the technology per annum per patient

Assumptions and detail of calculations of cost price

List below assumptions used to calculate cost per patient per annum:
Use weighted average cost where there may be different dosages and provide details of how this was calculated

Explain basis of calculation of cost and state any assumptions below:

(insert more rows and columns as necessary)

Additional supportive or concomitant treatments required

Name of treatment
3
Estimated supportive/concomitant treatment cost per patient per annum

If additional supportive or concomitant treatments are required to be administered alongside the treatme
regimen and duration of treatment.

Enter text

Notes

1 Value Based Pricing - Price Discounts

If a price discount, contingent on subsidy listing, is proposed in the evidence submission, you are required to su
versions of the budget impact calculations; one without and one with the price discount.
2 Estimated cost of the technology per annum per patient
Cost price should be calculated on the basis of annual cost of the technology to public healthcare institutions p
The technology may be administered in a variety of ways; as a single dose, as a regular dose, increasing doses
number of cycles, etc. It is important that the cost is calculated as the annual cost per patient and assumptioins
the dosing regimen used in the calculation is also provided.
If dosages of the technology vary, estimate the average dose to calculate the annual cost price.

3 Additional supportive/concomitant treatment(s) required

Identify any additional supportive or concomitant treatments that are required to be administered alongside the t
Insert the trade name and generic name of the supportive/concomitant treatment in the yellow shaded cell show

Calculate the estimated cost of the supportive/concomitant treatment on the basis of cost per patient per annum
Insert the cost in the yellow shaded cells.
Cost price of the supportive/concomitant treatment to public healthcare institutions must be used, excluding GST

Set out the assumptions used in your calculations and describe how you calculated the costs.
Add additional rows or columns if necessary.

If there is more than one additional supportive/concomitant treatment required, include the appropriate share of
Yes
No
 Yes Select using drop-down
Yes Select using drop-down

Year 1 Year 2 Year 3 Year 4 Year 5

ails of how this was calculated

[Insert name of treatment] Assumptions

Year 1 Year 2 Year 3 Year 4 Year 5

tered alongside the treatment under evaluation, please provide details below, including dosage

ssion, you are required to submit two

ount.
ublic healthcare institutions per patient.
gular dose, increasing doses, in a
per patient and assumptioins regarding

al cost price.

administered alongside the technology under evaluation.

n the yellow shaded cell shown.

of cost per patient per annum for each year of the five year period.

must be used, excluding GST.

d the costs.

ude the appropriate share of costs in your calculations and give details.
Summary

Year 1 Year 2 Year 3

Technology cost per patient per annum $ - $ - $ -

Supportive/concomitant treatment cost per patient per annum $ - $ - $ -

TOTAL NET COSTS PER PATIENT PER ANNUM $ - $ - $ -

Number of patients treated each year 0 0 0

BUDGET IMPACT $ - $ - $ -
Year 4 Year 5
$ - $ -

$ - $ -

$ - $ -

0 0

$ - $ -