By Ngumbo Njoroge
Cancer patients in the country spend an average of Sh143, 132 annually on treatment, a new study shows. The highest contributors to the cost of cancer therapy are the cost of medicines and inpatient admissions.
Study published in the Journal of Medical Economics, reports that the most expensive cancer treated in the country was refractory trophoblastic tumour, cancerous tumours in the uterus, at Sh2.2 million annually. It also showed that subglottic granuloma, a type of cancer causing airway obstruction in the trachea was among the most expensive costing Sh486, 876 each year. Renal carcinoma, a type of cancer that starts in the lining of small tubes in the kidney was among the cheapest, costing Sh68, 017 annually.
In addition to the cost of medicines and inpatient admissions, the study observed that the cost of medical devices can also be high in view of equipment costs, at a minimum of Sh5, 500. The study carried out at Kenyatta National Hospital involving 412 patients noted that the cost of surgery is higher when combined with other modes of therapy, adding that the most expensive procedures were surgery combined with radiotherapy and chemotherapy.
“The cost of using the theatre and consumables during surgery is charged separately. The theatre charge was Sh2, 000, while the theatre consumables vary with the patient,” said Dr. Sylvia Opanga, the lead researcher. Radiotherapy is the most expensive treatment regimen, costing an average of Sh31, 769 per patient, with the cost of radiotherapy increasing when used with other treatment modalities.
In addition, the research found that the cost of nursing, which includes wound dressing, drug infusion, nebulization, among others varied depending on the type of admission the patient used, whether private or public ward admission. The most expensive drug used during the survey period was fluorouracil and actinomycin D, costing Sh2.2 million per patient.
By injection, it is used to treat colon cancer, oesophageal cancer, stomach cancer, pancreatic cancer, breast cancer and cervical cancer. The study notes that there are huge differences in the cost of treatment in the private and public sector. “The cost of treating patients with cancer during was appreciably higher in the private sector than in the public sector for the same mode of therapy with variations ranging from Sh15, 369 to Sh602, 991, depending on treatment involved,” said Dr. Opanga.
The study shows that majority of patients seeking treatment in the referral hospital, 90 per cent, are treated in the public wing, and with only 10 per cent treated in the private wing where costs are higher. Patients pay Sh500 to Sh1000 per session for radiotherapy in Kenyatta National Hospital. Chemotherapy costs Sh6000 to Sh600, 000 depending on the drug used.
In private hospitals it costs about Sh50, 000 a week for radiotherapy. The findings of the study show that the cost of cancer treatment is prohibitively high for most patients, in a country where four out of 10 people live below the poverty line. “For this reason, patients may not afford expensive chemotherapy, surgical, radiotherapy procedures, and may default on their treatment, negatively impacting on their outcome,” said the researchers in the study. In terms of differences across gender, the study revealed six in 10 cancer patients in the country are women.
The hospital’s registry reported that there were more females than males being treated for cancer in the country. “The cancer rate for women is 231 per 100,000 people, while the rate for men is 161 per 100,000 people,” the study said. In East Africa, 116,800 men and 170,500 women were diagnosed with cancer in 2012. Of all the cases diagnosed that year, 92,500 men and 116,500 women died as a result of cancer.
Statistics presented in the study suggest that cancer morbidity and mortality affect women more than men, attributing the numbers to the healthseeking behaviour of women, who are more likely to seek treatment than men, as well as perhaps greater prevalence of overweight and obesity, as seen for instance in other African countries. “Women are also more likely to be on hormonal contraceptives, which could be an etiological factor in promoting the growth of hormone- dependent cancers, although studies on their role are conflicting,” said Dr Opanga.
The study recommends that all parties involved should play their role in reducing the prevalence and burden to patients, including instigating programs to reduce behaviours that increase the risk of cancer. “Public should be encouraged to go for regular check-ups to hasten early diagnosis and monitor progression, as well as be given advice and encouragement to alter their lifestyles to reduce their potential for developing cancer.
Lifestyle changes include dietary modifications, exercise, and weight loss where pertinent,” she said. In addition, the researcher recommends that insurance companies should allocate more resources to cancer therapy to ease the burden for their clients. The National Health Insurance Fund currently pays for some costs of patients but only caters for inpatient hospital stay