Why treatment of cancer costs an arm and a leg

Languishing in misery, Ms Monica Onyuro counts the days to her death. She prays that her life ends soon “so that I can rest in peace”.

“I’m not sure how much more time God wants me suffer,” she says weakly.

Ms Onyuro’s chest heaves with emotion and sorrow as she struggles to string together her next sentence.

“I don’t know the number of days, months or even years I still have to live,” she says.

Ms Onyuro has cancer of the ear. She believes no amount of medication or technology can save her.

The elderly woman’s only hope is palliative care.

She wants no pity or encouraging words.

In her 20-year marriage before her husband’s death, she remained childless.

The 56-year-old, who hails from Muhoroni in Kisumu county, says she has never known peace.

She does not have the money for treatment, even as her situation becomes worse.

Cancer has spread to most of her body. The only thing remaining is to manage the pain.

“I don’t know what I did to God. In vain did I pray for a child for  20 years. I lived alone. My husband died and now I’m imprisoned in pain, unable to escape,” she said when Sunday Nation team visited her.

Ms Onyuro depends on well-wishers for food, drugs and even transport for the monthly hospital visits.

Her story mirrors that of thousands of poor Kenyans living miserably and alone because of cancer.

It all started as a pimple in her left ear in 2013. For two years, Ms Onyuro managed it using painkillers.

A neighbour took her to Moi Teaching and Referral Hospital (MTRH) in Eldoret when the pain became unbearable.

Ms Onyuro did not start treatment for she had no money. She does not have a National Health Insurance Fund (NHIF) cover and depends on friends and relatives.

The fact that NHIF settles a portion of hospital bills has also affected families’ response to  illnesses.

In many cases, the patients stop treatment when money from the NHIF stops flowing.

Given the option of healthcare or food, health becomes a luxury for many households.

Getting three meals a day is already a big struggle for many.

With the high cost of cancer treatment, many Kenyans pray that the illness does not knock at their doors.

Cancer kills an estimated 30,000 people in Kenya while 47,000 are diagnosed with the disease every year.

The government estimates the prevalence of cases at 90,000 annually. This figure includes those patients that are not diagnosed at hospital.

The National Cancer Control Programme says treatment in Kenya goes for Sh175,000 to Sh800,000 where there is no need for an operation.

With surgery, the charges range fro Sh800,000 to Sh1.5 million, depending on the hospital and type of therapy.

Even the Sh3,500 cost of one radiotherapy session at selected public hospitals is prohibitively expensive for poor Kenyans.

Unfortunately, the number of people affected by this silent killer is growing by the day.

A cancer patient would need to spend about Sh70,000 at Kenyatta National Hospital (KNH) on tests and surgery, even before the start of chemotherapy or radiotherapy.

The cost of tests alone at private hospitals is Sh100,000 to Sh150,000.

A “cheap” chemotherapy regime would cost Sh25,000 to Sh30,000, with the most expensive regime going for Sh500,000 per cycle.

Most patients require six to 10 radiotherapy cycles, depending on the drug used and type of cancer.

If a patient requires four chemo sessions a year, it could cost him or her up to Sh4.9 million, well beyond the average annual income of an average citizen.

Even after premiums and deductibles of health insurance are met, this person could be responsible for more than Sh1.2 million a year in out-of-pocket costs, with co-insurance payments.

For Sh10,000, a patient can get at least three radiotherapy sessions at a public hospital, while a session is Sh6,600 to Sh10,000 at private health institutions. One needs 20 to 25 sessions.

An increasing number of studies shows how high medical bills can impact a person’s health as much as the biological effects of cancer therapy. Researchers call this “financial toxicity”.

“The high costs of cancer treatment adds to distress, hardships, and burdens to patients and their family. Out-of-pocket costs deplete checking and saving accounts and can dictate treatment decisions. Kenyans continue to bear the biggest burden of non-communicable diseases and significant costs of treatment, which is seeing more households pushed into poverty,” the Institute of Economic Affairs says.

It adds that for every Sh100 that a Kenyan spends on health, Sh28 is out-of-pocket.

Kenyatta University Teaching, Referral and Research Hospital (KUTRRH) Board of Directors chairperson, Olive Mugenda, says the NHIF cover should be made available to all.

She says almost 80 per cent of cancer patients receiving treatment at KUTRRH use NHIF cards.

“We have seen patients coming for radiotherapy and chemotherapy whose only hope is the NHIF card. But the sessions are not fully covered. This does not help much because the disease will progress,” Prof Mugenda says.

“I have seen patients covered by the NHIF stopping their chemotherapy sessions as they cannot afford it. For this cover to be comprehensive, patients should not add anything. We must ensure that treatment is complete.”

Premature termination of cancer treatment is lethal.

It leads to the multiplication of abnormal cells, meaning the disease progresses to a stage it becomes difficult to treat.

“What happens is that they come to get the NHIF sessions, then stop as they can’t raise the remaining amount. Kenyans need to be comprehensively covered,” Prof Mugenda says, adding that families are overwhelmed by the cost of cancer drugs.

A social worker at KNH – the hospital with the highest traffic of cancer patients in Kenya – says most chemotherapy drugs are not stocked at the institution.

Herceptin drug, for instance, is expensive yet NHIF does not fully cover the treatment cycles.

“A cycle costs Sh80,000 to Sh100,000. A patient needs 18 doses and NHIF can only cover four in a financial year,” she says.

The drug costs Sh100,000 to Sh150,000 outside KNH. The dispensing fee is Sh15,000.

“I sometimes ask myself how our patients survive. Some arrive here on empty stomachs and others sleep on the benches just to honour the doctor’s appointment.”

Dr Joseph Lenai, the Director of International Health Relations at the Ministry of Health, says before choosing a hospital, patients need to find out if it offers comprehensive cover or has a cost-share element.

“There are three types of NHIF covers– the comprehensive one in which patients do not need to pay anything, the cost-sharing one between patients and the hospital and capitation one where NHIF pays more for patients. You need to ask the hospital what it is offering before beginning treatment,” Dr Lenai says.

 “For those who cannot pay, ensure you choose hospitals that do not charge anything. All services should be free.”

Dr Lenai has advice for the very poor who cannot afford treatment.

“The government has released money to the medical insurer. When they go to a hospital, their details are keyed in. They can then get the services for free,” he says.

NHIF Chief Executive, Peter Kamunyo, says the agency has expanded the scope of health benefits through by covering people in formal and informal sectors as well as the vulnerable in society.

The Fund, he says, covers basic chemotherapy, paying Sh25,000 per session. However, only six sessions are covered.

For complex chemotherapy, four sessions are covered up to Sh150,000 per session.

“For radiotherapy, we pay Sh3,600 per session for 20 sessions while for PET scans, NHIF pays Sh40,000 for one image annually. When this is exhausted, the patient has to wait for the next financial year,” he says.

“We also pay for consumables, pre-meds, post-meds, routine lab investigations, treatment planning, bone scan, radio nucleoid scans and blood and blood products tests. The benefits package compliment one another. Should a patient require surgery, there is a surgical package or the diagnostic services covered under the radiology package.”

The Kenya Medical Dentists and Practitioners Council says the driving factors that increase the cost of cancer treatment include fees for the specialists, drugs, hospitals and technology.

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In tomorrow’s edition: To get treatment locally or abroad? Read about the dilemma that terrified cancer patients face