The cost of healthcare is becoming increasingly important as households struggle to make ends meet. Fortunately, there are bodies such as the Cancer Alliance, a group of non-profit organisations and advocates for the prevention and control of cancer. Its mandate: to provide a platform of collaboration so that civil society can speak with one voice and thus become a powerful tool to affect change for all South Africans living with cancer.
The Cancer Alliance is a member of the Fix the Patent Law Campaign that focuses on the call for patent law reform.
The Companies and Intellectual Property Commission is responsible for the registration of patents. The fact that this process is not open and transparent, however, largely contributes to the inequity of access effected by patent law. The Fix the Patent Law Campaign strongly believes that the following changes are required:
- Stricter patentability criteria to combat patent evergreening (extending the lifetime of patents in order to retain royalties);
- Stricter examination of patent applications to ensure the patentability criteria have been met prior to the granting of patents;
- Proper implementation of patent-opposition procedures; and
- The use of more workable procedures for granting compulsory licenses.
Research findings
In his foreword to “An analysis of oncology benefits offered by 10 medical schemes in South Africa”, Dr Jacques Snyman, director of research and development at Agility Holdings, highlights the cost of modern oncology treatment.
“This is a global issue and not restricted to low- and middle-income countries. The diagnosis of cancer is stated as the single most common reason for individual bankruptcies in the United States of America.”
He notes that it is not uncommon to find insurance products that limit the monetary value payable, particularly for newer innovations in cancer treatments.
For example, Car T-Cell therapy may cost more than $300 000 per patient, while cover is often limited to $70 000. This means the treatment is not fundable unless you have a house to sell.
Professor Manie de Klerk, chief medical officer of Vertica Health, says cancer care in South Africa, a developing country, is a tale of two funding sectors that are increasingly being pitted against the tale that is written in the developed world.
“Private medical schemes in South Africa serve about 16% of the population and have access to per capita health distributable funds that are roughly 10% to 16% of that of richer, first world countries. Yet, they are moved and sometimes bound to guidelines for care that are determined in the European or North American markets where relative abundance of funds exist.”
South African public sector patients (about 84% of the population) have much lower levels of funding available per capita and therefore have fewer resources in terms of facilities, qualified staff and access to the latest testing modalities, treatments and drugs.
De Klerk notes that both sectors await clarity on what National Health Insurance will include as cancer care benefits, and what such a funding system will be able to afford in terms of cancer care. The situation is complicated by the lack of productive and constructive communication between the funding sectors and the services sector.
According to Snyman, the problem is compounded by the fact that many clinicians do not concern themselves with the cost of treatment and make this decision the patients’ problem. Although the ethics of this approach are seriously questionable, one may appreciate the stance when reading through and trying to comprehend the cover by various medical schemes in the more than 80 different options on the South African market.
The spiralling cost of oncology medicines is blamed for the funding dilemma. However, this is a rather narrow view, because advances in the treatment for specific cancers have changed the survival rate of many from six months to more than five ears, or even curative. It is obvious that this problem needs a more co-ordinated approach.
De Klerk adds that it is notable that, even in the better-funded overseas markets, the costs of newer modalities of cancer care are increasingly investigated in terms of the relative contribution of new expensive drugs. Clinical health economists are increasingly commenting on the incremental cost per outcome of these drugs.
The study notes that diseases such as breast cancer have become chronic conditions, with most patients being cured, provided the diagnosis occurs early and the correct adjuvant treatments are available and funded when required. In particular, the cost of treatment for breast cancer dropped significantly as patents ended and biosimilars became available.
In contrast, there are the so-called orphan diseases, such as melanoma, and specific mutations in lung cancer, where treatments are available but at a significant price tag.
Snyman raises the question whether these diseases should be treated and funded equally with diseases where advances in science have made generic, more affordable treatments available, or should the industry discriminate based on price alone?
“As I read through scheme benefits, I see that this is exactly what is happening. If you are lucky, you have a common ‘affordable cancer’. If your cancer is ‘unaffordable’, then your diagnosis may be a death sentence.” This scenario is likely to worsen as the privately insured market has shrunk by about 10% due the Covid-19 pandemic, which means that those who remain insured are more costly and older, leaving the state to care for more.
The report also notes the paucity in benefit increases for oncology, and the issue of benefit structuring based on rolling years as opposed to benefit years. This means that the benefit is on average 50% of what is stated in the brochure, which adds to the difficulty of understanding what is and what is not covered by both patient and the treating clinician.
It is therefore clear that a more aligned approach to funding cancer is needed, requiring engagement with funders, regulators, clinicians, the pharmaceutical industry, and patients to ensure equitable access to care and especially for newer lifesaving technologies in cancers with orphan disease status.
Please click here to access the “Analysis of oncology benefits offered by 10 medical schemes in South Africa.”
