By Kate Okorie
It was a regular Wednesday for Sandra until she received a call instructing her to report urgently to the National Hospital of Abuja. Living in another State, she had to make plans to travel to Abuja. She packed for a one-week stay in the city, but life had other plans. When she got to the hospital, the doctor confirmed her worst fears. She would spend the next year fighting for her life.
Sandra was diagnosed with human epidermal growth factor receptor 2 (HER2)-positive breast cancer, which required additional treatment with the drug Herceptin alongside her chemotherapy drugs.
Even though Herceptin improves the cure rate in patients with HER2-positive breast cancer, it is high-priced. Like many breast cancer patients, Sandra was overwhelmed by the cost of accessing treatment, but she got some relief after her doctor introduced her to mPharma’s HER-Radio program.
In 2019, mPharma partnered with Roche to launch the HER-Radio program to improve the availability of radiotherapy and treatment for HER2+ breast cancer. Under this program, Sandra enjoyed a deferred payment plan for her complete 18-cycle treatment with Herceptin.
Breast cancer is a significant public health issue in many low- and middle-income countries (LMICs), with a rising number of cases and low survival rates primarily linked to late presentation and diagnosis. According to a 2020 study on the contemporary management of breast cancer in Nigeria by Olalekan Olasehinde and colleagues, financial limitation is a common barrier to the early diagnosis and treatment of breast cancer. Even worse is the high out-of-pocket expenses that dominate healthcare spending in Nigeria, with only about 5% of the population covered by the national health insurance scheme. Among the 607 patients captured in the study, less than 10% received radiotherapy, even though most needed it.
How the HER-Radio Programme Works
The HER-Radio program involves an interest-free phased payment plan and free radiotherapy for eligible patients. The healthcare company, mPharma, established the intervention on its proprietary Mutti platform, and its chain of physical pharmacies helps ensure a regular supply of the anticancer drug at stable prices. The program is currently being implemented at two Nigerian tertiary institutions: the National Hospital of Abuja (NHA) and the University of Nigeria Teaching Hospital Enugu.
“Before the introduction of the HER-Radio program, few patients were able to afford the treatment,” said Dr. Emmanuella Nwachukwu, Radiation and Clinical Oncologist at NHA.
During the course of Sandra’s treatment, the COVID-19 pandemic hit. This period was characterised by a dramatic rise in drug prices, severely affecting patients with chronic diseases like cancer. But as a participant in the program, Sandra was also protected from price irregularities in the drug market. mPharma declined requests to comment further on how they maintained drug prices during this period.
Since its inception, over 55 HER2-positive breast cancer patients have been enrolled, and available data from the company shows that 18 of them have completed treatment with Herceptin. The treatment with Herceptin is done over 18 cycles, which lasts a year. One vial of Herceptin is given every three weeks to complete a cycle.
In their research to determine the cost-effectiveness of trastuzumab (the key ingredient in Herceptin), Noga Gershon and his colleagues estimated the total cost of breast cancer treatment using trastuzumab without subsidies to be 9.2 million naira ($20,000). This is twice the total cost of treatment under the HER-Radio program, which is significantly subsidised at 4.6 million naira ($10,000). In addition, HER-Radio offers patients a four-phased payment plan to ease the financial burden.
The first phase of the payment plan involves a six-time payment of 1.9 million naira ($4,140) over sixteen weeks, which covers six treatment cycles with Herceptin. The pattern is the same for the second and third payment phases, although the amount is tapered down to 1.6 million naira ($3,490) and 806.3 thousand naira ($1,760), respectively. For the fourth phase, patients are to submit two post-dated cheques of 335.9 thousand naira ($730) at the end of their treatment. According to mPharma’s 2021 annual impact report, the patients enrolled in the program save 15% to 25% of their treatment costs.
“The program was a relief to many patients as they could easily make payments per dose knowing that there would be a reduction in the prices as they continue [their treatment] for one year,” remarked Nwachukwu. She continued, “They also benefit from receiving radiotherapy.”
The addition of adjuvant radiotherapy in the treatment of breast cancer has been associated with significantly better survival. “Radiotherapy is currently 800,000 naira for curative and 400,000 naira for palliative,” explained Richard Mshelia, Lead Pharmacist at the Oncology Pharmacy Unit, NHA. However, patients who have completed their Herceptin treatment under the HER-Radio program are qualified to receive free radiotherapy treatment at the hospital.
A recent report published by the National Bureau of Statistics shows that 63% of Nigerians are multi-dimensionally poor, and the average monthly living wage for individuals in Nigeria is estimated to be 43.2 thousand naira. A patient earning exactly this amount will have to save their entire salary for roughly eight months to afford one vial of Herceptin, which only covers one treatment cycle. Considering the low average income of the Nigerian population, Herceptin is not considered cost-effective.
According to Mshelia, cancer drugs are very expensive and use up a lot of resources. “Working partnerships [between NHA] and non-governmental organisations have been the saving grace,” he said.
For the people who can afford it, the HER-Radio program is worth every penny. Although, some of the patients have to deal with the temporary discomfort of relocating to areas near one of the two tertiary institutions where the program is being rolled out.
This story was produced in partnership with Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.