• UGI USER
  • Aug 04, 2024
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“HIGH COST OF CANCER TREATMENTS: CHALLENGES AND SOLUTIONS”

 Source:prepcource

Syllabus:

GS-2:

  • Health
  • Government Policies and Interventions for Development in various sectors and Issues arising out of their Design and Implementation.

Why in the news?

The recent Budget announcement of a price cut for targeted therapy cancer drugs has brought attention to the affordability and accessibility of advanced cancer treatments. This move aims to reduce the financial burden on patients but raises questions about the overall impact on healthcare costs and accessibility.

The Cost Dilemma

  • High Costs of Targeted Therapies: Targeted therapy drugs like Osimertinib, despite a 10% price reduction, still cost around Rs 1.35 lakh per month, making them unaffordable for many families.
  • Clinical Trials as an Alternative: Some patients opt to participate in clinical trials to access expensive treatments for free, although this option is not available to everyone.
  • Financial Strain on Families: Families are often faced with the difficult choice of either continuing with expensive treatments or stopping them due to financial constraints.
  • Long-Term Treatment Costs: Unlike short-term treatments, targeted therapies require long-term administration, adding to the financial burden.
  • Access to Treatment: Limited access to these expensive drugs means that only a few can benefit from the advancements in cancer treatment.
Cancer Care in India

Government Initiatives Related to Cancer Treatment:

Ayushman Bharat Health and Wellness Centres (AB-HWCs):

  • Screening for oral, breast, and cervical cancers.
  • Treatment under the Pradhan Mantri Jan Arogya Yojana (PMJAY), covering 10.74 crore families with Rs. 5 lakh insurance per family annually.
  • AIIMS Focus: Establishment of cancer treatment facilities in new and existing AIIMS across India.

Infrastructure:

  • Upgradation of 13 state government medical colleges.
  • Strengthening Tertiary Care of Cancer Scheme to enhance facilities.
  • Dedicated services for cancer management in North-East India under PM-DevINE.

National Cancer Grid (NCG):

  • Establishment: Launched in 2012.
  • Purpose: To create a network of cancer centres across India for uniform standards of cancer care.

Key Functions:

  • Standardised treatment protocols.
  • Facilitate collaborative research.
  • Improve access to cancer care and treatments.
  • Share best practices among member institutions.

National Cancer Awareness Day:

  • Date: Observed annually on November 7th.
  • Objective: To spread awareness about cancer prevention, early detection, and treatment.

Activities:

  • Organising screening camps.
  • Public education campaigns.
  • Distribution of informative materials on cancer prevention and treatment.

HPV Vaccine:

  • Introduction: The Human Papillomavirus (HPV) vaccine is promoted to prevent cervical cancer.
  • Target Group: Primarily aimed at adolescent girls before the onset of sexual activity.

Government Role:

  • Inclusion in the national immunisation schedule in some states.
  • Public awareness campaigns to promote vaccine uptake.
  • Collaboration with international organisations to ensure vaccine availability and affordability.

Research and Development

  • National Cancer Institute (NCI) at AIIMS Jhajjar: Focus on research in molecular biology, genomics, and more.
  • Chittaranjan National Cancer Institute, Kolkata: Expansion to a second campus.
  • Collaborative Research: Centre for Integrative Oncology and DBT-CRUK Cancer Research Initiative.

Other Initiatives

  • Drug Pricing: National Pharmaceutical Pricing Authority reduced prices of 390 anti-cancer drugs by up to 87%.
  • Manufacturing: Production Linked Incentive (PLI) Scheme for medical devices.

About FIRST Cancer Care (FCC) Initiative:

  • Objectives:
  • Digital Roadmap: Comprehensive cancer management focusing on prevention and curative care.
  • Projected Increase: Rising cancer rates expected to reach 1.57 million by 2025.

Nutraceutical ‘AKTOCYTE’ to Transform Cancer Care:

  • Development: Collaboration between the Department of Atomic Energy and M/s. IDRS Labs Pvt. Ltd., Bengaluru.
  • Effectiveness: Shows remarkable recovery in pelvic cancer patients suffering from radiotherapy-induced cystitis.
  • Approval: Received regulatory clearance from the Food Safety and Standards Authority of India (FSSAI).
  • Functionality: Acts as an adjuvant to cancer radiotherapy, regenerative nutraceutical, immunomodulator, and antioxidant.
  • Market Availability: Expected to be available from January 2024

Cancer Care Value Pathways:

  • Population Health: Early diagnosis and reduced cancer morbidity through digital screening tools.
  • Capacity Building: Blended learning model for health workers, utilising tele-technologies for remote care.
  • Data Pathways: Oncology Data Model for standardised data management aligned with Ayushman Bharat Digital Mission.

About CAR-T Cell Therapy:

  • Type: Immunotherapy using the patient’s immune system to fight cancer.
  • Uses: Approved for leukemias and lymphomas.
  • Nickname: Often called ‘living drugs’.

Procedure

  • Collection: T cells extracted from patient’s blood (Apheresis).
  • Genetic Engineering: T cells modified to express chimeric antigen receptors (CAR).
  • Expansion: Modified T cells multiplied in the lab.
  • Infusion: Expanded CAR-T cells infused into the patient’s bloodstream to target cancer cells.

Development in India

  • NexCAR19: Developed by ImmunoACT, IIT Bombay, and Tata Memorial Hospital.
  • Approval: Received CDSCO approval in October 2023.

Potential Benefits

  • High Remission Rates: Effective for advanced cancers unresponsive to other treatments.
  • Personalized: Tailored to individual patient’s cancer.

Potential Risks

  • Severe Side Effects: Includes cytokine release syndrome and neurological symptoms.
  • High Cost: Expensive treatment.

Do Generics Help?

  • Lower Cost Alternatives: Generic versions of drugs like Osimertinib are available at a fraction of the cost, making them a more feasible option for many patients.
  • Efficacy of Generics: Patients report fewer side effects and comparable effectiveness with generic drugs, making them a popular choice.
  • Availability and Legal Issues: Companies like Beacon Pharmaceuticals in Bangladesh produce generic versions, navigating patent laws to provide affordable options.
  • Patient Support Programs: Some pharmaceutical companies offer patient support programs to reduce costs, though these are not always sufficient.
  • Challenges with Generics: Despite the lower cost, even generic drugs can be expensive for many families, limiting their accessibility.

Drug Plus Other Costs

  • Allied Medical Costs: Beyond the cost of the drug, patients incur significant expenses for surgery, radiation, and follow-up therapies.
  • Hospitalisation and Complications: Repeated hospitalizations due to complications from treatments further increase the financial burden on families.
  • Diagnostic Tests: Regular scans and genetic testing to monitor the disease and tailor treatments add to the overall cost.
  • Supportive Care: Nutritional supplements and other supportive care measures are essential but add to the financial strain.
  • Long-Term Monitoring: Continuous monitoring and regular tests are necessary to manage the disease, leading to ongoing expenses.

Cost of Therapy

  • Breakdown of Costs: The overall cost of cancer treatment includes immunotherapy (around Rs 1.5 lakh), chemotherapy (Rs 1-2 lakh per cycle), surgery (around Rs 5 lakh), hospitalisation (around Rs 1 lakh per visit), scans (Rs 25,000 every 3-6 months), and genetic testing (Rs 30,000 to a couple of lakhs).
  • Initial Diagnosis and Tests: Initial diagnostic tests and confirmation of the type of cancer, such as testing for the EGFR marker, can be expensive and time-consuming.
  • Treatment Side Effects: Managing side effects of treatments requires additional therapies, increasing the overall cost.
  • Recurring Costs: Since targeted therapies do not cure cancer but manage it, patients face recurring costs for an indefinite period.
  • Economic Impact: The high cost of cancer treatment can lead to significant economic stress on families, affecting their overall well-being.

Insurance Coverage and Limitations

  • Insurance Coverage: Many insurance plans do not cover the cost of modern targeted therapies, considering them experimental.
  • Cancer-Specific Plans: Few companies offer cancer-specific insurance plans with sub-limits, which might not cover the entire cost of treatment.
  • Government Schemes: Schemes like CGHS and ECHS cover some routine costs, but often fall short in covering expensive targeted therapies.
  • Extended Lifespan as Privilege: Access to life-extending treatments remains a privilege for those who can afford the high costs.
  • Need for Better Coverage: There is a growing need for insurance providers to include comprehensive coverage for modern cancer treatments to alleviate the financial burden on patients.

Psychological Impact on Patients and Families

  • Emotional Toll: The high cost and uncertainty of cancer treatment can lead to significant emotional stress for patients and their families.
  • Mental Health Support: Access to mental health services is crucial for managing the anxiety and depression often associated with prolonged illness and financial strain.
  • Coping Mechanisms: Families develop various coping mechanisms to deal with the stress, such as seeking community support or participating in support groups.
  • Impact on Family Dynamics: The prolonged illness of a family member can strain relationships and alter family dynamics, sometimes leading to conflict.
  • Quality of Life: Despite financial constraints, maintaining a good quality of life for the patient remains a priority, necessitating a balanced approach to treatment and emotional well-being.

Challenges:

  • High Costs: The prohibitive costs of targeted cancer therapies remain a significant barrier for many patients, limiting access to life-saving treatments.
  • Limited Insurance Coverage: Many insurance policies do not fully cover modern cancer treatments, leaving patients to bear substantial out-of-pocket expenses.
  • Accessibility: Geographic and economic disparities mean that advanced cancer treatments are not equally accessible to all patients.
  • Side Effects: Even with newer drugs, managing side effects remains a challenge, necessitating additional therapies and costs.
  • Awareness: There is a lack of awareness about affordable generic alternatives and patient support programs.
  • Clinical Trials: Participation in clinical trials is not always an option for all patients, limiting access to potentially beneficial treatments.
  • Support Systems: The emotional and psychological support systems for patients and their families are often inadequate, adding to their overall burden.

Policy and Future Directions:

  • Government Initiatives: Increased government funding and subsidies for cancer treatment can alleviate the financial burden on patients.
  • Insurance Reforms: Policy changes to include comprehensive coverage for modern cancer treatments in insurance plans are essential.
  • Research and Development: Investing in research to develop cost-effective treatments and improve the efficacy of existing drugs is crucial.
  • Public Awareness: Raising awareness about the availability of generics and support programs can help more patients access affordable treatment.
  • International Cooperation: Collaboration with international organisations and pharmaceutical companies can lead to better pricing and availability of cancer drugs worldwide.

Conclusion:

While the government’s initiative to reduce prices of targeted therapy drugs is a step in the right direction, it does not fully address the high cost of cancer treatment. Patients and their families continue to face significant financial challenges, necessitating a broader approach to make these life-saving treatments accessible to all. Comprehensive insurance coverage, affordable generics, and support programs are crucial in reducing the economic burden of cancer care.

Source: The Indian Express

Mains Practice Question:

Discuss the challenges and potential solutions in making advanced cancer treatments affordable and accessible in India. Highlight the role of government initiatives, insurance reforms, and public awareness in addressing these issues.

Associated Article:

https://universalinstitutions.com/cancer/