Addressing women’s cancers: an economic evaluation of breast and cervical cancer interventions in Kenya

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Published: 23 Nov 2022
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Dr Mary Nyangasi - Head of the National Cancer Control Programme, Nairobi, Kenya

Dr Mary Nyangasi speaks to ecancer about an economic evaluation of breast and cervical cancer interventions in Kenya.

High-quality breast and cervical cancer services are not available to all the patients in Kenya and financial toxicity is a great barrier towards optimising cancer care.

Dy Nyangasi describes some of the challenges to decreasing this financial toxicity and what can be done to take the load off these cancer interventions.

My talk in this conference is about the study we conducted on the economic evaluation of breast and cervical cancer interventions in Kenya. Basically, this talk we were looking at what are the investments that the government will need to put in place so that they can be able to make efficient investments that can be provided to support screening and interventions for women’s cancers in Kenya.

What is the affordability of breast and cervical cancer services in Kenya?

Currently we have different models in terms of services for breast and cervical cancer in Kenya. We have services for prevention, for screening, early diagnosis and even for treatment. So we find that most of the time the screening services are provided in the primary healthcare setting. In some facilities there is no cost, especially if it is level 4 and below, but in higher level facilities they have to pay for screening or any services they attend to. However, for treatment services usually patients have to pay mostly for certain treatments, although we have a national health insurance fund – for patients who are in this insurance fund they only pay about $60 annually and they are able to get a comprehensive care package.  

What can be done to decrease financial toxicity and load of these cancer interventions?

There is a lot that needs to be done. We have just barely scratched the surface, really, to be honest. We need a lot of investment, especially domestic investment, to support the services for screening, early diagnosis. We need investments in the primary healthcare facilities so that we can be able to provide commodities for screening so that when women present for screening services they are able to find healthcare workers who have been trained, who understand how to screen and who are able to provide this service. Even in that facility we need equipment, we need the screening commodities in place. So all these investments are required to be put in place.

In terms of treatment we need to continue to support the availability of essential cancer medicines which we already have defined in our package of care. So we need domestic support; right now there are just a few drugs that are being supported domestically. We need to gradually increase that support so that more and more medicines are made available. Of course medicines also go with radiotherapy and brachytherapy services that need also further investment in. 

So we really are looking at a lot of support, both from the government itself as well as from other players. So we are looking at models like access programmes, negotiating with pharmaceutical companies who are developing these innovative molecules so that we can have them available at access prices for the majority. So these are initiatives that the government has put in place and we’ve been sitting at the table negotiating with various pharmaceutical organisations so that we can have these programmes in place.

Anything to add?

First of all I just want to thank the World Bank, RTA International, Forecast Health and the WHO for supporting us as the Minister of Health in Kenya to come up with this investment case. Actually this economic evaluation that we did was a collaborative effort and we really appreciate that collaboration. 

So from this work actually we were able to demonstrate that by just having a school-based HPV vaccination programme as well as a phased approach in terms of breast cancer screening, where we start with clinical breast examination in the first five years and then a mammography-led screening programme over the next 35 years, that’s a total of 40 years, we actually can save about 400,000 lives in this 40 year period.  The investment required will only be about a 6% increase in the government funding which translates to for every shilling investment, every Kenyan shilling that is invested, we will save 2.3 Kenyan shillings, so that’s quite significant. Really it gives us the impetus to move forward and now use this case and this study to request that priority for early diagnosis for women’s cancers be put in place so that we can save lives in the future.