Dr Maurice Goodman: The Citizen, 20 February 2006

The following is a letter to THE CITIZEN from Discovery Health's Dr Maurice Goodman explaining the medical schemes position on early-stage breast cancer treatment with the drug Herceptin:

RECENT coverage of Discovery Health's position on the funding of treatment of breast cancer with the drug Herceptin ("Fight with medical aid for right to live", The Citizen, February 14) creates the impression that Discovery Health does not want its members to have access to this drug. On the contrary, Discovery already does fund Herceptin in cases of advanced breast cancer. There is considerable debate around the world around the appropriateness of Herceptin in the early stages of treatment. The drug has not yet been approved for early-stage treatment by either the US Federal Drug Administration or South Africa's Medicines Control Council. The main issue, though, is balancing the costs of covering new technologies, such as Herceptin, with the overall affordability of medical scheme contributions. A full course of treatment with Herceptin will cost the medical scheme about R450 000 per patient per year. If Herceptin were to be funded in early-stage cases such as Ms Galliet's, our estimate is that it would cost the Discovery Health medical scheme more than the claims paid out for all other cancer treatments together. As the Discovery Health Medical Scheme is a not-for-profit entity funded entirely by member contributions (Discovery Health earns a fixed fee for administering the scheme), this is a cost that would have to be met completely by members, via their annual contributions. We estimate that this would cost all members an extra 2% in contributions every year. Discovery Health has approached Herceptin's manufacturers. Roche Pharmaceuticals, to re-examine the very high price of the drug. It is worth noting that the price of Herceptin has not fallen since it came on the market in 1998, despite increased use and, presumably improved benefits of scale. Worse, Herceptin is more expensive in SA than in many wealthy, developed countries. Herceptin costs about double the price in South Africa than in the UK or Canada. Even in those countries, national governments and healthcare funders are raising alarm at the high casts of the drug. Our analysis demonstrates that if Herceptin cost around R100 000 per patient per year, the scheme could afford to pay for treatment for about 30 times as many patients as currently.