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Financing Prostate Cancer Therapy in the Ashanti Region of Ghana: What are the Financial Implications on Patients and Caregivers?

  • At: PPR 2022 (2022)
  • Type: Poster
  • By: WIAFE, Ebenezer (University of KwaZulu-Natal)
  • Co-author(s): Ebenezer Wiafe, PhD Candidate, University of KwaZulu-Natal, South Africa
    Kofi Mensah, Lecturer, Ho Teaching Hospital, Ghana
    Kwaku Arhin, Lecturer, Kwame Nkrumah University of Science and Technology, Ghana
    Frasia Oosthuizen, Associate Professor of Pharmacology
    Varsha Bangalee, Associate Professor of Pharmacy Practice

  • Abstract:

    Background: The late detection of prostate cancer (PCa) and the unavailability of the needed financial muscle have contributed to a poor prognosis. Although the National Health Insurance Scheme (NHIS) funds top adult cancers such as breast and cervical, PCa has been ignored. The situation has financially burdened patients and caregivers and requires attention.

    Purpose: To investigate the direct cost incurred by patients/caregivers in diagnosing and managing PCa in Ghana. The availability and affordability of cytotoxic and hormonal agents for the management of PCa are studied.

    Methods: The prevalence approach to studying cost-of-illness was employed. This Kumasi study included a public and a private hospital, 4 laboratories, and 10 community pharmacies. Data was collected with validated instruments, computed, and analysed in Microsoft Excel Spreadsheet. The 2021 Ghana National Daily Minimum Wage (GHC 12.53) and the 2nd August 2021 foreign exchange rate of the Bank of Ghana ($ 1.00: GHC 5.8021) were utilized in analysing the results.

    Results: The estimated direct cost incurred by patients/caregivers in accessing a health facility and getting screened for PCa were respectively GHC 96.00 ($ 16.55) and GHC 1,205.00 ($ 207.68). Laboratory workouts that were routinely done for non-metastatic PCa were estimated to attract an additional cost of GHC 385.00 ($ 66.36) whilst metastatic PCa attracted approximately GHC 5,475.00 ($ 943.62). The need for specialized consultation from private laboratories, for metastatic PCa, incurred an additional GHC 100.00 ($ 17.24) which made the diagnosis of metastatic PCa 4 times as expensive as non-metastatic PCa. The management of localized (Gleason grade 6) PCa through radiotherapy and radical prostatectomy was respectively GHC 12,950.00 ($ 2,231.95) and GHC 15,000.00 ($ 2,585.27). Whilst the benefits of a 6-month androgen deprivation therapy (ADT) were assessed in managing localized (Gleason grade 7) PCa by the radiotherapy approach, which increased cost by GHC 3,000.00 ($ 517.05) when used, the surgical management did not require ADT. The management of locally advanced PCa was mainly radiotherapy and 18-24 months of ADT. The palliative nature of metastatic PCa did not permit the estimation of cost because various approaches were employed based on the patient’s peculiar needs and concerns. Cytotoxic and hormonal agents that were reported to be employed in the management of PCa were 6 with a mean availability of 51.54%, reflecting the various dosage forms and formulation strengths. The originator brand (OB) of bicalutamide 50 mg and 150 mg tablets, and generic (G) flutamide 250 mg tablets had median price ratios (MPR) above 4. The MPR of abiraterone acetate (G/OB) 250 mg tablets, docetaxel (G) 120 mg injection, goserelin (OB) 3.6 mg and 10.8 mg injection, and mitoxantrone (G) 20 mg injection could not be determined due to the unavailability of their median international reference prices.

    Conclusion: The diagnosis and management of PCa is expensive and unaffordable to Ghanaians. The NHIS must consider including PCa in the service package to reduce the financial distress on patients/caregivers, improve quality of life and reduce mortality. Also, efforts must be made to improve the early detection of PCa.

Last update 4 October 2019

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