While the Central Government is mulling ways to rein in the prices of essential drugs including AIDS and cancer drugs, cancer patient groups and NGOs lament that prohibitive costs of many critical cancer care drugs in India are causing treatment beyond the reach of common man.
Among the available 50 odd important drugs for cancer care in India, most of the original molecules for effective targeted treatment are unaffordable to more than 90 percent of the patients, says Y K Sapru, chairman and Shubh Maudgal, director of Cancer Patients Aid Association (CPAA), a Mumbai based NGO in the field of cancer care for the last 35 years.
As examples, they cite that treatment with Roche's Mab Thera (Rituximab), used in the treatment of several types of non-Hodgkin's lymphoma or chronic lymphocytic leukemia (CLL), costs about Rs.1.2 lakhs for a cycle of three weeks and the patient has to undergo treatment for six such cycles for effective cure. Treatment with Roche's another drug Herceptin (Trastuzumab), to treat the aggressive HER2-positive form of breast cancer, is equally a costly affair in India. The patient has to spend over a lakh of rupees for three-week medication and will have to undergo treatment for about nine such cycles.
Treatment with Taxol (Paclitaxel), the ovarian cancer drug from Bristol-Myers Squibb, costs Rs.70,000 per a cycle of three weeks and six cycles are required for the treatment. Gleevec, Novatis' myeloid leukemia drug treatment also costs Rs.1, 20, 000 per patient per month. Many of the cancer drugs are used in a combo therapy involving surgeries, radiation and chemo therapy, and the patients will have to undergo lifelong medication.
CPAA alone spends about Rs.40 lakhs in a year to help cancer patients prolong their lives through medication, says Dr Sapru. Novartis' offers free Gleevec to about 5400 patients out of the 25,000 odd cases detected myeloid leukemia cases in the country. CPAA treats another 50 odd patients with the help of free generics of Gleevec given by companies like Natco Pharma.
Countering the research based companies' argument that billions of dollars involved development costs are what that forces them to price the products high, the NGOs point out the lion's share of R&D expenditure is with public funds. Most of the drugs are born in the universities and the companies' only fast track them to commercialization.
To support the argument, sources with the Mumbai NGO Lawyers Collective cite the cases of Taxol and Gleevec. Taxol was invented by the U S National Institute of Health and was not patented. NIH gave the marketing rights to BMS and taking advantage of the five year data exclusivity period in U.S, the company maintained monopoly rights to generate over one billion dollar annual sales for the drug. Similarly, Gleevec was invented by NICR, a US university team led by Dr Brian Dekkar. The US Government spent 50 percent of the development costs, followed by 30 percent by US NGOs and 10% by the innovator university. Novartis had to spend only 10 percent of the development costs of Gleevec. Further, US rules like orphan drug status (drugs for rare diseases with 2 lakh or less patients) help companies to get incentives like seven-year market exclusivity, which guarantees return on investment, argues the activists.
They also cite that while the Governments in developed countries take care of the medical bills of their citizens through health insurance schemes, Indian citizens are forced to sell or pledge their assets for treatment involving several lakhs of rupees.
At present India has about eight lakh cancer patients and five lakh new patients added every year. Of this 40 percent die within a year as most of the cases are detected after the disease advances to chronic stages. According to a World Health Organization (WHO) assessment, cancer patient population in India is likely to increase by about 10 times by 2020. Of the various types of cancers, oral cancer, breast cancer and cervical cancer are most popular in India.