NHIA adds Specialist Anti-Breast Cancer Drug (Herceptin) to Ghana’s NHIS medicine list

In furtherance to the government’s push for attainment of Universal Health Coverage (UHC) by 2030, the National Health Insurance Authority (NHIA) has added a Specialist Anti-Breast Cancer Drug, (Herceptin) to the National Health Insurance Scheme’s (NHIS) Medicines list, elevating Ghana as the first country in the Sub-Saharan African Region, to do so.

Herceptin is the brand name of a medicine called Trastuzumab + recombinant human hyaluronidase which is used to treat Breast Cancer, Esophageal Cancer and Stomach Cancer.

From July 2019 to July 2020, 230 Ghanaian patients, including a 25 year old, have accessed this innovative treatment for Her2+ breast cancer under the NHIS.

The Authority adopted the Public-Private-Partnership (PPP) strategy to make the Herceptin drug affordable to beneficiaries.

The NHIA’s partnership is for the one that can be administered by subcutaneous injection, which is an injection into a person’s thigh that takes a few minutes (this can only be used for breast cancer).

Herceptin efficacy

Herceptin works by blocking the effects of HER2 and encouraging the immune system (the body's natural defenses) to attack and kill the cancer cells. Herceptin can help control the growth of cancer cells that contain high amounts of human epidermal growth factor receptor 2 (HER2).

High levels of HER2 are found in some types of breast, esophageal and stomach cancer, which helps the cancer cells grow and survive. These are known as HER2 positive cancers. About one (1) in five (5) breast and stomach cancers are HER2 positive.

Herceptin usage

If a person has breast, esophageal or stomach cancer, she is required to have tests to check if the cancer is HER2 positive before Herceptin is offered.

Herceptin can be used to treat early-stage HER2 positive breast cancer, following surgery and or radiotherapy and chemotherapy to reduce the risk of the cancer coming back.

It can be used to treat advanced HER2 positive breast cancer that has spread from the breast (metastatic breast cancer), to slow the growth of the cancer and increase survival time.

Herceptin is useful in treating advanced HER2 positive stomach cancer that has spread out of the stomach (metastatic stomach cancer) and advanced HER2 positive gastro-esophageal cancer, which affects where the food pipe (esophagus) meets the stomach.

Herceptin dosage

Herceptin is given during visits to a hospital or clinic. It can be given in two ways. That is by infusion, where the medicine slowly enters the blood through a drip. The first treatment usually takes about 90 minutes and further treatments take about 30 minutes.

It can also be given by subcutaneous injection, which is an injection into a person’s thigh that takes a few minutes (this can only be used for breast cancer).

Anyone who takes Herceptin for the first time will have to stay in a hospital for about 6 hours so she can be monitored for any side effects. For subsequent treatment sessions, the person will only need up to 2 hours in a hospital.

Someone with breast cancer will have treatment every 1 or 3 weeks but stomach and esophageal cancer are usually treated once every 3 weeks. Early-stage breast cancer will need treatment for 1 year. For breast, esophageal or stomach cancer that's spread, treatment is used for as long as it is helpful.

Exempt category

Herceptin should not be used to treat people with breast, esophageal or stomach cancer that is not HER2 positive. It may also not be suitable if a person is having a pre-existing heart condition, such as heart failure, severe angina or a problem with the heart valves, people with high blood pressure (hypertension), pregnant women, breastfeeding mothers and pregnant women.

Breast Cancer and its attendant consequences

Breast cancer forms in the cells of the breasts. This largely occurs in women and rarely in men. The most frequent cancer in women are cancers of the cervix, breast, liver, ovary and Non-Hodgkins Lymphoma (NHL).

Breast cancer is the leading cause of cancer mortality in women in Ghana and a leading cause of cancer morbidity. According to the National Strategy for Cancer Control (NSCC 2014-2017), in Ghana, most patients, approximately 50-70%, present with advanced (stage III and stage IV) disease many months (8-10 months) after first noticing a change in their breast.

Symptoms of breast cancer include a lump in the breast, bloody discharge from the nipple and changes in the shape or texture of the nipple or breast. Treatment depends on the stage of cancer. It may consist of chemotherapy, radiation and surgery.

Group of the International Agency for Research on Cancer estimates that 16,600 cases of cancer occur annually in Ghana, yielding an age-standardized rate of 109.5 cases per 100,000 persons.

The World Health Organisation estimates that, globally more than 11 million people are diagnosed with cancer every year. The disease causes 7 million deaths every year or 12.5% of the 58 million deaths worldwide. This being more than the combined total deaths from HIV/AIDS, Tuberculosis and malaria.

Economic Implications

In the Ghanaian perspective, breast cancer has a heavy impact on economically vibrant Ghanaian women and families at large. It was in this context, the government of Ghana entered into partnerships as part of a concerted effort to help address the health hazard.

Following an MOU signed in 2018, after a series of prior collaborations in cancer care in Ghana, an agreement was further signed between the world’s largest biotech company, based in Basel, Switzerland, Roche Global and the Ministry of Health aimed at improving access to quality cancer care and treatment.

Roche Global CEO and the Minister of Health were the signatories.

The MOU focuses on financing of cancer care, awareness of the disease, capability of healthcare professionals to adequately cater for patients, health systems capacity including the limited infrastructure among others.

Key areas of the partnership between Ministry of Health and its agencies and Roche under this program include, Development of a National Cancer Control Plan (NCCP), Early Detection Campaigns, Quality of Care – Healthcare Systems - Diagnosis and Treatment, Cancer Care Human Resource Capability Building and Cancer Data- Registry.

Breast cancer treatment funding is integral in the work plan of government, the NHIA and donor partners who are committed to achieving the set goals by implementing systematic, equitable and evidence-based prevention programs. NHIS your access to health care.