National Planning and Policy Improvement for ABC Patients in Kyrgyzstan

Abstract

Background and context: Breast cancer takes the first place among the cancer diseases in the Kyrgyz Republic. Almost 40% of breast cancer cases are detected in the advanced III and IV stages. Specialized oncology services for cancer patients are available in two oncology centers in the Kyrgyz Republic. One is in Bishkek (capital of the country), and another is in Osh (the second large city). However, medical services provided by the government are limited to the surgery, particularly, with mastectomy. Radiotherapy is not available because of deterioration and breakdown of equipment. Mandatory Health Insurance Fund does not cover chemotherapy cost for cancer patients, and patients pay out of pocket. Kyrgyz National Essential Drug List does not include many vital antineoplastic agents recommended by WHO. The absence of essential antineoplastic agents in National Essential Drug List negatively affects medicine registration and procurement, makes them unavailable, inaccessible and unaffordable in Kyrgyzstan. Advanced breast cancer patients cannot plan their upcoming expenses. Many patients can´t finish the full course of treatment. Ergene is the only organization in Kyrgyzstan that advocates and provides technical assistance to the Oncology Institute and the Ministry of Health to improve access to oncological drugs for the treatment of breast cancer. Aim: Improve access to oncology medicines and treatment of patients with advanced breast cancer. Strategy/Tactics: Ergene team accessed National Essential Drug List (EDL) and selected available oncology drugs. Then the experts compared available oncological drugs from the National EDL and oncology drugs from the WHO list. Together with oncologists, experts analyzed the availability of essential drugs for advanced breast cancer and identified missing drugs to be included in National EDL. These drugs are trastuzumab, anastrozole, paclitaxel, and gemcitabine. Program/Policy process: The team of experts calculated the cost of treatment of breast cancer regimens including therapy with trastuzumab and started negotiations with Mandatory Health Insurance Fund (MHIF) for chemotherapy treatment coverage. The policy makers agreed that the cost of basic chemotherapy regimens is affordable for insurance coverage (adriamycin cyclophosphamide-245 USD, cyclophosphamide methotrexate fluorouracil - 390USD, fluorouracil adriamycin cyclophosphamide -426 USD). However, the cost of monotherapy regimen is more expensive (capecitabine, docetaxel -2400 dollars) and requires additional financial resources. Outcomes: MHIF will include coverage of essential AC, FAC, and CMF regimens for women with breast cancer and will consider partial coverage of trastuzumab and several monotherapy regimens. What was learned: Chemotherapy regimens cost calculation is an integral part of advocacy and policy work. It helped to negotiate chemotherapy treatment insurance coverage for women with breast cancer.