/ 9 February 2022

High prices leave 10 000 breast cancer patients without life-saving treatment

Pandemic Delays Cancer Treatment
More than 10 000 breast cancer patients were unable to receive treatment because of excessive prices charged by health multinational Roche. (Photo by Travis Dove for The Washington Post via Getty Images)

More than 10 000 breast cancer patients were unable to receive treatment because of excessive prices charged by health multinational Roche. This is according to the Competition Commission, which has filed a referral to prosecute the Swiss firm.

The excessive pricing of Trastuzumab, used to stop the development of an aggressive type of breast cancer, constitutes a violation of basic human rights, the commission announced on Tuesday. 

It has asked the Competition Tribunal to impose a maximum penalty against Roche, for its alleged harmful and life-denying pricing conduct, commissioner Tembinkosi Bonakele said.

According to the commission, the alleged price hiking took place in both the private and public healthcare sector in the country. In South Africa, Trastuzumab is sold under Roche’s brand name Herceptin in the private sector and under the brand name Herclon in the public sector.

The commission initiated a complaint against Roche and its subsidiary, Genentech Incorporated, in June 2017. Towards the end of 2021, the commission amended the complaint to include Roche Basel and Roche SA.

Roche, the commission said, declined to provide it with its cost data. This was despite the commission pursuing all available legal channels, including the diplomatic channels needed to obtain the data from Switzerland, where it is allegedly being held.

The commission thus relied on the estimated cost of manufacturing a drug with the same active properties and clinical outcomes as Trastuzumab. It also relied on ratios estimating the benefit attributable to Trastuzumab against its affordability.

According to the commission, the competitive benchmarks it used show that Roche’s pricing of Trastuzumab “is significantly out of kilter”.

“In its findings, the commission found the prices charged by Roche for Trastuzumab in South Africa were unreasonably high and at unaffordable levels which impeded access to this live-saving drug by patients suffering from breast cancer both in the private and public healthcare sectors.”

A 12-month course of Herceptin in the private sector costs about R355 000

for 17 cycles of treatment for one year. In the public sector, an equivalent treatment with Herclon costs about R160 000.

The commission said the prohibitive cost of Herceptin impeded patients on medical aid schemes access to the drug in two main ways. Before 2019, Herceptin was only offered to medical aid members with comprehensive medical aid cover. Patients on noncomprehensive schemes, typically lower-income members, therefore had to pay for the drug out-of-pocket. And even patients on comprehensive medical cover were subjected to higher copayments for treatment with Herceptin.

In the public sector, the commission found that, if the government had been able to purchase Trastuzumab at a reasonable price, “a substantial number of patients would have accessed the life-saving drug”.

The commission estimated that more than 10 000 breast cancer patients — nearly 50% of the total number of newly diagnosed patients in the private and public healthcare sectors — were unable to receive treatment with Trastuzumab between 2011 and 2019.

The excessive prices charged by Roche could not be justified, even when allowing for reasonable compensation for research and development, the commission concluded.

Bonakele said the commission prioritised the case because of its negative effect on poor women in particular “who cannot access essential treatment because they cannot afford to pay for it”. 

“This is so even for the minority of women who belong to medical schemes. The commission is obligated to pursue this case in light of the fundamental rights implicated by the conduct, all of which are enshrined in our constitution.”

According to its financial results, released last week, Roche’s core operating profit increased 4% in 2021, while its earnings per share grew by 6%. 

On the release of Roche’s results, its chief executive, Severin Schwan, said: “We achieved good results in 2021. The demand for our new medicines and diagnostics remains very high … Based on our strong product portfolio in both divisions and the promising product pipeline, we are well positioned for future growth.”

The company is yet to make a statement addressing the Competition Commission’s prosecution referral.