A young couple came to me on behalf of his father. The young man sounded very disorientated. I could not figure what he was saying in his soft voice. Luckily he brought along his wife who could present their father’s case clearly and logically.
Ono (not real name) is a 64-year-old. He lives in an Indonesia town about seven-hour-bus ride to Kuching, Sarawak.
Ono’s problem started about four to five years ago when he had abdominal problems. He consulted a doctor in a private hospital in Kuching. According to the doctor there was stone in his gallbladder. He was told not to worry and was sent home.
About two to three years later, Ono suffered a mild stroke. He was given medication and was okay after that.
In July 2018, Ono had severe abdominal pain with cold sweat. According to the daughter-in-law this was not due to gastritis or wind in the stomach.
In mid September 2018, Ono went to a private hospital in Kuching. An USG showed his gallbladder had pus and there was infection of the liver.
Ono underwent an operation to remove his gallbladder. A pathology report indicated a perforated gallbladder with malignant glands. It was a moderately differentiated adenocarcinoma.
Blood test on 10 September 2018, showed elevated liver function enzymes.
|Alkaline phosphatase||133 H (30-120)|
|GGT||152 H (0-50)|
CT scan on 27 September 2018 indicated the following:
- metastatic liver nodules.
- metastatic paraortic lymph nodes.
- right upper lobe lung mass (2.3 x 3 cm), likely tumour, metastasis.
- small left lower lobe nodule, likely metastasis.
- right hilar and mediastinal lymph nodes.
Biopsy report dated 29 September 2018 confirmed:
- right upper lung lobe mass — moderately differentiated adenocarcinoma.
- subcarinal lymph node — no malignancy. Another report C2354-18 on the same date, subcarinal lymph node aspirate: few atypical cells that are suspicious for carcinoma.
MRI on 2 October indicated:
- T4 pathological facture causing compression on the thecal sac and spinal cord.
- T2 – T7 and S1 – S2 metastatic vertebral lesions.
- mild L4/5 posterior disc bulge.
EGFR PCR 6 October 2018: None of the mutations were detected.
11 October 2018: Tumour cells do not demonstrate a staining reaction to ALK-1.
Blood test on 13 October 2018 showed the following:
|Alkaline phosphatase||114 (30-120)|
|GGT||137 H (0-50)|
|ALT||65 H (0-55)|
|CEA||69.3 H (0-5)|
Ono was referred to the oncologist for follow up. He underwent one cycle of chemotherapy using Alimata, dosage 690 mg. The total cost per cycle is RM8,500. Ono was told that he might need to go for four to six cycles.
Was Ono better after the first shot of chemo? According to the son, he had less pain but he is still in great pain. The pain was in the chest. It was more severe at night than daytime. Ono’s son said he had to massage his father’s legs throughout the whole night to make him comfortable. In fact that was the reason why he was so disorientated when he came to see us due to lack of sleep. Ono had no energy and need to lie down all the time. His breathing was difficult.
I had to be up front with Ono’s children. I said, I cannot cure your father. Actually I told them to go home and continue with the chemo if they want to. Either way, the outcome would not be different. Ono’s children was very disappointed. They wanted to try the herbs.
At CA Care I learn many things each day. Today’s lesson is something I did not know before until I encounter Ono’s case.
The total cost of one cycle of chemo (Alimta and Carboplatin) is RM8,520.70. Of this total
- Alimta 500 mg cost RM4,600
- Alimta 100 mg cost RM2,560
- Kemocarb – carboplatin 450 mg cost RM151.50
So the total cost of the chemo-drugs is RM7,311.50. The remaining RM1,209.20 is the cost of hospital care inclusive of RM500 oncologist’s fee.
There are two interesting points to highlight after studying the detailed medical bills.
Alimta Special Offer
From the above, for every two cycles of Alimta, Ono will get the next two cycles free of charge. So it is like buy two, free two. And the offer gets even more attractive after that. If Ono could make it to a total of 12 cycles of Alimta, he will receive free Alimta for life!
One point that bothers me is this, does the offer: buy two free two and after 12 cycles you get free for life, really makes business sense? Like the Malay saying, ada udang disebalik batu? (is there a prawn behind the rock?). I am sure you are smart enough to come to your own conclusion.
Why not use generic Alimta from India?
Ono paid a total of RM7,160 for Alimta. Just for curiosity, what would this generic drug cost in India?
In India you have a choice between the expensive and cheap generic Alimta.
- Eli Lily or US brand cost Rs 91,343 for 600 mg injection (or RM5,175 as opposed to Kuching which cost RM 7,160)
- The generic Alimta cost one-fourth the price, Rs 23,990 to Rs 24,000 (or RM1,359).
Indeed if the Power-that-Be in the developing countries is wise, why don’t they opt for the cheaper generic drug from India?
But you may say, the Indian stuff does not work. The American one is better. Really?
Take a look below. In addition to Alimta, Ono also received carboplatin. The oncologist in Kuching did not use the American stuff. He used generic carboplatin from India called Kemocarb. Ono paid only RM151.50 for this generic carboplatin. Great doc., you tried to save money for your patient. That’s the way to go!