Cost of Chemotherapy For Colon-Lung Cancer in Penang

Harry underwent surgery of his Stage 3B colon cancer in Hospital A in Penang. However, after the surgery he underwent 8 cycles of chemotherapy in Hospital B, also in Penang . Harry handed me his the medical bills for two cycles of chemotherapy that he received.

1.The chemo done on 20 January 2022 costs RM 6,624.50

2. The chemo done on 16 February 2022 costs RM 9,856.30

Based on the above, the average cost of a cycle of chemo is RM8,240.40. So we can guess that Harry had to spend a total of RM65,923 for the 8 cycles of chemotherapy to treat his colon cancer.

Unfortunately, the cancer did not go away. Six months after the completion of his chemo treatment, the cancer recurred in his lung. Harry was told to undergo more chemo. This second round of chemo is estimated to cost him RM66,000. Harry refused the treatment.

Let us try to understand what makes chemotherapy such an expensive treatment and why this is being promoted everywhere as the only “proven” treatment modality.

The itemized costs of chemotherapy are as below:

There are many things we can learn from the above table.

1. By wanting to “kill” the cancer, we need medicine to repair the damaged body as well.

There are 3 types of chemo drugs used for treating Harry’s cancer.

  1. Eloxatin or oxaliplain.  This cost RM 1,653 per cycle.
  2. TS-1 (Tegafur + Gimeracil + Oteracil). This cost 1,390 per cycle.
  3. Raltitrexed (Tomudex). This cost RM 4,140.

Since chemo drugs can cause damage to the body, patients are give drugs that can help “repair” that damage. These are not cancer drugs.

  1. Netupitant  and palonosetron. This drug in capsule is to be taken by mouth about 1 hour before the start of chemotherapy with or without food. This drug is a combination of netupitant and palonosetron and  is used to prevent nausea and vomiting caused by cancer chemotherapy. This cost RM 630.60 per cycle.
  • Pegfilgrastim or Pelgraz. One common side effect of chemotherapy is neutropenia or low levels of neutrophils (a type of white blood cell). Pelgraz is used to help fight infection following chemotherapy.  This cost  RM 1,210 per cycle.

Other non-cancer drugs administered to Harry were:

  • Chlorpheniramine. This is a antihistamine used to relieve symptoms of allergy, hay fever and the common cold. These symptoms include rash, watery eyes, nose, throat, skin, cough, runny nose and sneezing.
  • Dexamethasone. This is a corticosteroid and is used to treat many different inflammatory conditions such as allergic disorders and skin conditions.
  • Dextrose injection. This is used for nutrition support to treat low blood sugar and to decrease high potassium levels in the blood.
  • Diphenoxylate and atropine. This combination of drugs is used to treat severe diarrhea.
  • Esomeprazole or Nexium. This drug reduces the amount of acid your stomach makes. It’s widely used to treat indigestion, heartburn and acid reflux, and gastro-oesophageal reflux disease.
  • Granisetrom or Kytron. This drug is used to prevent nausea and vomiting caused by chemotherapy and radiotherapy.
  • Itopride or Ganatron. This drug is used  to treat symptoms of functional dyspepsia, i.e. patients having difficulties digesting food. Patients feel full after eating; they have bloating and have stomach pain.
  • Loperamide or Lomodium. This is a drug to treat diarrhoea or runny poo.
  • Pantoprazole.  This drug is used to treat heartburn, acid reflux and gastro-oesophageal reflux. It is also taken to prevent and treat stomach ulcers.

Just ask yourself. Before going into the hospital for chemotherapy, do you have the above 11 conditions that need medication? If no, why do you need them when undergoing chemotherapy?

2. You help me, I help you! That makes everybody happy. Then the project will have the full support of all interested parties.

For each cycle of chemo delivered to a patient the doctor earned about 7.5% to 11.4% of the total cost of the treatment. The more chemo he/she gives to patients the money more he/she earns. Good – the oncologist is well rewarded and should be happy.

On the other hand about 88% to 92% of the treatment cost goes to the hospital. So all parties should be happy.

Total cost of chemo treatmentHospital’s  earningDoctor’s earning
Jan. chemo – RM 6,524.505,779.50 (88.5%)745.00 (11.4%)
Feb. chemo – RM 9,856.309,111.30 (92.4%)745.00 (7.5%)

From the gross earning, the hospital needs to spend on cost of equipment, laboratory charges, room charges for treatment, nursing care , medical supplies and cost of drugs.

Other parties that are happy when you undergo chemotherapy are the companies that make the drugs and medical supplies. They too have a share of the pie.

Hospital charges of each chemo treatmentCost of chemo drugCost damage control drugsCost of other drugs and medical supplies
Jan. chemo – RM 5,779.503,043 (52.6%)102.70 (1.7%)193.00 (3.3%)
Feb. chemo – RM 9,111.305,793 (63.6%)666.50 (11.4%)211.00  (2.3%)

3. Nothing is for free in the private hospital.

For everything that is used in your treatment, know that you need to pay for it. There is no free lunch, except the natural air that your breathe in! Yes, if you need oxygen while in the hospital, you have to pay for it.

In one institution, I learned that you need to pay for the chair that you sit on while undergoing chemotherapy.

A careful look at the medical bills, you will know that the alcohol swab, gloves, face mask, gown, plaster, etc. used during your treatment have to be paid for too.

There is one item that attracted my attention which I was not sure what it means –  Cytotoxic/Chemo Reconstitution. A check in the internet gives this explanation.

  • A process in preparing a ready-to-use form of chemotherapy agent for the patient.
  • Some drugs must be stored in powdered form because they rapidly lose their power once they are mixed into a solution. These drugs will then have to be reconstituted, or mixed with a liquid or diluent, before they can be administered.
  • Before starting reconstitution, ensure that SOPs are adhered to – Hand-washing – Gloving – Gowning – Reconstituting – Disposal of waste products.

For each chemo treatment a patient pays RM 95.00 for this process. So nothing is for free!

Let me come to the last point. Everyone involved in chemotherapy are happy! The oncologist earns good income.  The hospital has a good share of the pie too (88% to 92%). Of course, the drug companies make good profit from the chemo treatment (52% to 63% of hospital’s earning). The important party that is not asked or forgotten, is the patient! Was Harry happy after receiving 8 cycles of chemotherapy? His metastatic lung cancer came back after six months. Do you think he was happy?

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