Cancer Medicine Prices, Availability, and Affordability in Kisumu County, Western Kenya

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ABSTRACT Background The rising prices of cancer medicines have intensified concerns about treatment access and health system sustainability particularly in low- and middle-income settings. Facility level evidence on what medicines is actually available, at what prices, and at what cost to patients remains scarce, constraining evidence-based policy reform. Methods Using adapted WHO/Health action international methodology, we conducted a cross-sectional survey of 52 cancer medicines across five therapeutic classes at five health facilities in Kisumu County, Kenya. Availability was measured as the proportion of facilities stocking each medicine. Affordability was assessed using days’ wages required for the lowest-paid government worker to purchase standard treatment regimens. Results Overall medicine availability was 48.1%. The breast cancer AC regimen required 19.6 to 47.4 days’ wages per full course; cervical cancer cisplatin, 19.8 to 49.2 days’ wages, colorectal FOLFOX, 80.0 to 303.6 days’ wages, and prostate docetaxel reached 437 days’ wages at the highest-cost facility. The Social Health Authority’s (SHA) KES 550,000 annual ceiling adequately covered cytotoxic regimens for common cancers at competitive prices but was exceeded by 24 to 116% for HER2-positive breast cancer requiring trastuzumab, with further strain for recurrent cervical and metastatic prostate cancers. A subsequent cap to KES 800,000, substantially improves adequacy for standard cytotoxic chemotherapy but does not resolve gaps for HER2-targeted or continuous hormonal therapies. Conclusions Cancer medicines in Kisumu County are inconsistently available and highly variable in price. We call for urgent retail price markup regulation, expanded pooled procurement, inclusion of priority targeted therapies on the Kenya Essential Medicines List, and SHA benefit packages redesigned around full-course regimen costs. HIGHLIGHTS Only 48% of essential cancer medicines were available in Kisumu. Full-course chemotherapy can cost patients up to 437 days’ wages. Kenya’s insurance cap inadequately covers patients needing targeted therapies. Universal health coverage cannot succeed without medicine price reform.

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