Provinces are scrambling to find resources to fund Roche’s breast cancer drug trastuzumab after the health department approved a policy to provide it without securing additional funding.

As a result, the Western Cape has opted not to provide the drug at this stage, saying to do so would mean depriving other patients of services. Provinces that are providing trastuzumab are having to reprioritise their budgets, in effect taking the money from other projects.

"Trastuzumab use in the Western Cape has been extensively discussed in collaboration with experts within the oncology units and at present has not been approved for use in public-sector hospitals in the province," said Western Cape health department spokesman Mark van der Heever.

"As the tertiary hospitals would need to absorb the cost within their current budget, [the] high acquisition cost with no additional allocated budget would mean cutting services from other indigent patients."

The policy was launched in August 2017 by health minister Aaron Motsoaledi and provinces were expected to start providing trastuzumab to state-sector patients in January. However, the programme has got off to a slow start. In the Eastern Cape, for example, only Frere Hospital is offering trastuzumab, and it has so far enrolled only three patients, according to the hospital’s CEO, Ronelle Wagner.

"We have had to reprioritise the budgets to accommodate the new regimen," she said. Strict criteria were being applied to select patients who were most likely to benefit from the drug, as it was so expensive, she said.

It is understood the Free State is about to start enrolling patients, Gauteng has already begun doing so, but KwaZulu-Natal has not.

Trastuzumab has been available in the private sector under the name Herceptin since 2008, but was only added to the state’s essential medicines list in June 2017 because "it was simply too expensive", according to the department’s deputy director-general for HIV/TB, child and maternal health, Yogan Pillay.

He confirmed that no additional budget had been secured for trastuzumab and that provincial departments were expected to fund it from current allocations. While the R4.2bn National Health Insurance grant did make provision for cancer services, these funds had been earmarked for tackling the radiation therapy backlog, he said.

Herceptin costs R23,769 for a 440mg vial in the private sector, which puts the cost of a year’s treatment at about R475,380. The state version, which is branded Herclon, costs R6,531.61 for a 440mg vial, or about R130,632 for a year’s treatment, according to information provided by the Cancer Alliance.

Cancer Alliance’s Salomé Meyer said the Health Products Regulatory Authority urgently needed to register rivals to trastuzumab to drive down the price of the drug.