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Srinivasan S, Bolous NS, Batra A, Bharti S, Singh N, Shaikh T, Yadav A, Kanwar V. Cost-effectiveness of treating childhood acute myeloid leukemia at a tertiary care center in North India. Pediatr Blood Cancer 2024:e31242. [PMID: 39126354 DOI: 10.1002/pbc.31242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 07/01/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Childhood cancers are a significant global health concern, particularly in low- and middle-income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost-effectiveness of childhood AML treatment in India and other LMICs remain limited. METHODS The study focused on children (<15 years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment-related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost-effectiveness was assessed using disability-adjusted life years (DALY) averted in relation to the country-specific cost-effectiveness threshold. RESULTS Among 59 AML patients, treatment-related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis-related complications, with treatment-related mortality reaching 30%. The 3-year event-free survival and overall survival of the 43 patients who received intensive therapy were 24.5% ± 7.6% and 27.9% ± 8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost-effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost-effective with a stringent cost-effectiveness threshold utilized. CONCLUSION The study underscores the challenges faced while treating childhood AML in LMICs, including treatment-induced high sepsis-related mortality and abandonment. Despite these challenges, it remains cost-effective to treat childhood AML in India. Future efforts should focus on reducing treatment-related morbidity and mortality to further improve outcomes and cost-effectiveness.
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Affiliation(s)
- Shyam Srinivasan
- Department of Pediatric Oncology, Tata Memorial Hospital and ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Akshay Batra
- Department of Transfusion Medicine, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, Uttar Pradesh, India
| | - Sujit Bharti
- Department of Microbiology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, Uttar Pradesh, India
| | - Neha Singh
- Department of Hematopathology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, Uttar Pradesh, India
| | - Tanveer Shaikh
- Department of Pediatric Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, Uttar Pradesh, India
| | - Anil Yadav
- Department of Cytogenetics, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, Uttar Pradesh, India
| | - Vikramjit Kanwar
- Department of Pediatric Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, Uttar Pradesh, India
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Semerci R, Samba VL, Diaz DRN, Punjwani R, Challinor J. Advanced Practice Pediatric Oncology Nursing as Imagined or In Place in Four Lower- and Upper-Middle-Income Countries. Semin Oncol Nurs 2024; 40:151631. [PMID: 38735785 DOI: 10.1016/j.soncn.2024.151631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES The implementation of pediatric oncology advanced practice nurse (s) roles in low- and middle-income countries (LMICs) presents opportunities and challenges. The authors explore the implications of pediatric oncology advanced practice nursing roles in Pakistan, Cameroon, Turkey, and Mexico. Potential benefits and drawbacks of advanced practice nursing roles, impacts on nursing care, and strategies for advanced practice nursing role development in LMIC settings are considered. METHODS Information from scholarly articles, policy documents, and four LMIC pediatric oncology nurse expert perspectives on existing and imagined advanced practice nursing roles in pediatric oncology in LMIC were synthesized. RESULTS Current literature and policies point to efforts across LMICs to establish a wide variety of advanced nursing practices, not necessarily aligned with internationally accepted advanced practice nursing standards of practice or education. The LMIC nurses describe a wide range of national general nurse education and government advanced practice nurse recognition/licensing. Challenges to achieving or strengthening advanced practice nursing roles include, for example, healthcare professional resistance, government unwillingness to recognize/license advanced practice nurses, and lack of advanced practice nursing faculty. To promote a pediatric oncology advanced practice nursing role in LMICs requires navigating the national nursing scope of practice and nursing culture. CONCLUSION The strategic introduction of pediatric oncology advanced practice nursing roles in LMICs has the potential to significantly enhance patient care by, for example, addressing healthcare workforce shortages and facilitating timely care delivery. However, challenges related to role complexity, resistance from traditional healthcare structures, and role overlap must be considered. Tailoring these roles to local contexts and fostering stakeholder collaboration are essential for successful implementation. IMPLICATIONS FOR NURSING PRACTICE The adoption of advanced practice nursing roles can lead to improved quality of care for pediatric oncology patients and their families in LMICs, where cancer care is challenging. The positive impact of pediatric oncology advanced practice nurses on patient outcomes and healthcare delivery cannot be discounted but must align with local nursing and healthcare culture and expectations.
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Affiliation(s)
- Remziye Semerci
- Assistant Professor, Department of Pediatric Nursing, School of Nursing, Koç University, Health Sciences Campus, Topkapi, Istanbul
| | - Vera Larfi Samba
- Nurse practitioner/pediatric oncology nurse, Department of Childhood Cancer Program, Mboppi Baptist Hospital, Douala Cameroon Baptist Convention Health Services, Mboppi, Cameroon
| | - Dorian René Navarro Diaz
- Profesor de Asignatura de Licenciatura en Enfermería, Departamento de Clinicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Rehana Punjwani
- Additional Director Nursing, Department of Nursing, DOW University Hospital, W4VQ+CMW, Gulzar-e-Hijri Gulshan-e-Iqbal, Karachi, Pakistan
| | - Julia Challinor
- Associate Adjunct Professor, Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California.
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Bolous NS, Chokwenda-Makore N, Bonilla M, Chingo G, Kambugu J, Mulindwa JM, Noleb M, Chitsike I, Bhakta N. Addressing the gap in health economics data to support national cancer control plans in low- and middle-income countries: The Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) tool. Cancer 2024; 130:1112-1124. [PMID: 38100617 DOI: 10.1002/cncr.35146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND National cancer control plans (NCCPs) are complex public health programs that incorporate evidence-based cancer control strategies to improve health outcomes for all individuals in a country. Given the scope of NCCPs, small and vulnerable populations, such as patients with childhood cancer, are often missed. To support planning efforts, a rapid, modifiable tool was developed that estimates a context-specific national budget to fund pediatric cancer programs, provides 5-year scale-up scenarios, and calculates annual cost-effectiveness. METHODS The tool was codeveloped by teams of policymakers, clinicians, and public health advocates in Zimbabwe, Zambia, and Uganda. The 11 costing categories included real-world data, modeled data, and data from the literature. A base-case and three 5-year scale-up scenarios were created using modifiable inputs. The cost-effectiveness of the disability-adjusted life years averted was calculated. Results were compared with each country's projected gross domestic product per capita for 2022 through 2026. RESULTS The number of patients/total budget for year 1 was 250/$1,109,366 for Zimbabwe, 280/$1,207,555 for Zambia, and 1000/$2,277,397 for Uganda. In year 5, these values were assumed to increase to 398/$5,545,445, 446/$4,926,150, and 1594/$9,059,331, respectively. Base-case cost per disability-adjusted life year averted/ratio to gross domestic product per capita for year 1, assuming 20% survival, was: $807/0.5 for Zimbabwe, $785/0.7 for Zambia, and $420/0.5 for Uganda. CONCLUSIONS This costing tool provided a framework to forecast a budget for childhood-specific cancer services. By leveraging minimal primary data collection with existing secondary data, local teams obtained rapid results, ensuring that childhood cancer budgeting is not neglected once in every 5 to 6 years of planning processes.
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Affiliation(s)
- Nancy S Bolous
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Nester Chokwenda-Makore
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Miguel Bonilla
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Grace Chingo
- Department of Pediatric Oncology, Cancer Disease Hospital, Lusaka, Zambia
| | - Joyce Kambugu
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Justin M Mulindwa
- Department of Pediatric Oncology, Cancer Disease Hospital, Lusaka, Zambia
| | - Mugisha Noleb
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Inam Chitsike
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Bolous NS, Mercredi P, Bonilla M, Friedrich P, Bhakta N, Metzger ML, Gassant PY. Determining the cost and cost-effectiveness of childhood cancer treatment in Haiti. Ecancermedicalscience 2024; 18:1675. [PMID: 38439808 PMCID: PMC10911665 DOI: 10.3332/ecancer.2024.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Indexed: 03/06/2024] Open
Abstract
Haiti is a low-income country with one of the lowest human development index rankings in the world. Its childhood cancer services are provided by a single hospital with the only dedicated paediatric oncology department in the country. Our objective was to assess the cost and cost-effectiveness of all types of childhood cancer in Haiti to help prioritise investments and to support national cancer control planning. All costing data were collected from the year 2017 or 2018 hospital records. Costs were classified into 11 cost categories, and the proportion of the overall budget represented by each was calculated and converted from Haitian Gourde to United States dollars. The 5-year survival rate was retrieved from hospital records and used to calculate the cost-effectiveness of disability-adjusted life year (DALY) averted, using a healthcare costing perspective. Additional sensitivity analyses were conducted accounting for late-effect morbidity and early mortality and discounting rates of 0%, 3% and 6%. The annual cost of operating a paediatric oncology unit in Haiti treating 74 patients with newly diagnosed cancer was $803,184 overall or $10,854 per patient. The largest cost category was pharmacy, constituting 25% of the overall budget, followed by medical personnel (20%) and administration (12%). The cost per DALY averted in the base-case scenario was $1,128, which is 76% of the gross domestic product per capita, demonstrating that treating children with cancer in Haiti is very cost-effective according to the World Health Organisation Choosing Interventions that are Cost-Effective (WHO-CHOICE) threshold. In the most conservative scenario, the cost per DALY averted was cost-effective by WHO-CHOICE criteria. Our data will add to the growing body of literature illustrating a positive return on investment associated with diagnosing and treating children with cancer in even the most resource-limited environments. We anticipate that these data will aid local stakeholders and policymakers when identifying cancer control priorities and making budgetary decisions.
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Affiliation(s)
- Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | | | - Miguel Bonilla
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | | | - Pascale Y Gassant
- Nos Petit Frères et Sœurs-St Damien Hospital, Port-au-Prince 6124, Haiti
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Sichali J, Denburg A, Khofi H, Mdoka C, Nyirenda D, Chimalizeni Y, Chagaluka G, Molyneux E, Henrion MYR, Gupta S, Israels T. Prevention of treatment abandonment in sub-Saharan Africa; Lessons learned in Malawi that guide the way forward to cost-effective interventions: A report from CANCaRe Africa. Pediatr Blood Cancer 2023; 70:e30654. [PMID: 37644661 DOI: 10.1002/pbc.30654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Junious Sichali
- Department of Paediatrics, Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
| | - Avi Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Harriet Khofi
- Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Cecilia Mdoka
- Department of Paediatrics, Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
| | | | | | | | | | - Marc Y R Henrion
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Trijn Israels
- Department of Paediatrics, Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
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Mjumbe CK, Kulimba DM, Numbi OL, Nkumuyaya M, Balimo DM, Diyoka CK, Ilunga BK. Financial costs of pediatric cancer management in Africa: systematic review. Front Public Health 2023; 11:1175560. [PMID: 37808990 PMCID: PMC10556248 DOI: 10.3389/fpubh.2023.1175560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
The high costs of cancer treatment and the lack of investment in health care are significant barriers to public health on the African continent. The objective of this study was to investigate the financial cost of children cancer treating in sub-Saharan Africa. We systematically searched PubMed, Cochrane, and Google Scholar to identify relevant studies between March 2000 and December 2022. We selected articles that specifically addressed the US dollar financial costs of childhood cancer in African countries. Medians and interquartile ranges (IQR) were calculated. We also calculated the economic burden of childhood cancer at the individual level, by dividing the direct costs of cancer per patient by the GDP per capita, PPP of the country studied. The quality of economic studies was assessed using the CHEERS (2022) 28-point checklist. A total of 17 studies met our eligibility criteria. The median (IQR) of total childhood cancer costs by region was $909.5 ($455.3-$1,765) and ranged from $88803.10 for neuroblastoma to $163.80 for lymphoma. No significant differences (p < 0.05) were observed for comparisons of the direct cost of childhood cancer between the geopolitical zone of sub-Saharan Africa. Differences in the direct costs of childhood cancer were significant for different cancer types (p < 0.05). In the majority of 17 out of 54 countries on Africa the continent, the economic burden of childhood cancer exceeds 80% of GDP per capita, PPP, up to 345.38% of Nigeria's GDP for Rhabdomyosarcoma. The cost of treating childhood cancers is high in Africa is catastrophic, if not downright prohibitive for households in Sub-Saharan Africa. We believe that the data from our study will be able to help make different objective advocacy allowing it to be provided with funds based of the evidence that can strengthen this program in order to install cancerology structures in the countries and by following the system plan. Cost reduction in the treatment of childhood cancer in particular and in general all types of cancer. Systematic review registration Approval of the study was given by the ethics committee of the Faculty of Medicine of the University of Lubumbashi (UNILU/CEM/135/2018) and (UNILU/CEM/096/2019).
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Affiliation(s)
- Criss Koba Mjumbe
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Desiré Mashinda Kulimba
- Department of Public Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Oscar Luboya Numbi
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Paediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Murielle Nkumuyaya
- Department of Paediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | | | - Chadrack Kabeya Diyoka
- Department of Public Health, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Benjamin Kabyla Ilunga
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
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Genemo I, Chala TK, Hordofa DF, Sinkie SO. Cost and Cost-Effectiveness of Treating Childhood Cancer at Jimma Medical Center. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:433-442. [PMID: 37309357 PMCID: PMC10257924 DOI: 10.2147/ceor.s395170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
Background More than 70% of childhood cancer patients die in Sub-Saharan African countries due to a lack of access. Additionally establishing a childhood cancer treatment service is perceived as expensive by the decision-makers of LMICs. However, there is a paucity of evidence on the actual cost and cost-effectiveness of this service in LMICs including Ethiopia. This study provides context-relevant evidence to consider childhood cancer treatment in the healthcare priority settings in Ethiopia and other LMICs. Methods Newly admitted case files of children for the year 2020/21 were reviewed. The cost was analyzed from the provider's perspective. The effectiveness was calculated using DALY averted based on the 5 years of survival rates, which is estimated from the 1-year survival rate of Kaplan-Meier output. The do-nothing was our comparator, and we assumed no cost (zero cost) will be incurred for the comparator. To account for sensitivity analyses, we varied the discount rate, 5-year survival rate, and life expectancy. Results During the study period, 101 children were treated in the unit. The total annual and unit cost to give treatment to childhood cancer patients was estimated at $279,648 and $2769, respectively. The highest per-patient annual unit cost of treatment was Hodgkin's lymphoma ($6252), while Retinoblastoma ($1520) was the least. The cost per DALY averted was $193, which is significantly less than Ethiopia's GDP per capita ($936.3). The results remained very cost-effective in sensitivity analyses. Conclusion Childhood cancer treatment is very cost-effective in Ethiopia as per WHO-CHOICE thresholds even in a conservative adjustment of assumptions. Therefore, to enhance and improve children's health, childhood cancer should get a better concern in health priority.
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Affiliation(s)
- Idiris Genemo
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
| | - Temesgen Kabeta Chala
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
| | - Diriba Fufa Hordofa
- Department of Pediatric Oncology Unit, Jimma University, Jimma, Oromia, Ethiopia
| | - Shimeles Ololo Sinkie
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
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Mirutse MK, Palm MT, Tolla MT, Memirie ST, Kefyalew ES, Hailu D, Norheim OF. Cost of childhood cancer treatment in Ethiopia. PLoS One 2023; 18:e0286461. [PMID: 37267276 DOI: 10.1371/journal.pone.0286461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/09/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Despite the recent interest in expanding pediatric oncology units in Ethiopia, reflected in the National Childhood and Adolescent Cancer Control Plan (NCACCP), little is known about the cost of running a pediatric oncology unit and treating childhood cancers. METHODS We collected historical cost data and quantity of services provided for the pediatric oncology unit and all other departments in Tikur Anbessa Specialized Hospital (TASH) from 8 July 2018 to 7 July 2019, using a provider perspective and mixed (top-down and bottom-up) costing approaches. Direct costs (human resources, drugs, supplies, medical equipment) of the pediatric oncology unit, costs at other relevant clinical departments, and overhead cost share are summed up to estimate the total annual cost of running the unit. Further, unit costs were estimated at specific childhood cancer levels. RESULTS The estimated annual total cost of running a pediatric oncology unit was USD 776,060 (equivalent to USD 577 per treated child). The cost of running a pediatric oncology unit per treated child ranged from USD 469 to USD 1,085, on the scenario-based sensitivity analysis. Drugs and supplies, and human resources accounted for 33% and 27% of the total cost, respectively. Outpatient department and inpatient department shared 37% and 63% of the cost, respectively. For the pediatric oncology unit, the cost per OPD visit, cost per bed day, and cost per episode of hospital admission were USD 36.9, 39.9, and 373.3, respectively. The annual cost per treated child ranged from USD 322 to USD 1,313 for the specific childhood cancers. CONCLUSION Running a pediatric oncology unit in Ethiopia is likely to be affordable. Further analysis of cost effectiveness, equity, and financial risk protection impacts of investing in childhood cancer programs could better inform the prioritization of childhood cancer control interventions in the Ethiopia Essential Health Service Package.
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Affiliation(s)
- Mizan Kiros Mirutse
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
- Ministry of Health Ethiopia, Addis Ababa, Ethiopia
| | | | - Mieraf Taddesse Tolla
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Kiros M, Memirie ST, Tolla MTT, Palm MT, Hailu D, Norheim OF. Cost-effectiveness of running a paediatric oncology unit in Ethiopia. BMJ Open 2023; 13:e068210. [PMID: 36918241 PMCID: PMC10016307 DOI: 10.1136/bmjopen-2022-068210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority. METHODS We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses. RESULTS The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold. CONCLUSIONS The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
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Affiliation(s)
- Mizan Kiros
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Mieraf Taddesse Taddesse Tolla
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Michael Tekle Palm
- Department of Health Financing, Clinton Health Access Initiative, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Soliman R, Oke J, Sidhom I, Bhakta N, Bolous NS, Tarek N, Ahmed S, Abdelrahman H, Moussa E, Zamzam M, Fawzy M, Zekri W, Hafez H, Sedky M, Hammad M, Elzomor H, Ahmed S, Awad M, Abdelhameed S, Mohsen E, Shalaby L, Eweida W, Abouelnaga S, Elhaddad A, Heneghan C. Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidence. EClinicalMedicine 2023; 55:101729. [PMID: 36386036 PMCID: PMC9646894 DOI: 10.1016/j.eclinm.2022.101729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resource-limited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status. METHODS Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disability-adjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality. FINDINGS For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO-CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1-1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio <3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers. INTERPRETATION Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote high-value in care delivery, with implications on practice and policy. FUNDING Egypt Cancer Network; NIHR School for Primary Care Research; ALSAC.
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Affiliation(s)
- Ranin Soliman
- Department of Continuing Education, University of Oxford, UK
- Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt
- Corresponding author. Department for Continuing Education, Kellogg College, University of Oxford, UK; Health Economics and Value Unit, Children's Cancer Hospital 57357–Egypt (CCHE), Cairo, Egypt.
| | - Jason Oke
- Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Iman Sidhom
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Nickhill Bhakta
- Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
| | - Nancy S. Bolous
- Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
| | - Nourhan Tarek
- Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Sonia Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hany Abdelrahman
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Emad Moussa
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Clinical Oncology Department, Menoufia University, Egypt
| | - Manal Zamzam
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Mohamed Fawzy
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Wael Zekri
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hanafy Hafez
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Mohamed Sedky
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatrics Department, National Research Centre, Cairo, Egypt
| | - Mahmoud Hammad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Hossam Elzomor
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Sahar Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Madeha Awad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Sayed Abdelhameed
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Enas Mohsen
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Clinical Oncology Department, Beni-suef University, Egypt
| | - Lobna Shalaby
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Wael Eweida
- Chief Operating Office, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Sherif Abouelnaga
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
- Chief Executive Office, Children's Cancer Hospital Egypt – 57357, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Carl Heneghan
- Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Shukar S, Zahoor F, Omer S, Awan SE, Yang C, Fang Y. Experience of Pharmacists with Anti-Cancer Medicine Shortages in Pakistan: Results of a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16373. [PMID: 36498446 PMCID: PMC9740989 DOI: 10.3390/ijerph192316373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to examine the current situation of anti-cancer drug shortages in Pakistan, namely its determinants, impacts, adopted mitigation strategies, and proposed solutions. Qualitative semi-structured, in-depth interviews were conducted with 25 pharmacists in oncology hospitals in Pakistan from August to October 2021. Data were collected in person and online, recorded, and subjected to inductive thematic analysis after being transcribed verbatim. Most participants experienced anti-cancer drug shortages that increased during the pandemic. Etoposide, paclitaxel, vincristine, dacarbazine, and methotrexate were frequently short. Important causes included the compromised role of regulatory authorities, lack of local production, and inventory mismanagement. The impacts were delayed/suboptimal treatment and out-of-pocket costs for patients, patients' prioritization, increased workload, negative work environment, and patients' trust issues for pharmacists. The participants proposed that a cautious regulator's role is needed to revise policies for all stakeholders and support all stakeholders financially at their level to increase access to these medicines. Based on the outcomes, it is clear that anti-cancer medicine shortages are a current issue in Pakistan. Governmental authorities need to play a role in revising policies for all levels of the drug supply chain and promoting local production of these drugs. Stakeholders should also collaborate and manage inventory.
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Affiliation(s)
- Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Fatima Zahoor
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway 47500, Malaysia
| | - Sumaira Omer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Sundas Ejaz Awan
- Faculty of Pharmacy, Gadjah Mada University, Yogyakarta 55281, Indonesia
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China
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12
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Pharmacoeconomics in Africa: needs, prospect and challenges. J Pharm Policy Pract 2021; 14:47. [PMID: 34059103 PMCID: PMC8166127 DOI: 10.1186/s40545-021-00328-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Africa as a continent has experienced a continuous increase in the cost of healthcare as its demands increase. With many of these African countries living below the poverty threshold, Africans continue to die from preventable and curable diseases. Population increases have led to an increase in demands for healthcare, which unfortunately have been met with inequitable distribution of drugs. Hence, the outcomes from healthcare interventions are frequently not maximized. These problems notably call for some economic principles and policies to guide medication selection, procurement, or donation for population prioritization or health insurance. Pharmacoeconomics drives efficient use of scarce or limited resources to maximize healthcare benefits and reduce costs. It also brings to play tools that rate therapy choice based on the quality of life added to the patient after a choice of intervention was made over an alternative. In this paper, we commented on the needs, prospect, and challenges of pharmacoeconomics in Africa.
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Joseph A, Akinsete A, Awofeso O, Balogun O, Oyeyinka K, Onitilo A. Direct cost of treating childhood cancer in Lagos, Nigeria: A tale of financial inaccessibility to care. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_87_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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