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Opoku KB, Santiago T, Kumar P, Roush SM, Fedoriw Y, Tomoka T, Leventaki V, Furtado LV, Bhakta N, Alexander TB, Wang JR. Transcriptome profiling of pediatric extracranial solid tumors and lymphomas enables rapid low-cost diagnostic classification. Sci Rep 2024; 14:19456. [PMID: 39169157 PMCID: PMC11339337 DOI: 10.1038/s41598-024-70541-0] [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: 02/09/2024] [Accepted: 08/18/2024] [Indexed: 08/23/2024] Open
Abstract
Approximately 80% of pediatric tumors occur in low- and middle-income countries (LMIC), where diagnostic tools essential for treatment decisions are often unavailable or incomplete. Development of cost-effective molecular diagnostics will help bridge the cancer diagnostic gap and ultimately improve pediatric cancer outcomes in LMIC settings. We investigated the feasibility of using nanopore whole transcriptome sequencing on formalin-fixed paraffin embedded (FFPE)-derived RNA and a composite machine learning model for pediatric solid tumor diagnosis. Transcriptome cDNA sequencing was performed on a heterogenous set of 221 FFPE and 32 fresh frozen pediatric solid tumor and lymphoma specimens on Oxford Nanopore Technologies' sequencing platforms. A composite machine learning model was then used to classify transcriptional profiles into clinically actionable tumor types and subtypes. In total, 95.6% and 89.7% of pediatric solid tumors and lymphoma specimens were correctly classified, respectively. 71.5% of pediatric solid tumors had prediction probabilities > 0.8 and were classified with 100% accuracy. Similarly, for lymphomas, 72.4% of samples that had prediction probabilities > 0.6 were classified with 97.6% accuracy. Additionally, FOXO1 fusion status was predicted accurately for 97.4% of rhabdomyosarcomas and MYCN amplification was predicted with 88% accuracy in neuroblastoma. Whole transcriptome sequencing from FFPE-derived pediatric solid tumor and lymphoma samples has the potential to provide clinical classification of both tissue lineage and core genomic classification. Further expansion, refinement, and validation of this approach is necessary to explore whether this technology could be part of the solution of addressing the diagnostic limitations in LMIC.
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Affiliation(s)
- Kofi B Opoku
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Teresa Santiago
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, USA
| | - Priya Kumar
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, USA
| | - Sophia M Roush
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Tamiwe Tomoka
- University of Malawi College of Medicine, Blantyre, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, USA
- UNC Project Malawi, Lilongwe, Malawi
| | - Vasiliki Leventaki
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Larissa V Furtado
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, USA
| | - Thomas B Alexander
- Department of Pediatrics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jeremy R Wang
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, USA.
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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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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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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Salifu N, Segbefia CI, Alhassan Y, Renner LA, Tette EMA. Short-term chemotherapy-related complications and undernutrition in children diagnosed with cancer at Korle Bu Teaching Hospital, Accra, Ghana: A prospective cohort study. PLoS One 2024; 19:e0301208. [PMID: 38547211 PMCID: PMC10977704 DOI: 10.1371/journal.pone.0301208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
Undernutrition in children with cancer is associated with complications during cancer therapy. The study objective was to determine the association between specific anthropometric parameters and short-term chemotherapy-related complications and mortality. This was a hospital-based, prospective cohort study of children, age ≤12 years, with a new cancer diagnosis at the Paediatric Oncology Unit, Korle Bu Teaching Hospital, Ghana. Socio-demographic information, cancer characteristics and anthropometric measurements were obtained at enrolment. Participants were followed up for twelve weeks from commencement of chemotherapy and selected treatment-related complications such as anaemia and thrombocytopenia requiring transfusions, prolonged neutropenia resulting in treatment delays, febrile neutropenia, mucositis and death were recorded. A total of 133 participants were recruited with a median age of 4.5 years. Eighty-one (60.9%) were diagnosed with solid tumours, 31 (23.3%) had leukaemias and 21 (15.8%) had lymphomas. Of the anthropometric parameters assessed, only arm anthropometry using upper arm muscle area (UAMA) and mid-upper arm circumference (MUAC) were associated with complications. Participants with wasting were more likely to develop anaemia and mucositis. However, the incidence of prolonged neutropenia was significantly higher among participants with average UAMA (p = 0.043) and low average UAMA (p = 0.049) compared to those with low UAMA. Risk of neutropenia was also significantly less among those with wasting by MUAC compared to those well-nourished (p = 0.045). Twenty-three participants (17.3%) died with a greater proportion (11/44; 25%) occurring in those who were wasted using MUAC. These findings underscore the need for nutritional surveillance at diagnosis and during chemotherapy, particularly where co-morbid disease is prevalent.
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Affiliation(s)
- Nihad Salifu
- Department of Paediatrics, Greater Accra Regional Hospital, Accra, Ghana
| | | | - Yakubu Alhassan
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Lorna A. Renner
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Edem M. A. Tette
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
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Marfo M, Acheampong AK, Asare C. Financial burden faced by breastfeeding mothers caring for children diagnosed with cancer in Ghana; an exploratory qualitative study. BMC Womens Health 2024; 24:177. [PMID: 38486146 PMCID: PMC10938724 DOI: 10.1186/s12905-024-02931-5] [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: 07/08/2023] [Accepted: 01/25/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND When children are diagnosed of cancer, parents face varied financial issues. Among some of the identifiable factors that cause financial challenges among breastfeeding mothers include the high cost of childhood cancer care. The high cost of childhood cancer care could impede the sustainability of access to prompt care. There is paucity of literature on the financial burdens faced by breastfeeding mothers with children diagnosed with cancer in Ghana. Therefore, this study sought to explore the financial burden faced by mothers with breastfeeding children diagnosed with cancer. METHODS The study employed qualitative exploratory descriptive design. One-on-one interviews were conducted among 13 mothers with breastfeeding children diagnosed of cancer. Permission was sought for data to be recorded, transcribed concurrently and inductive content analysis done. RESULTS Three main themes emerged after data analysis: High cost (sub-themes; expensive medications, laboratory investigation fees, and cost of mothers' feeding), Public support (sub-themes; appeal for funds, national health insurance scheme) and Self-financing (loans, personal savings). Most of the breastfeeding mothers narrated that high cost of childhood cancer care generated financial distress to them. They shared that the cost involved in purchasing their children's cancer medications, paying for laboratory investigations and feeding themselves to produce adequate breastmilk to feed their children were challenging. Some of the mothers self-financed the cost of their children's cancer care through loans and personal savings. CONCLUSION Government and other stakeholders should allocate annual budget and funds towards childhood cancer care to lessen the financial burden breastfeeding mothers caring for children with cancer experience.
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Affiliation(s)
- Margaret Marfo
- School of Nursing and Midwifery, Wisconsin International University College-Ghana, Accra, Ghana
| | | | - Comfort Asare
- School of Nursing and Midwifery, Wisconsin International University College-Ghana, Accra, Ghana
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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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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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Assessing the cost and economic impact of tertiary-level pediatric cancer care in Tanzania. PLoS One 2022; 17:e0273296. [PMCID: PMC9674137 DOI: 10.1371/journal.pone.0273296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Worldwide, an estimated 400,000 children develop cancer each year. The bulk of the mortalities from these cases occur in low-and-middle-income countries (LMICs). In Sub-Saharan Africa, there is a tremendous need to strengthen the capacity of health systems to provide high-quality cancer care for children. However, a lack of data on the economic impact of cancer treatment in low-resource settings hinders its consideration as a healthcare priority. To address this gap, this study models the clinical and financial impact of pediatric cancer care in Tanzania, a lower-middle income country in East Africa. Methods We conducted a retrospective review of patients with cancer under the age of 19 years treated at Bugando Medical Centre from January 2010 to August 2014. Information was collected from a total of 161 children, including demographics, type of cancer, care received, and five-year survival outcomes. This data was used to calculate the number of averted disability-adjusted life-years (DALYs) with treatment. Charges for all direct medical costs, fixed provider costs, and variable provider costs were used to calculate total cost of care. The societal economic impact of cancer treatment was modeled using the value of statistical life (VSL) and human capital methods. Findings The total health impact for these 161 children was 819 averted DALYs at a total cost of $846,743. The median cost per patient was $5,064 ($4,746–5,501 interquartile range). The societal economic impact of cancer treatment ranged from $590,534 to $3,647,158 using VSL method and $1,776,296 using a human capital approach. Interpretation Despite the limitations of existing treatment capacity, economic modeling demonstrates a positive economic impact from providing pediatric cancer care in Tanzania. As many countries like Tanzania progress towards achieving Universal Health Coverage, these key economic indicators may encourage future investment in comprehensive pediatric cancer care programs in low-resource settings to achieve clinically and economically beneficial results not only for the individual patients, but for the country as a whole.
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Bekui BAA, Ohene LA, Badzi C, Ampomah M, Aziato L. Physical and socioeconomic burden of caregiving on family caregivers of children with cancer at a tertiary Hospital in Ghana. Nurs Open 2022; 10:915-925. [PMID: 36126082 PMCID: PMC9834190 DOI: 10.1002/nop2.1359] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/01/2022] [Accepted: 08/23/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Childhood cancer is proportionately higher in Africa and these result in increased demands on caregivers. The inability of affected children to take care of themselves; coupled with prescribed medical interventions presents physical and social burdens on family caregivers. AIMS AND METHODS This study used a qualitative exploratory design to explore the physical and socioeconomic challenges for family caregivers of children diagnosed with cancer and receiving care at one of the biggest tertiary hospitals in Ghana. A total of thirteen family caregivers of children with cancer were interviewed. FINDINGS Two major themes were identified: Burden of care on Physical Health and Socioeconomic burdens of caregiving on the family caregiver. It was reported that family caregivers encounter physical challenges such as Aches and Pains when performing caregiving activities, Loss of Appetite, Fatigue, Compromised Functional State and Sleep Disruption. The second theme, Socioeconomic burdens of caregiving on family caregivers account for the consequences of caregiving on social lives, family relationships, finance and employment. CONCLUSIONS AND RECOMMENDATIONS The study recommends that measures that provided relief for the caregivers such as teaching them to adopt local measures of pain relief such as massage should be encouraged. Policies should adopt measures that encourage caregivers to have some days of rest whiles providing care to their children with cancer. Also, health insurance packages that provide relief for the cost of accessing healthcare, should be extended to children with cancers to support their caregivers.
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Affiliation(s)
| | - Lillian Akorfa Ohene
- Department of Community Health Nursing, School of Nursing and MidwiferyUniversity of GhanaLegonGhana
| | - Caroline Badzi
- Maternal and Child Health Department, School of Nursing and MidwiferyUniversity of GhanaLegonGhana
| | - Menford Owusu Ampomah
- Department of Adult Health Nursing, School of Nursing and MidwiferyUniversity of GhanaLegonGhana
| | - Lydia Aziato
- School of Nursing and MidwiferyUniversity of GhanaLegonGhana
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Painschab MS, Kohler R, Kimani S, Mhango W, Kaimila B, Zuze T, Mithi V, Kasonkanji E, Mumba N, Nyasosela R, Wheeler S, Gopal S. Comparison of best supportive care, CHOP, or R-CHOP for treatment of diffuse large B-cell lymphoma in Malawi: a cost-effectiveness analysis. Lancet Glob Health 2021; 9:e1305-e1313. [PMID: 34303416 PMCID: PMC8403678 DOI: 10.1016/s2214-109x(21)00261-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/05/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cost-effectiveness data for cancer treatment are needed from sub-Saharan Africa, where diffuse large B-cell lymphoma (DLBCL) is a common, curable cancer. In high-income countries, the standard of care for DLBCL is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemoimmunotherapy. Rituximab is often not available in sub-Saharan Africa due to perceived unaffordability, and treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) is common. We aimed to evaluate the cost-effectiveness of treatment in Malawi, comparing best supportive care, CHOP, or R-CHOP in patients with DLBCL. METHODS For this cost-effectiveness analysis, we used published Malawi microcosting data, clinical data from a prospective cohort treated with CHOP, and clinical trial data evaluating R-CHOP. We used a decision-tree model to calculate costs per disability-adjusted life-year (DALY) averted from the health system perspective for the treatment of patients with DLBCL with best supportive care, CHOP, or R-CHOP, running the model on a per-patient basis and a Malawi population-level basis. We used the WHO definitions of cost-effective (three times the GDP per capita of the country) and extremely cost-effective (equal to the GDP per capita of the country) as willingness-to-pay thresholds for Malawi. FINDINGS On a per-patient level, compared with best supportive care, CHOP was estimated to avert a mean 7·4 DALYs at an incremental cost of US$1384, for an incremental cost-effectiveness ratio (ICER) of $189 per DALY averted, which is substantially lower than the willingness-to-pay threshold (extremely cost-effective). Compared with CHOP, R-CHOP was estimated to avert 2·8 DALYs at an incremental cost of $3324, resulting in an ICER of $1204 per DALY averted, which is slightly higher than the cost-effective willingness-to-pay threshold. In probabilistic sensitivity analyses, CHOP remained cost-effective for DLBCL treatment in more than 99% of simulations, whereas R-CHOP was lower than the threshold in 46% of simulations. INTERPRETATION We estimated CHOP to be cost-effective for DLBCL treatment in Malawi, and that the addition of rituximab might be cost-effective. Despite upfront costs, DLBCL treatment is probably a prudent investment relative to other accepted health interventions in sub-Saharan Africa. FUNDING National Institutes of Health.
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Affiliation(s)
- Matthew S Painschab
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Project Malawi, Lilongwe, Malawi.
| | - Racquel Kohler
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Stephen Kimani
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Bongani Kaimila
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Takondwa Zuze
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Victor Mithi
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Noel Mumba
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Stephanie Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
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12
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Boateng R, Renner L, Petricca K, Gupta S, Denburg A. Health system determinants of access to essential medicines for children with cancer in Ghana. BMJ Glob Health 2021; 5:bmjgh-2020-002906. [PMID: 32967979 PMCID: PMC7513566 DOI: 10.1136/bmjgh-2020-002906] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/13/2020] [Accepted: 08/11/2020] [Indexed: 01/06/2023] Open
Abstract
Background Evidence of the context-specific challenges related to childhood cancer drug (CCD) access is vital to improving outcomes for children with cancer in low- and middle-income countries, such as Ghana. We sought to determine the availability and cost of essential CCD in Ghana and identify the underlying determinants of access. Methods Our study integrated quantitative data on drug prices and availability with qualitative insights into health system and sociopolitical determinants of CCD access in Ghana. We analysed retrospective monthly price and stock data for 41 cancer and supportive care drugs on the WHO Essential Medicines List (EML) from private retail and public institutional pharmacies. Non-parametric analyses evaluated relationships between drug price and availability, and impacts of drug class and formulation on availability and procurement efficiency. We assessed the determinants of drug access through thematic analysis of policy documents and semi-structured interviews (n=21) with key health system stakeholders. Results Ghana lists only 47% of essential CCD on its National EML, revealing gaps in domestic formulary inclusion. Stock-outs occurred for 88% of essential CCD, with a 70-day median stock-out duration; 32% had median price ratios above internationally-accepted efficiency thresholds. Drugs procured inefficiently were more susceptible to stock-outs (p=0.0003). Principal determinants of drug access included: (1) lack of sociopolitical priority afforded childhood cancer and (2) the impact of policy and regulatory environments on drug affordability, availability and quality. Establishment of a population-based cancer registry, a nationally-coordinated procurement strategy for CCD, public financing for childhood cancer care and policies to control drug costs emerged as priority interventions to improve drug access in Ghana. Conclusion Our study provides context-specific evidence to enable responsive policy development for efficient drug procurement and supply management in Ghana and establishes a rigorous approach to the analysis of childhood cancer drug access in similar health system settings.
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Affiliation(s)
- Rhonda Boateng
- Unit for Policy and Economic Research in Childhood Cancer, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lorna Renner
- University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Kadia Petricca
- Unit for Policy and Economic Research in Childhood Cancer, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Unit for Policy and Economic Research in Childhood Cancer, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Avram Denburg
- Unit for Policy and Economic Research in Childhood Cancer, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada .,Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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13
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Pritchard-Jones K, de C V Abib S, Esiashvili N, Kaspers GJL, Rosser J, Van Doorninck JA, Braganca JML, Hoffman RI, Rodriguez-Galindo C, Adams C, Connor SR, Abdelhafeez AH, Bouffet E, Howard SC, Challinor JM, Hessissen L, Dalvi RB, Kearns P, Chantada GL, Frazier LA, Sullivan MJ, Schulte FSM, Morrissey LK, Kozhaeva O, Luna-Fineman S, Khan MS. The threat of the COVID-19 pandemic on reversing global life-saving gains in the survival of childhood cancer: a call for collaborative action from SIOP, IPSO, PROS, WCC, CCI, St Jude Global, UICC and WHPCA. Ecancermedicalscience 2021; 15:1187. [PMID: 33777180 PMCID: PMC7987488 DOI: 10.3332/ecancer.2021.1187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic poses an unprecedented health crisis in all socio-economic regions across the globe. While the pandemic has had a profound impact on access to and delivery of health care by all services, it has been particularly disruptive for the care of patients with life-threatening noncommunicable diseases (NCDs) such as the treatment of children and young people with cancer. The reduction in child mortality from preventable causes over the last 50 years has seen childhood cancer emerge as a major unmet health care need. Whilst survival rates of 85% have been achieved in high income countries, this has not yet been translated into similar outcomes for children with cancer in resource-limited settings where survival averages 30%. Launched in 2018, by the World Health Organization (WHO), the Global Initiative for Childhood Cancer (GICC) is a pivotal effort by the international community to achieve at least 60% survival for children with cancer by 2030. The WHO GICC is already making an impact in many countries but the disruption of cancer care during the COVID-19 pandemic threatens to set back this global effort to improve the outcome for children with cancer, wherever they may live. As representatives of the global community committed to fostering the goals of the GICC, we applaud the WHO response to the COVID-19 pandemic, in particular we support the WHO’s call to ensure the needs of patients with life threatening NCDs including cancer are not compromised during the pandemic. Here, as collaborative partners in the GICC, we highlight specific areas of focus that need to be addressed to ensure the immediate care of children and adolescents with cancer is not disrupted during the pandemic; and measures to sustain the development of cancer care so the long-term goals of the GICC are not lost during this global health crisis.
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Affiliation(s)
- Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1E, United Kingdom.,International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Simone de C V Abib
- Division of Pediatric Surgery, Pediatric Oncology Institute (GRAACC), Federal University of São Paulo, Rua Pedro de Toledo, 572, 04039-001 São Paulo, Brazil.,International Society of Paediatric Surgical Oncology (IPSO), Tienrayseweg 10, 5961NL Horst, The Netherlands
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute at Emory University, 1365 Clifton Road, NE, Atlanta, GA 30322, USA.,Paediatric Radiation Oncology Society (PROS), 28 rue Laennec, F-69373 Lyon, Cedex 08, France
| | - Gertjan J L Kaspers
- Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, NL-3584 CS Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands.,World Child Cancer (WCC), The Netherlands, P.O. Box 113, 3720 AC Bilthoven, The Netherlands
| | - Jon Rosser
- World Child Cancer (WCC) UK, 9 Maltings Place, London SE1 3JB, UK
| | - John A Van Doorninck
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Rocky Mountain Hospital for Children, 2055 High Street, #340, Denver, CO 80211, USA.,World Child Cancer (WCC) USA, 1301 Arapahoe St Suite 105, Golden, CO 80401, USA
| | - João M L Braganca
- Childhood Cancer International (CCI), Kraijenhoffstraat 137A, 1018RG Amsterdam, The Netherlands
| | - Ruth I Hoffman
- Childhood Cancer International (CCI), Kraijenhoffstraat 137A, 1018RG Amsterdam, The Netherlands
| | - Carlos Rodriguez-Galindo
- Department of Global Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Cary Adams
- Union for International Cancer Control (UICC), 31-33 Avenue Giuseppe Motta, 1202 Geneva, Switzerland
| | - Stephen R Connor
- Worldwide Hospice Palliative Care Alliance (WHPCA), 10990 Rice Field Pl, Fairfax Station, VA 22039, USA
| | - Abdelhafeez H Abdelhafeez
- International Society of Paediatric Surgical Oncology (IPSO), Tienrayseweg 10, 5961NL Horst, The Netherlands.,Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Eric Bouffet
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Division of Haematology/Oncology, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, Canada
| | - Scott C Howard
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Acute and Tertiary Care, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Julia M Challinor
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,School of Nursing, University of California San Francisco, 36 Rockview Dr., Santa Cruz, CA 95062, USA
| | - Laila Hessissen
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Pediatric Hematology and Oncology, Children Hospital of Rabat, Mohamed V university of Rabat, Ibn Rochd avenue, Rabat 6542, Morocco
| | - Rashmi B Dalvi
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Pediatrics and Pediatric Hematology Oncology, Bombay Hospital Institute of Medical sciences, street 20, New Marine lines, Mumbai 400020, India
| | - Pamela Kearns
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Institute of Cancer and Genomic Sciences, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK.,European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Guillermo L Chantada
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Hematology-Oncology, Hospital Pereira Rossell-Fundacion Perez-Scremini (secondary: Hospital Sant Joan De Deu), Bulevar Artigas 1556, 11600 Montevideo, Uruguay
| | - Lindsay A Frazier
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA
| | - Michael J Sullivan
- International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Children's Cancer Centre and Department of Paediatrics, Royal Children's Hospital and University of Melbourne, 50 Flemington Road, Parkville 3052, Melbourne, Australia.,Paediatric Oncology in Developing Countries (PODC) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Fiona S M Schulte
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, 2202 2 St., T2S 3C3, Calgary, Canada.,Paedatric Psycho-Oncology (PPO) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Lisa K Morrissey
- Nursing and Patient Services, Division of Hematology/Oncology/HSCT, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.,Nursing Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland
| | - Olga Kozhaeva
- Policy Affairs, European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Sandra Luna-Fineman
- Paediatric Oncology in Developing Countries (PODC) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Division of Hematology/Oncology/SCT, Department of Pediatrics, Children's Hospital Colorado, U Colorado, 13123 E 16th Ave, B115, Aurora, CO 80045, USA
| | - Muhammad S Khan
- Paediatric Oncology in Developing Countries (PODC) Committee, International Society of Paediatric Oncology (SIOP), Industriestrasse 25, 6312 Steinhausen, Switzerland.,Pediatric Hematology and Oncology Division, Tawam Hospital, Al Ain (Abu Dhabi), PO Box 15258, United Arab Emirates
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14
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Nukpezah RN, Khoshnavay FF, Hasanpour M, Nasrabadi AN. Striving to reduce suffering: A Phenomenological Study of nurses experience in caring for children with cancer in Ghana. Nurs Open 2021; 8:473-481. [PMID: 33318855 PMCID: PMC7729530 DOI: 10.1002/nop2.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022] Open
Abstract
Aim To provide insights into nurses lived experiences in caring for children with cancer. Background Little is known about the paediatric oncology nurses shared practices of caring for children with cancer in Ghana. Design A hermeneutic phenomenological qualitative study. Methods A semi-structured interview with 14 purposely sampled Ghanaian paediatric oncology nurses. Findings were analysed using Diekelman, Allen and Tanner's approach. Results The theme "Striving to reduce suffering" and three relational subthemes: "knowing children's needs," "Rendering a hopeful fight" and "Ensuring continuity and coordination of care" emerged. Increased awareness of this phenomenon for the nurses who care for these children is vital to ensure quality and holistic care that is meaningful and satisfying by nurses for children with cancer. Paediatric oncology nurses can use the result of the study to evaluate their caring practice and as an avenue to develop better caring practice.
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Affiliation(s)
- Ruth Nimota Nukpezah
- Department of Pediatric NursingSchool of Nursing and MidwiferyInternational campus‐Tehran University of Medical SciencesTehranIran
| | - Fatemeh Fomani Khoshnavay
- Department of Pediatric NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Marzieh Hasanpour
- Department of Pediatric NursingNIDCAP ProfessionalSpiritual Health Branch of Rresearch Center of the Quran; Hadith and MedicineSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Alireza Nikbakht Nasrabadi
- Department of Medical and Surgical NursingSchool of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
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15
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Githang'a J, Brown B, Chitsike I, Schroeder K, Chekwenda-Makore N, Majahasi F, Ogundoyin O, Renner L, Petricca K, Denburg AE, Horton SE, Gupta S. The cost-effectiveness of treating childhood cancer in 4 centers across sub-Saharan Africa. Cancer 2020; 127:787-793. [PMID: 33108002 DOI: 10.1002/cncr.33280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The treatment of childhood cancer often is assumed to be costly in African settings, thereby limiting advocacy and policy efforts. The authors determined the cost and cost-effectiveness of maintaining childhood cancer centers across 4 hospitals throughout sub-Saharan Africa. METHODS Within hospitals representing 4 countries (Kenya, Nigeria, Tanzania, and Zimbabwe), cost was determined either retrospectively or prospectively for all inputs related to operating a pediatric cancer unit (eg, laboratory costs, medications, and salaries). Cost-effectiveness was calculated based on the annual number of newly diagnosed patients, survival rates, and life expectancy. RESULTS Cost per new diagnosis ranged from $2400 to $31,000, attributable to variances with regard to center size, case mix, drug prices, admission practices, and the treatment abandonment rate, which also affected survival. The most expensive cost input was found to be associated with medication in Kenya, and medical personnel in the other 3 centers. The cost per disability-adjusted life-year averted ranged from 0.3 to 3.6 times the per capita gross national income. Childhood cancer treatment therefore was considered to be very cost-effective by World Health Organization standards in 2 countries and cost-effective in 1 additional country. In all centers, abandonment of treatment was common; modeling exercises suggested that public funding of treatment, additional psychosocial personnel, and modifications of inpatient policies would increase survival rates while maintaining or even improving cost-effectiveness. CONCLUSIONS Across various African countries, childhood cancer treatment units represent cost-effective interventions. Cost-effectiveness can be increased through the control of drug prices, appropriate policy environments, and decreasing the rate of treatment abandonment. These results will inform national childhood cancer strategies across Africa.
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Affiliation(s)
- Jessie Githang'a
- Department of Human Pathology, University of Nairobi, Nairobi, Kenya
| | - Biobele Brown
- Department of Paediatrics, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Inam Chitsike
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kristin Schroeder
- Department of Pediatrics and Global Health, Duke University School of Medicine, Durham, North Carolina
| | - Nester Chekwenda-Makore
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Olakayode Ogundoyin
- Department of Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Lorna Renner
- Department of Child Health, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Kadia Petricca
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram E Denburg
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sue E Horton
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sumit Gupta
- Unit for Policy and Economic Research in Childhood Cancer, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Psychological and spiritual wellbeing of family caregivers of children with cancer at a teaching hospital in Ghana. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Fung A, Horton S, Zabih V, Denburg A, Gupta S. Cost and cost-effectiveness of childhood cancer treatment in low-income and middle-income countries: a systematic review. BMJ Glob Health 2019; 4:e001825. [PMID: 31749998 PMCID: PMC6830048 DOI: 10.1136/bmjgh-2019-001825] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/20/2019] [Accepted: 10/12/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION A major barrier to improving childhood cancer survival is the perception that paediatric oncology services are too costly for low-income and middle-income country (LMIC) health systems. We conducted a systematic review to synthesise existing evidence on the costs and cost-effectiveness of treating childhood cancers in LMICs. METHODS We searched multiple databases from their inception to March 2019. All studies reporting costs or cost-effectiveness of treating any childhood cancer in an LMIC were included. We appraised included articles using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Where possible, we extracted or calculated the cost per disability-adjusted life year (DALY) averted using reported survival and country-specific life expectancy. Cost/DALY averted was compared with per capita gross domestic product (GDP) as per WHO-Choosing Interventions that are Cost-Effective guidelines to determine cost-effectiveness. RESULTS Of 2802 studies identified, 30 met inclusion criteria. Studies represented 22 countries and nine different malignancies. The most commonly studied cancers were acute lymphoblastic leukaemia (n=10), Burkitt lymphoma (n=4) and Wilms tumour (n=3). The median CHEERS checklist score was 18 of 24. Many studies omitted key cost inputs. Notably, only 11 studies included healthcare worker salaries. Cost/DALY averted was extracted or calculated for 12 studies and ranged from US$22 to US$4475, although the lower-end costs were primarily from studies that omitted key cost components. In all 12, cost/DALY averted through treatment was substantially less than country per capita GDP, and therefore considered very cost-effective. CONCLUSION Many included studies did not account for key cost inputs, thus underestimating true treatment costs. Costs/DALY averted were nonetheless substantially lower than per capita GDP, suggesting that even if all relevant inputs are included, LMIC childhood cancer treatment is consistently very cost-effective. While additional rigorous economic evaluations are required, our results can inform the development of LMIC national childhood cancer strategies.
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Affiliation(s)
- Alastair Fung
- Pediatrics and Child Health, Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Veda Zabih
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram Denburg
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sumit Gupta
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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