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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] [What about the content of this article? (0)] [Affiliation(s)] [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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2
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Ehrlich BS, McNeil MJ, Pham LTD, Chen Y, Rivera J, Acuna C, Sniderman L, Sakaan FM, Aceituno AM, Villegas CA, Force LM, Bolous NS, Wiphatphumiprates PP, Slone JS, Carrillo AK, Gillipelli SR, Duffy C, Arias AV, Devidas M, Rodriguez-Galindo C, Mukkada S, Agulnik A. Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Oncol 2023; 24:967-977. [PMID: 37517410 PMCID: PMC10812862 DOI: 10.1016/s1470-2045(23)00318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3-5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality. METHODS For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0-21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849). FINDINGS Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99-7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65-18·73) in low-income countries, 9·21% (7·93-10·49) in lower-middle-income countries, and 4·47% (3·42-5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope -0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16). INTERPRETATION Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival. FUNDING American Lebanese Syrian Associated Charities and National Cancer Institute.
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Affiliation(s)
- Bella S Ehrlich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Linh T D Pham
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jocelyn Rivera
- Department of Pediatric Emergency Medicine, Hospital Infantil Teletón de Oncología, Querétaro, México
| | - Carlos Acuna
- Department of Pediatric Intensive Care, Dr Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - Liz Sniderman
- Northern Alberta Children's Cancer Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Firas M Sakaan
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Alejandra Mendez Aceituno
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Pediatric Intensive Care Unit, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Cesar A Villegas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Jeremy S Slone
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela K Carrillo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Caitlyn Duffy
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Anita V Arias
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Sheena Mukkada
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
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Ritter J, Allen S, Cohen PD, Fajardo AF, Marx K, Loggetto P, Auste C, Lewis H, de Sá Rodrigues KE, Hussain S, Omotola A, Bolous NS, Thirumurthy H, Essue BM, Steliarova-Foucher E, Huang IC, Meheus F, Bhakta N. Financial hardship in families of children or adolescents with cancer: a systematic literature review. Lancet Oncol 2023; 24:e364-e375. [PMID: 37657477 PMCID: PMC10775706 DOI: 10.1016/s1470-2045(23)00320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/03/2023]
Abstract
Financial hardship in childhood cancer contributes to poor health outcomes and global disparities in survival, but the extent of the financial burden on families is not yet fully understood. We systematically reviewed financial hardship prevalence and individual components characterising financial hardship across six domains (medical, non-medical, and indirect costs, financial strategies, psychosocial responses, and behavioural responses) and compared characteristics across country income levels using an established theory of human needs. We included 123 studies with data spanning 47 countries. Extensive heterogeneity in study methodologies and measures resulted in incomparable prevalence estimates and limited analysis. Components characterising financial hardship spanned the six domains and showed variation across country income contexts, yet a synthesis of existing literature cannot establish whether these are true differences in characterisation or burden. Our findings emphasise a crucial need to implement a data-driven methodological framework with validated measures to inform effective policies and interventions to address financial hardship in childhood cancer.
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Affiliation(s)
- Julie Ritter
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | | | - Kelsey Marx
- Prometheus Federal Services, Washington, DC, USA
| | - Patrícia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Hedley Lewis
- CHOC Childhood Cancer Foundation South Africa, Rivonia, South Africa
| | | | | | - Ayomide Omotola
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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Habashy C, Yemeke TT, Bolous NS, Chen Y, Ozawa S, Bhakta N, Alexander TB. Variations in global prices of chemotherapy for childhood cancer: a descriptive analysis. EClinicalMedicine 2023; 60:102005. [PMID: 37251630 PMCID: PMC10209684 DOI: 10.1016/j.eclinm.2023.102005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background The stark disparity in survival for children with cancer across the world has inspired a global call to expand chemotherapy access in low and middle income countries. Among the numerous barriers to success, a paucity of reliable information regarding chemotherapy pricing hinders the ability of governments and other key stakeholders to make informed budget decisions or negotiate lower medication prices. The aim of this study was to generate comparative price information on both individual chemotherapy agents and comprehensive treatment regimens for common childhood cancers using real-world data. Methods Chemotherapy agents were selected based on their inclusion in the World Health Organization (WHO) Essential Medicines List for Children (EMLc) and their use in frontline regimens for the tracer cancer types prioritized by the WHO's Global Initiative for Childhood Cancer (GICC). Sources included IQVIA MIDAS data, obtained under license from IQVIA, and publicly available data from Management Sciences for Health (MSH). Data on chemotherapy prices and purchase volumes spanning 2012-2019 were aggregated according to WHO region and World Bank (WB) income classification. Cumulative chemotherapy prices for treatment regimens were compared across WB income classification. Findings Data representing an estimated 1.1 billion doses of chemotherapy were obtained for 97 countries: 43 high income countries (HICs), 28 upper middle income countries (UMICs), and 26 low and lower middle income countries (LLMICs). Median drug prices in HICs were 0.9-20.4 times those of UMICs and 0.9-15.5 times those of LMICs. Regimen prices were generally higher for HICs, hematologic malignancies, non-adapted protocols, and higher risk stratification or stage, albeit with notable exceptions. Interpretation This study represents the largest price analysis to date of chemotherapy agents used globally in childhood cancer therapy. The findings of this study form a basis for future cost-effectiveness analysis in pediatric cancer and should inform efforts of governments and stakeholders to negotiate drug prices and develop pooled purchasing strategies. Funding NB received funding support from the American Lebanese Syrian Associated Charities and Cancer Center Support grant (CA21765) from the National Cancer Institute through the National Institutes of Health. TA received funding through the University of North Carolina Oncology K12 (K12CA120780) and the University Cancer Research Fund from the UNC Lineberger Comprehensive Cancer Center.
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Affiliation(s)
- Catherine Habashy
- Division of Pediatric Hematology-Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Tatenda T. Yemeke
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Nancy S. Bolous
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sachiko Ozawa
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas B. Alexander
- Division of Pediatric Hematology-Oncology, University of North Carolina, Chapel Hill, NC, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bolous NS, Graetz DE, Ashrafian H, Barlow J, Bhakta N, Sounderajah V, Dowdeswell B. Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust. J Health Organ Manag 2022; ahead-of-print:1-16. [PMID: 36520658 PMCID: PMC10430796 DOI: 10.1108/jhom-05-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation. DESIGN/METHODOLOGY/APPROACH This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale. FINDINGS The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure. PRACTICAL IMPLICATIONS This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result. ORIGINALITY/VALUE Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.
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Affiliation(s)
- Nancy S. Bolous
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Dylan E. Graetz
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - James Barlow
- Business School,
Imperial College London
, London,
UK
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - Barrie Dowdeswell
- Management Center Innsbruck, Internationale Hochschule GmbH
, Innsbruck,
Austria
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8
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Bolous NS, Bhatt N, Bhakta N, Neufeld EJ, Davidoff AM, Reiss UM. Gene Therapy and Hemophilia: Where Do We Go from Here? J Blood Med 2022; 13:559-580. [PMID: 36226233 PMCID: PMC9550170 DOI: 10.2147/jbm.s371438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Gene therapy for hemophilia using adeno-associated virus (AAV) derived vectors can reduce or eliminate patients' disease-related complications and improve their quality of life. Broad implementation globally will lead to societal gains and foster health equity. Several vector products each for factor IX (FIX) or factor VIII (FVIII) deficiency are in advanced clinical development. Safety data are reassuring. Efficacy data for up to 8 and 5 years, respectively, vary considerably among vector types and among individuals, but indicate significant reduction in bleeds and factor use. Products will soon be approved for marketing. This review highlights the relevant considerations for implementation of hemophilia gene therapy, specifically across a broad range of socioeconomic backgrounds globally, based on recent publications and our own experience. We address the current efficacy and safety data and relevant aspects of vector immunology. We then discuss pertinent implementation steps including pre-implementation and readiness assessments, considerations on cost, cost-effectiveness and payment models, approaches to education and informed consent, and the operational needs as well as the need for monitoring of health outcomes and implementation outcomes. To prevent a lag or complete lack of establishing access to this life-changing therapy option for all patients with hemophilia worldwide, adaptable pathways supported by collaborative and international efforts of all stakeholders are needed.
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Affiliation(s)
- Nancy S Bolous
- Department of Global Pediatric Medicine – St. Jude Children’s Research Hospital, Memphis, TN, USA,Correspondence: Nancy S Bolous, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 721, Memphis, TN, 38105, USA, Tel +1 901 595 1968, Fax +1 901 595 5319, Email
| | - Nidhi Bhatt
- Department of Hematology – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ellis J Neufeld
- Department of Hematology – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ulrike M Reiss
- Department of Hematology – St. Jude Children’s Research Hospital, Memphis, TN, USA
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9
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Soliman R, Heneghan C, Bolous NS, Sidhom I, Ahmed S, Roberts N, Oke J, Elhaddad A. Systematic review of costs and cost-effectiveness of treatment for relapsed/refractory acute leukaemia in children and young adults. Expert Rev Hematol 2022; 15:345-357. [PMID: 35485262 DOI: 10.1080/17474086.2022.2069096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Survival outcomes of children with relapsed/refractory (r/r) acute leukaemia remain poor. Novel expensive treatments have been developed to improve their outcomes, yet, limited evidence exists about cost-effectiveness of alternative treatment strategies. AREAS COVERED A systematic review was conducted to summarize the health-economic evidence about costs/cost-effectiveness of treating r/r acute leukaemia in children/young adults. We searched Medline, Embase, and Cochrane databases until August 13th, 2021. Eligible articles included peer-reviewed original studies addressing r/r paediatric/young-adult acute lymphoblastic leukaemia (ALL), and acute myeloid leukaemia (AML). Quality assessment was conducted using Consolidated Health Economics Evaluation Reporting Standards (CHEERS) checklist. EXPERT OPINION The majority of papers focused on CAR-T cell therapy, which is still a novel treatment for r/r ALL, and was found to be cost-effective, yet, there remain concerns over its long-term effectiveness, affordability, and equity in access. The next best treatment option is Blinatumomab, followed by Clofarabine therapy, whereas FLA-IDA salvage chemotherapy provides least value for money. The quality of evidence is moderate to high, with limited generalizability of findings due to high variability in outcomes obtained from modelling studies. Limited studies evaluated r/r AML. We provide recommendations to deliver cost-effective treatments in real-world contexts, with implications for healthcare policy and practice.
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Affiliation(s)
- Ranin Soliman
- Department for Continuing Education, University of Oxford, UK.,Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, USA
| | - Iman Sidhom
- Department of Pediatric Oncology, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt
| | - Sonia Ahmed
- Department of Pediatric Oncology, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt
| | - Nia Roberts
- Oxford Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Jason Oke
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alaa Elhaddad
- Department of Pediatric Oncology, Children's Cancer Hospital 57357 Egypt (CCHE), Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt
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10
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Graetz DE, Sniderman E, Villegas C, Ragab I, Laptsevich A, Maliti B, Naidu G, Zhang H, Gassant P, Nunes L, Arce D, Vasquez JM, Arora RS, Alcasabas AP, Rusmawatiningtyas D, Raza MR, Hamid SA, Velasco P, Kambugu J, Vinitsky A, Bolous NS, Haidar CE, Bihannic L, Sa da Bandeira D, Wang JX, Li D, Graca F, Vasilyeva A, Lesmana H, Galindo CR, Agulnik A, Moreira DC. Utilizing Multilingual Methods and Rapid Analysis for Global Qualitative Research During a Pandemic. Glob Qual Nurs Res 2022; 9:23333936221080969. [PMID: 35237707 PMCID: PMC8883294 DOI: 10.1177/23333936221080969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Historically, qualitative research has complemented quantitative biologic and epidemiologic studies to provide a more complete understanding of pandemics. The COVID-19 pandemic has generated unique and novel challenges for qualitative researchers, who have embraced creative solutions including virtual focus groups and rapid analyses to continue their work. We present our experience conducting a multilingual global qualitative study of healthcare resilience among teams of pediatric oncology professionals during the COVID-19 pandemic. We provide an in-depth description of our methodology and an analysis of factors we believe contributed to our study’s success including our use of technology, engagement of a large multilingual team, global partnerships, and framework-based rapid analysis. We hope these techniques may be useful to qualitative researchers conducting studies during the current pandemic, as well as for all pediatric oncology studies including multiple languages or geographically disparate subjects.
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Affiliation(s)
| | | | | | - Iman Ragab
- Ain Shams University, Children’s Hospital, Hematology-Oncology Unit, Cairo, Egypt
| | - Aliaksandra Laptsevich
- Belarusian Research Center for Pediatric Oncology Hematology and Immunology, Minsk, Belarus
| | | | - Gita Naidu
- Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Hui Zhang
- Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | | | | | - Daniela Arce
- Hospital Pediatrico de Sinaloa, Culiacan, Mexico
| | | | | | - Ana P Alcasabas
- University of the Philippines, Philippine General Hospital, Manila, Philippines
| | | | | | | | | | | | - Anna Vinitsky
- St Jude Children’s Research Hospital, Memphis, TN, USA
| | | | | | | | | | - Jade X Wang
- St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Dongfang Li
- St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Flavia Graca
- St Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Harry Lesmana
- St Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Asya Agulnik
- St Jude Children’s Research Hospital, Memphis, TN, USA
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11
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Sniderman ER, Graetz DE, Agulnik A, Ranadive R, Vedaraju Y, Chen Y, Devidas M, Chantada GL, Hessissen L, Dalvi R, Pritchard‐Jones K, Rodriguez‐Galindo C, Moreira DC, Bolous NS, Haidar CE, Bihannic L, Sa da Bandeira D, Wang JX, Li D, Graca F, Vasilyeva A, Lesmana H. Impact of the COVID‐19 pandemic on pediatric oncology providers globally: A mixed‐methods study. Cancer 2022; 128:1493-1502. [PMID: 35067925 PMCID: PMC9015299 DOI: 10.1002/cncr.34090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease 2019 (COVID‐19) disrupted pediatric oncology care globally, increasing demands on health care providers (HCPs) who adapted to continue care. This study sought to characterize the pandemic's impact on pediatric oncology HCPs worldwide. Methods A 60‐item survey focused on changes to clinical care, resources, and effects on clinicians. A diverse subgroup of institutions was purposefully selected for focus groups that explored teamwork, communication, and changes to care delivery. Results The survey included 311 responses from 213 institutions representing 79 countries. Sixteen institutions participated in 19 multidisciplinary focus groups in 8 languages. Decreased clinical staff availability was cited by 51% of institutions as a major impact. Staffing modifications included decreased provider availability (66% of institutions), roles or responsibility changes, and transfer outside the specialty. Physical effects included frequent COVID‐19 illness; 8% of respondents reported HCP deaths. Fifty percent of providers did not have the necessary personal protective equipment. HCPs also experienced psychological distress and financial concerns. Findings indicated more frequent impact on nurses than other providers. Impacts were described across all hospital resource levels, with staffing modifications more frequent in countries with higher COVID‐19 incidence (P < .001) and mortality rate (P = .004). Focus groups revealed negative impacts were stabilized by increased teamwork, communication, contributions outside usual roles, policies aimed at optimizing safety, and feeling that they were contributing. Conclusions COVID‐19 had a profound impact on the pediatric oncology workforce, creating challenging modifications to staffing and resulting in physical, psychological, and financial distress. Despite these challenges, HCPs caring for children with cancer came together to continue to provide high‐quality care. This mixed‐methods study reveals the impact that the coronavirus disease 2019 (COVID‐19) pandemic has had on pediatric oncology providers globally, and it highlights the importance of implementing strategies to protect the health care workforce during challenging situations.
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Affiliation(s)
- Elizabeth R. Sniderman
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Dylan E. Graetz
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Asya Agulnik
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Radhikesh Ranadive
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Yuvanesh Vedaraju
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Yichen Chen
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
| | - Guillermo L. Chantada
- Department of Pediatric Hematology and Oncology Fundacion Perez Scremini‐Hospital Pereira Rossell Montevideo Uruguay
- Department of Pediatric Hematology and Oncology Hospital Sant Joan de Deu Barcelona Spain
| | - Laila Hessissen
- Department of Pediatric Hematology and Oncology Mohammed V University Rabat Morocco
| | - Rashmi Dalvi
- Department of Pediatrics Bombay Hospital Institute of Medical Sciences Bombay India
| | - Kathy Pritchard‐Jones
- Great Ormond Street Institute of Child Health University College London London England
| | | | - Daniel C. Moreira
- Department of Global Pediatric Medicine St. Jude Children's Research Hospital Memphis Tennessee
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