Childhood cancer therapies cost effective in sub-Saharan Africa
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Childhood cancer therapies cost effective in sub-Saharan Africa Childhood cancer therapies appear to be cost effective in countries in sub-Saharan Africa, according to findings of a study published in Cancer.1 Costs associated with paediatric cancer units in four hospitals in Kenya, Nigeria, Tanzania and Zimbabwe, respectively, were determined prospectively or retrospectively, and included costs for medical and support personnel, family accommodation, outpatient visits, healthcare services and hospital administration. The cost effectiveness of childhood cancer therapies in each country was estimated based on the annual number of patients newly diagnosed with cancer, survival rates and life expectancy; cost effectiveness in terms of cost per disability-adjusted life-year (DALY) averted was estimated from the healthcare system perspective in each country over a lifetime time horizon. The estimated cost per new diagnosis ranged from $2338 in the centre in Zimbabwe to $31 344 in the centre in Kenya. Variables affecting the cost per diagnosis included the centre size, drug prices, and the treatment discontinuation rate (which impacted survival). Annual operating costs at the four centres ranged from $229 000 in Nigeria to over $4 million in Kenya. Costs were greatest for medication in Kenya, and for medical personnel in the other three countries. The estimated cost per DALY averted was lowest in Nigeria ($323) and highest in Kenya ($5783), and ranged from 0.3 to 3.6 times the per-capita gross national income. Based on WHO cost-effectiveness thresholds, childhood cancer treatment was considered to be very cost effective in Tanzania and Zimbabwe, and cost effective in Nigeria, but the cost per DALY averted just exceeded the cost-effectiveness threshold in Kenya. "The results of the current study have demonstrated that the treatment of childhood cancer can be very cost-effective in both low-income and lower middle-income countries within sub-Saharan Africa. The control of drug prices, enhancement of outpatient care capabilities including outpatient accommodations for caregivers and patients, and interventions targeting the abandonment of treatment will not only improve clinical outcomes but cost-effectiveness as well," said the authors. "The authors of the report . . . will surely continue to exert a leadership role in this area of study . . . It will be especially useful to revisit the sites of their studies after elements influencing cost-effectiveness, such as abandonment of therapy, have been addressed substantially. Then, it is on to resolving the dilemma of cost-effectiveness versus affordability, as the authors have recognized," commented Dr Ronald Barr From McMaster University, Hamilton, Ontario, Canada, in an accompanying editorial published in Cancer.2 1. Githang’a J, et al. The cost-effectiveness of treating childhood cancer in 4 centers across sub-Saharan Africa. . Cancer : 27 Oct 2020. Available from: URL: http:// doi.org/10.1002/cncr.33280. 2. Barr RD. The challenges of delivering cost-effective and afford
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