Cost of Treating Pediatric Cancer at the Butaro Cancer Center of Excellence in Rwanda

Abstract

Purpose Improvements in childhood survival rates have been achieved in low- and middle- income countries that have made a commitment to improve access to cancer care. Accurate data on the costs of delivering cancer treatment in these settings will allow ministries of health and donors to accurately assess and plan for expansions of access to care. This study assessed the financial cost of treating two common pediatric cancers, nephroblastoma and Hodgkin lymphoma, at the Butaro Cancer Center of Excellence in rural Rwanda. Methods A microcosting approach was used to calculate the per-patient cost for Hodgkin lymphoma and nephroblastoma diagnosis and treatment. Costs were analyzed retrospectively from the provider perspective for the 2014 fiscal year. The cost per patient was determined using an idealized patient receiving a full course of treatment, follow-up, and recommended social support in accordance with the national treatment protocol for each cancer. Results The cost for a full course of treatment, follow-up, and social support was determined to be between $1,490 and $2,093 for a patient with nephroblastoma and between $1,140 and $1,793 for a pediatric patient with Hodgkin lymphoma. Conclusion Task shifting, reduced labor costs, and locally adapted protocols contributed to significantly lower costs than those seen in middle- or high-income countries.

Enhancing global access to cancer medicines

“…Locally adapted cancer treatment guidelines that take account of available resources can help to improve affordability. For instance, the cost of diagnosing and treating a child with Hodgkin lymphoma was lower in Rwanda than in South Africa because radiotherapy and computed tomography scans were not standard components of care in Rwanda due to a lack of availability, chemotherapy costs were lower, and care was provided by generalists with support from volunteer US‐based oncologists …”

“…108 An alternative workforce of generalists (including physicians, nurses, and pharmacists) could be trained to provide basic cancer care (such as diagnosis, treatment, management of cancer medicine side effects, and palliative care) under the supervision of oncology specialists, as implemented in India and Rwanda. 109,110 Various locally appropriate methods can be used to deliver training and share expertise. 110 Workforce planning should allow for expected increases in cancer incidence.…”

“…For instance, the cost of diagnosing and treating a child with Hodgkin lymphoma was lower in Rwanda than in South Africa because radiotherapy and computed tomography scans were not standard components of care in Rwanda due to a lack of availability, chemotherapy costs were lower, and care was provided by generalists with support from volunteer US-based oncologists. 109 The National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification defines appropriate pathways for management of some cancers based on available resources: basic, core, enhanced, and NCCN guidelines. 111 The NCCN Harmonized Guidelines are region-specific guidelines that low-income and middle-income countries aspire to provide.…”

Optimizing outcomes for children with non‐Hodgkin lymphoma in low‐ and middle‐income countries by early correct diagnosis, reducing toxic death and preventing abandonment

“…There are major variations in the epidemiology of Burkitt lymphoma, with reported annual incidences ranging from 4 to 60 cases per 1 000 000 children depending on the setting, a 15‐fold difference based on geographic, ethnic and environmental factors (Stefan & Lutchman, ; Steliarova‐Foucher et al , ). Endemic Burkitt lymphoma is highly prevalent in tropical Africa and, despite its presentation as relatively localized disease in many cases, EFS is lower than 50%, mostly because of comorbid conditions such as malnutrition and infection, low availability of resources for treatment, suboptimal supportive care, and logistical and financial obstacles that lead to treatment abandonment (Traore et al , ; Marjerrison et al , ; Gopal & Gross, ; Neal et al , ). However, it is uncertain if it shares the exquisite chemosensitivity shown by sporadic Burkitt lymphoma because there have been no reported results of clinical trials for children with endemic Burkitt lymphoma treated with intensive regimens.…”

Building the financial case for treating childhood cancer in resource‐limited settings

“…However, this series of work reflects the costs associated with treating a heterogenous group of diseases, some of which are likely more cost-effective than others. By quantifying the costs associated with a single, common cancer, the Denburg et al study adds substantially to the growing childhood cancer health economics literature 9 by demonstrating that the costs of treating BL in Uganda are remarkably low and very cost-effective, thus supporting the prospect of more public and private sector advocacy to support these service.…”