Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries

Tangka

Edwards

et al. 2016

Self Cite

Background This article reports on the methods and framework we have developed to guide economic evaluation of noncommunicable disease registries. Methods We developed a cost data collection instrument, the Centers for Disease Control and Prevention’s (CDC’s) International Registry Costing Tool (IntRegCosting Tool), based on established economics methods We performed in-depth case studies, site visit interviews, and pilot testing in 11 registries from multiple countries including India, Kenya, Uganda, Colombia, and Barbados to assess the overall quality of the data collected from cancer and cardiovascular registries. Results Overall, the registries were able to use the IntRegCosting Tool to assign operating expenditures to specific activities. We verified that registries were able to provide accurate estimation of labor costs, which is the largest expenditure incurred by registries. We also identified several factors that can influence the cost of registry operations, including size of the geographic area served, data collection approach, local cost of living, presence of rural areas, volume of cases, extent of consolidation of records to cases, and continuity of funding. Conclusion Internal and external registry factors reveal that a single estimate for the cost of registry operations is not feasible; costs will vary on the basis of factors that may be beyond the control of the registries. Some factors, such as data collection approach, can be modified to improve the efficiency of registry operations. These findings will inform both future economic data collection using a web-based tool and cost and cost-effectiveness analyses of registry operations in low- and middle-income countries (LMICs) and other locations with similar characteristics.

Section: Discussionmentioning

confidence: 99%

Developing and testing a cost data collection instrument for noncommunicable disease registry planning

Tangka

Edwards

et al. 2016

Self Cite

“…About three-fourths of the expenditures support data collection/abstraction, quality review, analysis, and data reporting from Mumbai and the three satellite registries. The cost per case for the Mumbai and satellite registries (almost 4 US $) is quite inexpensive compared to the 61 US $ per case reported by US registries [22]. Past analysis of cancer registries has indicated that fixed-cost components such as administration, management, and reporting requirements account for a large proportion of overall expenditures [23–25].…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of Mumbai and its satellite cancer registries: Implications for expansion of data collection

Koyande

Edwards

et al. 2016

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Background The Mumbai Cancer Registry is a population-based cancer registry that has been in operation for more than five decades and has successfully initiated and integrated three satellite registries in Pune, Nagpur, and Aurangabad, each covering specific urban populations of the Indian state Maharashtra. Data collectors at the satellites perform data abstraction, but Mumbai carries out all other core registration activities such as data analysis and quality assurance. Each of the three satellite registries follows the same data collection methodology as the main Mumbai Cancer Registry. This study examines the cost of operating the Mumbai and its satellite cancer registries. Methods We modified and used the Centers for Disease Control and Prevention’s (CDC’s) International Registry Costing Tool (IntRegCosting Tool) to collect cost and resource use data for the Mumbai Cancer Registry and three satellites. Results Almost 60% of the registration expenditure was borne by the Indian Cancer Society, which hosts the Mumbai Cancer Registry, and more than half of the registry expenditure was related to data collection activities. Across the combined registries, 93% of the expenditure was spent on labor. Overall, registration activities had a low cost per case of 226.10 Indian rupees (or a little less than 4.00 US dollars in 2014 [used average exchange rate in 2014: 1 US $ = 60 Indian rupees]). Conclusion The centralization of fixed-cost activities in Mumbai likely resulted in economies of scale in operating the Mumbai and satellite registries, which, together, report on almost 20,000 cancer cases annually. In middle-income countries like India, where financial resources are limited, the operational framework provided by the Mumbai and satellite registries can serve as a model for other registries looking to expand data collection.

“…A substantial proportion of the registry operations expenditure is related to staff employed by the registry, reflecting the labor-intensive nature of collecting and reporting incidence cases worldwide, Europe included [12,16,17]. The cost per cancer case for the BNR-Cancer registry (US$382–US$573) is six to nine times higher than the cost per cancer case collected by the registries funded by the CDC; the average cost per case for the US registries is about US$61 [7,8], with low-volume registries incurring a higher cost per case than high-volume registries.…”

Section: Discussionmentioning

confidence: 99%

“…The cost per cancer case for the BNR-Cancer registry is higher than the average cost per cancer case collected by European registries, which is about US$70 [17]. The cost is also significantly higher than the cost-per-case registries in low- and middle-income countries (LMICs) studied by Tangka et al, which ranged from US$4 (Mumbai, India) to US$113 (Pasto, Colombia) [16]. There are several potential reasons for the BNR-Cancer’s costs being comparatively higher than those of US and LMIC registries.…”

Section: Discussionmentioning

confidence: 99%

Economic assessment of integrated cancer and cardiovascular registries: The Barbados experience

Martelly

Rose

et al. 2016

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Background This report describes the resources required to support the integrated approach of the Barbados National Registry for Chronic Non-communicable Diseases (BNR) to non-communicable disease (NCD) case registration, and to identify differences in cost for collecting and maintaining information on cancer and cardiovascular disease (CVD) case registration. Methods We used the modified Centers for Disease Control and Prevention’s International Registry Costing Tool to collect data from the CVD and cancer registries. We used cancer and CVD cost data for the annual period April 2014 through March 2015 to estimate the total cost and cost per case. We used prospectively collected average annual CVD cases, and for cancer cases we assumed 2 or 3 years are needed for retrospective data collection. Results The Ministry of Health provided 56% of the resources for the registries. Labor accounted for over 70% of both registries’ budgets, while management and administration, along with data collection and analysis, incurred the highest costs per case. Total variable cost activities related to data collection and analysis were higher for the CVD component (US$131,297) than the cancer component (US$58,917). The CVD cost per case (US$489) was in between the cancer 2-year (US$382) and the cancer 3-year (US$573) cost-per-case estimates. Conclusion These findings indicate that there are substantial fixed costs related to management and administration of NCD registries. All registries need management and administration support. When registries are combined, management and administration costs can be shared. We project that registries that can share fixed-cost infrastructure are likely to incur a lower total cost per case.