The cost effectiveness of treating paediatric cancer in low-income and middle-income countries: a case-study approach using acute lymphocytic leukaemia in Brazil and Burkitt lymphoma in Malawi

Abstract

Approximately 90% of children with cancer reside in low-income and middle-income countries (LMIC) where healthcare resources are scarce and allocation decisions difficult. The cost effectiveness of treating childhood cancers in these settings is unknown. The objective of the present work was to determine cost-effectiveness thresholds for common paediatric cancers using acute lymphoblastic leukaemia (ALL) in Brazil and Burkitt lymphoma (BL) in Malawi as examples. Disability-adjusted life years (DALYs) prevented by treatment were compared to the gross domestic product (GDP) per capita of each country to define cost-effectiveness thresholds using WHO-CHOICE ('CHOosing Interventions that are Cost-Effective') guidelines. The case examples were selected due to the data available and because ALL and BL both have the potential to yield significant health gains at a low cost per patient treated. The key findings were as follows: the 3:1 cost/DALY prevented to GDP/capita ratio for ALL in Brazil was US $771,225; expenditures below this threshold were cost effective. Costs below US $257,075 (1:1 ratio) were considered very cost effective. Analogous thresholds for BL in Malawi were US $42,729 and US $14,243. Actual costs were far less. In Brazil, US $16,700 was spent to treat each patient while in Malawi total drug costs were less than US $50 per child. In summary, treatment of certain paediatric cancers in LMIC is very cost effective. Future research should evaluate actual treatment and infrastructure expenditures to help guide policymakers.

Barriers to Cure for Children with Cancer in India and Strategies to Improve Outcomes: A Report by the Indian Pediatric Hematology Oncology Group

“…The first such study MCP841 was done under aegis of the International Network for Cancer Treatment and Research (INCTR). It showed improvement in cure for ALL to 40-60% [16]. Most centers follow individual protocols and abandonment is censored.…”

“…In LMIC, such frontline therapy must include psychosocial support for those who need it. Furthermore, treatment of curable childhood cancers is highly cost-effective, even in LMIC [16]. Another interesting observation in a recent study highlighted that true abandonment rates might be lower as almost half the patients who abandoned therapy when contacted by phone/mail were taking treatment at some other center in India [12].…”

Pediatric Oncology as the Next Global Child Health Priority: The Need for National Childhood Cancer Strategies in Low- and Middle-Income Countries

“…About half of children with Burkitt lymphoma, the most common childhood malignancy in parts of sub-Saharan Africa, are curable with three to six doses of single-agent cyclophosphamide, demonstrating the achievements possible in even the most resource-limited settings [11]. Preliminary evidence suggests that such treatment is very cost effective [12].…”

Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries

“…[7] Abbreviations: AGHE, annual government health expenditure; EML, model list of essential medicines; GAVI, global alliance for vaccines and immunizations; GHO, global health observatory; GNI, gross national income; HIC, high income country; LIC, low income country; LMIC, lower middle income country; NCD, The high price of some drugs for the treatment of cancer is a complex challenge, [8] and all-too-often is a major obstacle to the provision of appropriate care for children with cancer in low and middle income countries. [9] Yet treatment in these circumstances is demonstrably very cost-effective. [10] Indeed the Institute of Medicine in the USA has identified the treatment of highly curable cancers in young people as one of the three main strategies to address the global cancer crisis.…”