The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Wellesley Institute, Toronto, Ontario, Canada.
Cancer. 2019 Jun 1;125(11):1918-1928. doi: 10.1002/cncr.32006. Epub 2019 Mar 6.
Perceptions of high cost and resource intensity remain political barriers to the prioritization of childhood cancer treatment programs in many low- and middle-income countries (LMICs). Little knowledge exists of the actual cost and cost-effectiveness of such programs. To improve outcomes for children with Burkitt lymphoma (BL), the most common childhood cancer in Africa, the Uganda Cancer Institute implemented a comprehensive BL treatment program in 2012. We undertook an economic evaluation of the program to ascertain the cost-effectiveness of BL therapy in a specific LIC setting.
We compared the treatment of BL to usual care in a cohort of 122 patients treated between 2012 and 2014. Costs included variable, fixed, and family costs. Our primary measure of effectiveness was overall survival (OS). Patient outcomes were determined through prospective capture and retrospective chart abstraction. The cost per disability-adjusted life-year (DALY) averted was calculated using the World Health Organization's Choosing Interventions That Are Cost-Effective (WHO-CHOICE) methodology.
The 2-year OS with treatment was 55% (95% CI, 45% to 64%). The cost per DALY averted in the treatment group was US$97 (Int$301). Cumulative estimate of national DALYs averted through treatment was 8607 years, and the total national annual cost of treatment was US$834,879 (Int$2,590,845). The cost of BL treatment fell well within WHO-CHOICE cost-effectiveness thresholds. The ratio of cost per DALY averted to per capita gross domestic product was 0.14, reflecting a very cost-effective intervention.
This study demonstrates that treating BL with locally tailored protocols is very cost-effective by international standards. Studies of this kind will furnish crucial evidence to help policymakers prioritize the allocation of LMIC health system resources among noncommunicable diseases, including childhood cancer.
在许多低收入和中等收入国家（LMICs），高成本和资源密集度的看法仍然是优先考虑儿童癌症治疗项目的政治障碍。对于这些项目的实际成本和成本效益知之甚少。为了改善非洲最常见的儿童癌症——伯基特淋巴瘤（BL）患儿的预后，乌干达癌症研究所于 2012 年实施了全面的 BL 治疗方案。我们对该方案进行了经济评估，以确定在特定的 LIC 环境中 BL 治疗的成本效益。
我们比较了 2012 年至 2014 年间治疗的 122 名患者的 BL 治疗与常规治疗。成本包括可变成本、固定成本和家庭成本。我们的主要疗效指标是总生存（OS）。通过前瞻性捕获和回顾性图表提取来确定患者的结局。通过使用世界卫生组织选择具有成本效益的干预措施（WHO-CHOICE）方法计算每避免一个残疾调整生命年（DALY）的成本。
治疗的 2 年 OS 为 55%（95%CI，45%至 64%）。治疗组每避免一个 DALY 的成本为 97 美元（Int$301）。通过治疗避免的全国 DALY 累积估计数为 8607 年，治疗的全国年度总成本为 834879 美元（Int$2590845）。BL 治疗的成本远低于 WHO-CHOICE 成本效益阈值。每避免一个 DALY 的成本与人均国内生产总值的比率为 0.14，表明这是一种非常具有成本效益的干预措施。
这项研究表明，按照国际标准，用本地定制的方案治疗 BL 非常具有成本效益。此类研究将为决策者提供至关重要的证据，以帮助他们在非传染性疾病（包括儿童癌症）中优先分配 LMIC 卫生系统资源。
