The cost effectiveness of treating Burkitt lymphoma in Uganda

Avram E Denburg; Nazeefah Laher; Innocent Mutyaba; Suzanne McGoldrick; Joyce Kambugu; Erica Sessle; Jackson Orem; Corey Casper

doi:10.1002/cncr.32006

The cost effectiveness of treating Burkitt lymphoma in Uganda

Cancer. 2019 Jun 1;125(11):1918-1928. doi: 10.1002/cncr.32006. Epub 2019 Mar 6.

Authors

Avram E Denburg¹, Nazeefah Laher^{1

2}, Innocent Mutyaba^{3

4}, Suzanne McGoldrick⁴, Joyce Kambugu³, Erica Sessle⁵, Jackson Orem^{3

4}, Corey Casper^{4

6}

Affiliations

¹ The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Wellesley Institute, Toronto, Ontario, Canada.
³ Uganda Cancer Institute, Makerere University, Kampala, Uganda.
⁴ Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, Seattle, Washington.
⁵ PATH, Seattle, Washington.
⁶ Infectious Disease Research Institute, University of Washington School of Medicine, Seattle, Washington.

PMID: 30840316
DOI: 10.1002/cncr.32006

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: childhood cancer; cost effectiveness; global health; health policy; lymphoma.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Agents / economics
Antineoplastic Agents / therapeutic use*
Burkitt Lymphoma / drug therapy*
Burkitt Lymphoma / economics*
Child
Cost-Benefit Analysis
Female
Humans
Male
Prospective Studies
Quality-Adjusted Life Years
Retrospective Studies
Survival Analysis
Treatment Outcome
Uganda

Substances

Antineoplastic Agents