Lives and Economic Loss in Brazil due to Lack of Radiotherapy Access in Cervical Cancer: A Cost-Effectiveness Analysis

L C Mendez; F Y Moraes; M S Castilho; A V Louie; X M Qu

doi:10.1016/j.clon.2019.05.004

Lives and Economic Loss in Brazil due to Lack of Radiotherapy Access in Cervical Cancer: A Cost-Effectiveness Analysis

Clin Oncol (R Coll Radiol). 2019 Sep;31(9):e143-e148. doi: 10.1016/j.clon.2019.05.004. Epub 2019 May 31.

Authors

L C Mendez¹, F Y Moraes², M S Castilho³, A V Louie⁴, X M Qu⁵

Affiliations

¹ Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: lucas.mendez@lhsc.on.ca.
² Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
³ Division of Radiotherapy, Radiocare - Hospital Felicio Rocho, Belo Horizonte, Brazil.
⁴ Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁵ Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.

PMID: 31160129
DOI: 10.1016/j.clon.2019.05.004

Abstract

Aims: Among all malignancies, the use of radiotherapy incurs the highest survival benefit within cervical cancers. Radiotherapy, however, remains underutilised for cervical cancers within the Brazilian public health system (BPHS). The objective of this study was to estimate the potential health and monetary benefits for universal access to radiotherapy and chemoradiotherapy (CRT) for untreated cervical cancer patients in the BPHS.

Materials and methods: Using 2016 data on Brazilian cervical cancer incidence and availability of radiotherapy/CRT in the BPHS, the number of cancer deaths due to radiotherapy/CRT underutilisation was estimated. The incremental effectiveness was calculated by life-year gain. The indirect costs from mortality-related productivity loss (MRPL) were estimated based on life expectancy, wage and labour force participation rate. MRPL was compared with direct medical costs after being adjusted to 2016 US dollars. This study was conducted from the payer's perspective; both costs and effectiveness were discounted at a rate of 3%. The incremental cost-effectiveness ratio (ICER) was calculated to determine the cost-effectiveness of radiotherapy for cervical cancer in Brazil. One-way sensitivity analyses were carried out to assess the robustness of the model.

Results: The total number of life-years lost due to lack of universal access to radiotherapy and CRT per year were 27 199 and 31 627, respectively. The annual cost to match the radiotherapy gap was $10.5 million, with an additional cost of $3 million to close the CRT gap. The mean years of potential life lost per death was 20.5. The cost per life saved was $7942 for radiotherapy alone (ICER $388/life-year) and $8774 for CRT (ICER $429/life-year). MRPL due to shortage of radiotherapy and CRT were $59 million and $69 million, respectively.

Conclusion: Providing universal access to radiotherapy/CRT for cervical cancer patients in the BPHS is highly cost-effective and should be prioritised as an impactful public health initiative.

Keywords: Brazil; cervical cancer; cost-effectiveness analysis; radiotherapy access.

MeSH terms

Brazil
Chemoradiotherapy / methods*
Cost-Benefit Analysis / economics*
Female
Humans
Middle Aged
Uterine Cervical Neoplasms / economics*
Uterine Cervical Neoplasms / radiotherapy