Cost and Cost-Effectiveness of Treating Childhood Cancer at Jimma Medical Center

Abstract

Background

More than 70% of childhood cancer patients die in Sub-Saharan African countries due to a lack of access. Additionally establishing a childhood cancer treatment service is perceived as expensive by the decision-makers of LMICs. However, there is a paucity of evidence on the actual cost and cost-effectiveness of this service in LMICs including Ethiopia. This study provides context-relevant evidence to consider childhood cancer treatment in the healthcare priority settings in Ethiopia and other LMICs.

Methods

Newly admitted case files of children for the year 2020/21 were reviewed. The cost was analyzed from the provider’s perspective. The effectiveness was calculated using DALY averted based on the 5 years of survival rates, which is estimated from the 1-year survival rate of Kaplan–Meier output. The do-nothing was our comparator, and we assumed no cost (zero cost) will be incurred for the comparator. To account for sensitivity analyses, we varied the discount rate, 5-year survival rate, and life expectancy.

Results

During the study period, 101 children were treated in the unit. The total annual and unit cost to give treatment to childhood cancer patients was estimated at $279,648 and $2769, respectively. The highest per-patient annual unit cost of treatment was Hodgkin’s lymphoma ($6252), while Retinoblastoma ($1520) was the least. The cost per DALY averted was $193, which is significantly less than Ethiopia’s GDP per capita ($936.3). The results remained very cost-effective in sensitivity analyses.

Conclusion

Childhood cancer treatment is very cost-effective in Ethiopia as per WHO-CHOICE thresholds even in a conservative adjustment of assumptions. Therefore, to enhance and improve children’s health, childhood cancer should get a better concern in health priority.

Keywords:

• unit cost
• cost-effectiveness
• childhood cancer
• Ethiopia

Ethical Consideration

Ethical clearance was secured by Jimma University Institutional Review Board (IRB). Thereafter, permission was sought from the Head of the Oncology unit, to use the dataset about the study participants for research purposes only. The authors declare that the procedures were followed according to the regulations to the Helsinki Declaration of the World Medical Association.

Acknowledgments

We would like to thank JMCPOU and its healthcare professionals for providing all the necessary information about the staff composition and their time and dedication to the center. We acknowledge the cooperating Jimma Medical Center administrative staff for giving cost information. We would also like to extend our thanks to Jimma University, the Institute of Health, School of Post Graduate Director for providing financial support to carry out this research.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors have no conflicts of interest to disclose except Dr Diriba Fufa who is a Head of the pediatric oncology unit at Jimma Medical Centre, and also a Chair, at Jimma University, Health Institute Staff Council.