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

Figures & data

Table 1 Variables and Sources Included in the Cost-Effectiveness Model

Base Case Variables	Values	Sources
Number of incidents per year	101	JMC pediatric oncology unit data
Discount rate	0.03	WHO-CHOICE^Citation22
Average Length of disability (in a year)	1	Assumed for the length of therapy
Disability weight during therapy	0.288	GBD^Citation5
The life expectancy of the Ethiopian population	58.71	Macro Trends (2020)^Citation20
Ethiopia’s GDP per capita	$936.30	The World Bank (2020)^Citation23
Mean age at diagnosis (in a year)	8	Calculated
The proportion of patients with 1-year survival	76.76	Calculated using Kaplan-Meier survival analysis using SPSS
The proportion of patients with 5-year survival	47.59	Assumed; authors’ best estimates using 1-year survival data, and the ratio of 5:1-year survival similar to Swaminathan^Citation21
Adjustments for sensitivity analysis Variables
Disability weight for a treated form of non-Hodgkin’s lymphoma (adjustment for utility)	0.06	GBD.^Citation19
Discount rate	0 and 0.06	WHO-CHOICE^Citation22
15% decrease in life expectancy	49.90	Calculated
30% decrease in the 5-year survival rate	41.09	Assumed
20% increase in annual Personnel and overhead costs	-	Assumed

Abbreviations: GBD Global burden of disease, JMC Jimma Medical Centre.

Table 2 Distribution of the Types of Cancer and Their Costs in Different Genders

Type of Cancer Diagnosis	Sex		Percentage of the Patients	Total Annual Cost
	Male	Female
Acute Lymphoblastic Leukemia (ALL)	23	19	41.6%	$101,069
Wilms tumor (WT)	5	8	12.8%	$43,761
Retinoblastoma (RB)	5	4	8.9%	$30,398
Hodgkin’s lymphomas (HL)	6	1	6.9%	$17,821
Non-Hodgkin’s lymphoma (NHL)	4	1	5%	$13,708
Rhabdomyosarcoma (RMS)	3	2	5%	$13,676
Osteosarcoma (OS)	2	3	5%	$10,232
Acute Myeloid Leukaemia (AML)	0	4	4%	$9235
Other*	7	4	10.9%	$39,748

Notes: *Neuroblastoma, Hepatoblastoma, Ewing’s sarcoma, Burkitt lymphoma, nasopharyngeal cell, Germ cell tumor, and Bladder Mass.

Table 3 The Annual Total Cost of Major Cost Categories in the JMC Pediatric Oncology Unit

Cost Centers	In USD ($)	Percentage
Medical personal cost	$109,305	39%
Total drug cost	$71,611	26%
Total building cost	$48,274	17%
Total overhead costs	$38,609	14%
Total diagnosis test	$8024	3%
Total equipment cost	$3489	0.9%
Total OR cost	$336	0.1%
Total cost per year	$279,648	100%
The average cost	$2769

Figure 1 The treatment unit cost per patient for each type of cancer.

Figure 2 One-year survival curve of childhood cancer patients in Jimma Medical Center pediatric oncology unit.

Table 4 One-Way and Multiway Sensitivity Analysis

	Scenarios for Sensitivity				Cost per DALY Averted
The Survival of Patients If They Did not Receive Treatment	Reduction in Life Expectancy	Utility Adjustment for Late Effect Morbidity	Reduction In Survival Rate	Increase in the Annual Cost of Personnel and Overhead	3%	0%	6%
1 month	0%	0.06	0%	0%	$218	$102	$365
1 month	15%	0.06	0%	0%	$235	$106	$409
1 month	30%	0.06	0%	0%	$262	$113	$469
6 month	0%	0.06	30%	0%	$447	$182	$829
1 year	0%	0.06	30%	20%	$494	$201	$916

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