Best buys for Africa: Improvements in Child Cancer Diagnostics and Treatment in Africa
In Africa, more than 50% of cases of childhood cancer go undiagnosed. Africa accounts for 146,000 of the projected 397,000 new cases globally per year (including both diagnosed and undiagnosed cases) (Ward et al, 2019a). Of the diagnosed cases, only 11.6% of children in Africa survive (Ward et al, 2019b). Based on the above modeling exercise, we estimate that only about one-third of those who are diagnosed actually receive treatment; no hard data are available. Increasing access to treatment will increase survival, although to reach survival rates comparable to high income countries, investments will also be needed to decrease treatment abandonment and improve quality of treatment (Ward et al, 2019b).We recommend investing to expand treatment of five key cancers that are both treatable and affordable. These five cancers together account for 40% of the burden of childhood cancer in Africa. Studies of cost per child treated in sub-Saharan Africa for three of the conditions (Burkitt lymphoma, nephroblastoma and early-stage retinoblastoma) were $1248, $1976 and $2202 USD respectively in various low- and lower-middle income countries in Africa. More conservatively, costs of a comprehensive cancer centre in one African country which achieved a projected 5-year survival rate of 35% for a cohort of children with multiple cancer types, were around $10,000 per child in 2018 USD, or around 6.5 times per capita GNI (see text below for all study references).
Benefit:cost ratios were estimated as 9.1 to 19.3 for the three diseases for which studies were available, and a more conservative 5.2:1 for a comprehensive centre which treats not only the priority diseases, but also provides treatment for other less-treatable conditions and palliative care to children for whom cure is not possible. Ratios would be a little lower (4.6:1) but still very attractive if indirect costs to families were included in treatment costs, and higher if non-profit organizations took the lead in small investments to reduce treatment abandonment rates, as has been done successfully in a number of low- and middle-income country (LMIC) contexts.
Expanding care from the estimated one-third of those diagnosed to all those currently diagnosed would cost $407m using the comprehensive cancer centre model. This amount would double, if 90% coverage of were attained (i.e. if 80% of all undiagnosed children could be diagnosed and linked to treatment). The value of the benefits would however be an estimated 5.2 times the costs, or $2116m. There are other potential unquantifiable benefits, such as helping to show that cancer is indeed curable and helping reduce the stigma associated with cancer in Africa, potentially leading adults with cancer to seek care earlier and improve their survival. In addition, improving capabilities to treat childhood cancers has the potential to strengthen health systems more broadly, by developing radiologic and pathologic services, medicines procurement and supply management, surgical facilities, health human resource training and retention, and supportive care capacities.