The cost effectiveness of treating paediatric cancer in South Africa: a review of treatment cost for Burkitt Lymphoma

Kay, Chane (2016-12)

Thesis (MMed)--Stellenbosch University, 2016.

Thesis

ENGLISH SUMMARY: Background In middle and low income countries, childhood cancer is rare when compared to trauma and infectious diseases. There is a paucity of literature regarding the cost and cost-effectiveness of treatment for paediatric cancers to guide decisions on resource allocation. Burkitt Lymphoma (BL) is a fairly common paediatric cancer in South-Africa. Optimal treatment and supportive care of BL translates in high cure rates. Study aim To determine the cost to avert 1 Disability Adjusted Life Year (DALY) in treating children with Burkitt Lymphoma in Tygerberg Children’s Hospital and whether this meets the WHO-CHOICE threshold of cost-effectiveness. Methodology The study is a retrospective, longitudinal descriptive audit and cost-effectiveness analysis. Data was collected from all available records at Tygerberg Children’s Hospital and total direct cost for treatment and follow up was calculated. Using the WHO’s ‘Choosing Interventions that are Cost-Effective’ guidelines, the disability adjusted years of life lost averted by treatment were calculated and divided by the total cost of treatment. The result was compared to the South-African Gross Domestic Product (GDP) per capita. Results Ten patients treated for Burkitt Lymphoma between 2005 and 2010 were included in the study. The average direct cost was US$12829 per patient. A trend was found for treatment of late stage disease to be more expensive than early stage disease, as well as a less favourable prognosis of late stage disease, as expected. A trend was also noted for the treatment of HIV infected children with Burkitt Lymphoma to fall well within the very cost-effective threshold. Cost related to general supportive care, was by far the largest contributing factor with hospitalisation contributing 49% of the total cost. The average cost to avert 1 DALY, was US$610.52, thus the average ratio to GDP per capita was 0.1:1, which indicates that the treatment of BL in South-Africa is well within the limits of being very cost effective (1:1). Conclusion The treatment of children with Burkitt Lymphoma in Tygerberg Children’s Hospital, South Africa is very cost effective, as it is well below the WHO-CHOICE threshold of very cost-effectiveness. It is also very cost-effective to treat children with Burkitt Lymphoma who present with advanced disease as well as children with associated HIV infection. Cost constraints should therefore not be a limitation to treating children with Burkitt Lymphoma, even if they present with advanced stage disease or HIV infection. Similar cost-effective studies in another type of paediatric cancer, private health sector or low-income countries, should be done to verify that the treatment of childhood cancers is very cost-effective.

AFRIKAANSE OPSOMMING: Inleiding In lande met middel tot laer inkomste is die aantal pediatriese kankergevalle skaars in vergelyking met trauma en infeksie-siektes. Daar is ‘n gebrek aan inligting in die literatuur oor die koste en koste-effektiwiteit van pediatriese kankerbehandeling, wat kan help met besluitneming oor die rasionele besteding van bronne. Burkitt Limfoom (BL) is ‘n redelik algemene pediatriese kanker in Suid-Afrika. Optimale behandeling en ondersteunende sorg van kinders met BL lei tot hoë genesingsyfers. Studie mikpunte Berekening van die koste om die verlies van een Ongeskiktheids-Aangepaste Lewensjaar (DALY) te voorkom deur die behandeling van kinders met BL in Tygerberg Kinderhospitaal en te bepaal of dit onder die drempel van koste-effektiwiteit val. Metodes Die studie is ‘n longitudinale, beskrywende oudit en koste-effektiwiteits analise. Data is ingesamel uit alle moontlike rekords van Tygerberg Kinderhospitaal en die totale direkte koste van behandeling en opvolg is bereken. Deur die Wêreld Gesondheids Organisasie se ‘Choosing Interventions that are Cost-Effective’ riglyne te gebruik, is die verlies aan ongeskiktheids-aangepaste lewensjare wat voorkom is deur behandeling bereken en gedeel deur die totale koste van behandeling. Die resultaat is dan vergelyk met die Suid-Afrikaanse bruto binnelandse produk per kapita. Resultate Tien pasiënte wat behandel is vir BL tussen 2005 en 2010 is ingesluit in die studie. Die gemiddelde direkte koste was US$12829 per pasiënt. ‘n Neiging is gevind dat die behandeling van vroeë stadium siekte minder koste beloop as laat stadium siekte, sowel as ‘n swakker prognose geassosieer met laat stadium siekte, soos verwag. Die onkoste van algemene ondersteunende sorg, was by verre die grootste bydraende faktor en hospitalisasie alleen het 49% van die totale koste beloop. Die gemiddelde koste om 1 DALY te voorkom, was US$610.52 en die gemiddelde verhouding tot Bruto Binnelandse Produk was 0.1:1, wat aandui dat die behandeling van BL in Suid-Afirka gemaklik onder die bo-grens van hoë koste-effektiwiteit, wat 1:1 beloop, val. Gevolgtrekkings Die behandeling van Burkitt Limfoom in Tygerberg Kinderhospitaal, Suid-Afrika is hoogs koste-effektief, omdat dit ver onder die WGO-CHOICE riglyne se drempel van koste-effektiwiteit val. Dit bly ook koste-effektief, ongeag gevorderde stadium van siekte by presentering of ‘n positiewe HIV-status. Koste beperkings behoort dus nie behandeling van kinders met Burkitt Limfoom te ondermyn nie, al presenteer hulle met laat-stadium siekte of ‘n positiewe HIV-status. Soortgelyke studies wat koste-effektiwiteit analiseer, behoort uitgevoer te word in ander tipes pediatriese kankers, die privaat sektor en in lande met lae-inkomste om te bevestig dat behandeling van kinders met kanker koste-effektief is.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100407
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