I’m presenting about estimating the cost of cancer care in a low-resource setting and I’m using a time-driven activity-based costing approach to estimate the cost in a low-resource setting. I’ve taken Nepal as a case example.

What was the study design?

In this study we have tried to estimate the cost by using the TDABC approach. So from the name you can understand that it is a time-driven activity-based costing, so basically in this approach we take two things into consideration. The first thing is the process map for the services utilised in the process for different cancers and then we estimate the resources used. For example, we estimate the cost of providing cancer care like the human resource perspective and also the cost of equipment, the cost of infrastructure and the cost of indirect costs.

What were the results?

The major outcome of this study is that we will be able to obtain unit costs of providing cancer interventions for different types of cancers. So, basically, the process that we employed is the UHC Compendium package proposed by the World Health Organisation. From this UHC Compendium we get different interventions for different types of cancers. From that we calculate the resources used for providing each of these interventions.

Basically, when we obtain this unit cost we’ll be able to utilise this information as an input for cost effectiveness analysis which is also another objective of this study.

What is the significance of these results and how could they be applied to guidelines to enhance cancer care in LMICs?

Before going into the major results of this study, or the major outcomes of this study, let me tell you one thing, is that we are trying to utilise FairChoices, a modelling tool developed by the University of Bergen and which has been recognised by the WHO for designing health benefit packages for different interventions, including cancer.

So the major outcome would be the unit cost for providing cancer care which, although the study is based in Nepal, this could be a reference for other low- and middle-income countries so that the policy makers, the decision makers, can allocate the resources, they can allocate what resources are required for delivering cancer care. Moreover, it also helps in the estimations of resources required for providing cancer care and also it can be used as evidence to inform scaling up of cancer services in different parts of the country.

Is there anything else you would like to add?

Regarding this topic, this approach, the TDABC approach, is a very useful approach because it closely estimates the cost of cancer care; it tracks the patient’s journey of taking services in a hospital setting. So the importance is that it closely estimates the cost of cancer care.

Moreover, the other importance of this particular method is that it gives you rich evidence of data which can be utilised for allocating the scarce resources that the resource-constrained settings have. So it’s basically a tool to empower the cancer stakeholders to allocate the resources and also to negotiate with the decision makers about this much of resources are required.

The other thing is that it also gives you information about the health system insufficiencies. For example, there might be long waiting lines, there might be underutilised equipment and there might be other things where resources can be reallocated to different care processes. So basically it’s also about improving health system efficiencies which can, again, save resources which can be utilised to provide cost-effective cancer services.