Treating Burkitt's lymphoma in Kampala

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Published: 21 Nov 2017
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Dr Avram Denburg - University of Toronto Toronto, Canada

Dr Denburg speaks with ecancer at AORTIC 2017 about a trial to assess cost-effectiveness of treating Burkitt's lymphoma, a common childhood cancer, in Uganda.

He sets out the measures used to assess cost-effectiveness, noting the difference between that and affordability, and reports that interventions were found to be very cost effective.

This was a cost effectiveness study that we conducted with colleagues at the Uganda Cancer Institute in Kampala and colleagues from Fred Hutchinson Cancer Research Centre in Seattle. They had developed a very robust and detailed Burkitt lymphoma treatment programme in Uganda to treat one of the most common prevalent childhood cancers in the region. We undertook to do a costing study to demonstrate the degree to which that treatment programme was cost effective or not, to help inform decision making at the policy level nationally around whether to prioritise treatment of this cancer, to provide financing for it and whether it’s sustainable in the context of their health system.

So what criteria did you use?

We used internationally accepted thresholds for cost effectiveness published by the WHO called the WHO Choice Methodology. These take into account relative GDP in a country as compared to others to assess what is cost effective. So something that has a 3:1 ratio of the cost per disability life year averted to per capita GDP is considered cost effective and that with a 1:1 ratio is considered very cost effective. Now, I should stress that these don’t speak specifically to affordability in a given health system context but they give some measure of being able to adjudicate relative cost effectiveness as compared to other interventions internationally.

So what did you find?

We found, perhaps unsurprisingly for those in the paediatric cancer world but surprisingly for those outside of it, that it was a very cost effective intervention. So the cost per DLY averted for the full treatment programme was $88 and that’s largely because these children can be cured of their disease and live long, healthy fruitful lives as a result which is in sharp contradistinction to many adult cancers. So from that point of view it’s arguably a very wise and effective health system intervention and should be prioritised as a result but, again, needs to be considered in the context of competing priorities.

I should say this is, to our knowledge, the first study that actually took a micro-costing approach to doing cost effectiveness analysis. What that means is we prospectively tracked patient outcomes and had detailed data at the patient level on both outcomes of treatment and the costs associated with that treatment. So very little modelling went into the analysis, it was actually prospective clinical data.