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Cost-effectiveness of running a paediatric oncology unit in Ethiopia
Mizan Kiros1, Solomon Tessema Memirie2,3, Mieraf Taddesse Taddesse Tolla2
1Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway mizukiros@gmail.com.
Insights
Establishing a pediatric oncology unit in Ethiopia is cost-effective for treating childhood cancers, offering significant health gains. This finding supports revising national health service priorities to include better childhood cancer care.
Area of Science:
- Health Economics
- Paediatric Oncology
- Public Health Policy
Background:
- Childhood cancer treatment is a low-medium priority in Ethiopia's Essential Health Service Package.
- Estimating the cost-effectiveness of specialized paediatric oncology care is crucial for policy revision.
Purpose of the Study:
- To assess the cost-effectiveness of a paediatric oncology unit in Ethiopia.
- To inform the revision of the Ethiopia Essential Health Service Package (EEHSP) regarding childhood cancer treatment.
Main Methods:
- A decision tree model was used from a healthcare provider perspective.
- Costing data from Tikur Anbessa Specialized Hospital (TASH) and disability-adjusted life years (DALYs) averted from other studies were utilized.
- Sensitivity analyses were performed to test uncertainty, with a willingness-to-pay threshold of USD 477.
Main Results:
- The incremental cost-effectiveness ratio (ICER) was USD 361 per DALY averted.
- Running a paediatric oncology unit was found to be cost-effective in 90% of simulations.
- The incremental cost per child treated was USD 876, with 2.4 DALYs averted.
Conclusions:
- Paediatric cancer services in specialized units are likely cost-effective in Ethiopia.
- This is particularly true for treatable cancers in centers with moderate capabilities.
- Reassessing the priority of childhood cancer treatment in the EEHSP is recommended.
Objective:
To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority.
Methods:
We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses.
Results:
The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold.
Conclusions:
The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
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