Article Type : Research Article
Authors : Seydou Mbaye EH
Keywords : Cancer program; Cancer control; Prevention; Early detection; Institutional reinforcement; Diagnosis; Treatment; Low and Middle-Income countries; Namibia
Worldwide, one in
eight deaths is due to cancer. Projections based on the GLOBOCAN 2012 estimates
predict a substantive increase new cancer cases per year by 2035 in developing
countries if preventive measures are not widely applied. According to the World
Health Organization (WHO), millions of lives could be saved each year if
countries made use of existing knowledge and the best cost-effective methods to
prevent and treat cancer. Therefore, the aim of this study is to estimate a
provisional budget against cancer in low and middle incomes countries,
according the GNI-PPP, the cancer incidence and the number of population.
Economically country classification is determining with the Gross national
income (GNI), per capita, Purchasing power parity (PPP), according the
administrations of the International Monetary Fund (IMF), the World Bank (WB)
and the Central Intelligence Agency (CIA). Cancer incidence data presented are
based on the most recent data available at IARC. However, population compares
estimates from the US Bureau of the Census. The provisional budget is establishing
among the guidelines developed by WHO for regional and national cancer control
programs according to national economic development. Provisional budget against
cancer is estimated to 39,406.012 (thousands of U.S $) for a population of
2,484,780 persons in Namibia.
Worldwide, one in eight deaths is due to cancer.
Cancer causes more deaths than AIDS, tuberculosis, and malaria combined [1].
When countries are grouped according to economic development, cancer is the
leading cause of death in developed countries and the second leading cause of
death in developing countries [2]. Rates of cancers common in Western countries
will continue to rise in developing countries if preventive measures are not
widely applied [3-5]. Projections based on the GLOBOCAN 2012 estimates predict
a substantive increase to 19.3 million new cancer cases per year by 2025, due
to growth and ageing of the global population. Incidence has been increasing in
most regions of the world, but there are huge inequalities between rich and
poor countries. More than half of all cancers (56.8%) and cancer deaths (64.9%)
in 2012 occurred in less developed regions of the world, and these proportions
will increase further by 2025 [6]. By 2030, the global burden is expected to
grow to 21.4 million new cancer cases and 13.2 million cancer deaths [7]. Rates
of cancers will continue to rise by 2035 with 23,980,858 new cancer cases
[3-5]. In addition to the human toll of cancer, the financial cost of cancer is
substantial [8-10]. Cancer has the most devastating economic impact of any
cause of death in the world [10]. Data limitations do not allow estimating the
worldwide economic costs of cancer. However, portions of the total costs of
cancer have been estimated to be as high as $895 billion (US) worldwide [9,10].
It is estimated that more than half of all cancer cases and deaths worldwide
are potentially preventable [3-5]. In Namibia, the number of new cancer cases
is estimated to 1,338 with 789 deaths in 2015. By 2025, incidence is expected
to grow to 1,795 with 1,068 deaths. Rates of cancers will continue to rise to
2,414 new cancer cases by 2035 with 1,470 deaths if preventive measures are not
widely applied. According to the World Health Organization (WHO); Entitled:
National Cancer Control Programs: Policies and Managerial Guidelines, millions
of lives could be saved each year if countries made use of existing knowledge
and the best cost-effective methods to prevent and treat cancer [11]. “An
urgent need in cancer control today is to develop effective and affordable approaches
to the early detection, diagnosis, and treatment of breast cancer among women
living in less developed countries,” explains Dr Christopher Wild, Director of
IARC. “It is critical to bring morbidity and mortality in line with progress
made in recent years in more developed parts of the world”. With the data
highlighting a large variability of GNI/capita even within similar income
levels in the various world regions, it is expected that additional investment
in resources and costs may be more dependent on income level of the country
than on the GNI group or the geographic region of the world [12]. Therefore,
the aim of this study is to estimate a provisional budget against cancer in
Namibia, according the GNI-PPP, the cancer incidence and the number of
population.
Economically
country classification
The economics states
are established among the means of GNI-PPP according the administrations of the
International Monetary Fund (IMF); the World Bank (WB) and the Central
Intelligence Agency (CIA) [13-15]. The difference concerning the same country
can be considerable among the data origin. These variations are explaining by:
·
GNI-PPP
is estimated
·
Anterior
projection of an economic crisis changes GNI-PPP data
·
The
estimation of the population included in the local population
·
The
choice elements for GNI-PPP evaluation have some subjective part.
These data must be
taken with precaution
Economically Country is
divided according to the gross national income (GNI) per capita 2016, Atlas
method and PPP [15].
·
Estimated
to be low income ($1,005 or less)
·
Estimated
to be lower middle income ($1,006 to $3,995)
·
Estimated
to be upper middle income ($3,956 to $12,235)
·
Estimated
to be high income ($12,236 or more).
Gross
national income (GNI), Per capita, Purchasing power parity (PPP)
PPP is purchasing power
parity; an international dollar has the same purchasing power over GNI as a
U.S. dollar has in the United States. PPP exchange rates are used to account
for the local prices of goods and services not traded internationally. However,
PPP is used to compare across national accounts, not for making international
poverty comparisons [15].
Cancer
incidence
Incidence is the number
of new cases that occurs during a given period of time in a specified
population. It can be expressed as an absolute number of cases per year or as a
rate per 100,000 persons per year. The rate provides an approximation of the
average risk of developing a cancer. Cancer incidence data presented are based
on the most recent data available at IARC. GLOBOCAN 2012 provides a global
profile of cancer that has been developed using a number of methods that are
dependent on the availability and the accuracy of the data. National sources
are used where possible, with local data and statistical modeling used in their
absence.
Population
Standard population
(POPst) is determining to Senegal population (Western Africa) with 14,668,522
persons. Namibia population is estimated to 2,484,780 persons. Population
estimates for this country explicitly take into account the effects of excess
mortality due to AIDS; this can result in lower life expectancy, higher infant
mortality, higher death rates, lower population growth rates, and changes in
the distribution of population by age and sex than would otherwise be expected.
Population compares estimates from the US Bureau of the Census [16]. Based on
statistics from population censuses, vital statistics registration systems, or
sample surveys pertaining to the recent past and on assumptions about future
trends.
Provisional
budget (thousands of U.S $)
The World Health
Organization (WHO) emphasizes that, when developing national strategies for
controlling cancer, countries should consider the following four broad
approaches based on their economic development:
·
The
primary prevention
·
The
early detection and secondary prevention
·
The
diagnosis and treatment
·
The
palliative care.
The provisional budget
is establishing among the guidelines developed by WHO for regional and national
cancer control programs according to national economic development. However, an
International Atomic Energy Agency Report suggested that in developing
countries at least 60% of cancer patients require radiation treatment [17].
Radiotherapy is one of the main components of modern cancer treatment and requires
substantial capital investment, trained professionals in several disciplines,
high precision equipment and a particular external and internal organizational
structure. In High Incomes Countries, the healthcare costs can be as much as
8.4% (UK in 2007) to 18% (USA in 2009) of a country’s gross domestic product
[18]. Cancer consumes about 5-10% of the global healthcare budget, of which
radiotherapy only consumes about 5%; thus, more than 50% of cancer patients
requiring radiotherapy in low and middle-income countries lack access to
treatment. A benchmark of between 400 and 500 patients per treatment unit per
year has been used to calculate machine throughput in several reports. The
benchmark of 450 patients per machine, which corresponds to about 8 operating
hours per day, seems adequate for High Incomes Countries. For scenarios where
radiotherapy demand is not satisfied, a treatment day of 10 h optimizes the
utilization of equipment and decreases the number of machines needed. But, the
range of needs currently covered varies from 0% and 3-4% in Low Incomes
Countries in Latin America and Africa up to 59-79% in Up-Middle Incomes
Countries in Europe-Central and Asia. However, in this study, in order to found
the best cost-effective methods to prevent and treat cancer, the number of
machines needs is establishing among 3 millions of peoples and not by the
number of cancer cases, according to the weakness of the countries incomes
[19,20].
Standard
budget for 5 years (S0)
Standard budget for 5
years (S0) is estimated using a population of 1,000,000 persons in
Senegal (POPst). Senegal has 8361 new cancer cases with a means GNI-PPPst of
US$ 2,551 referred to the year 2016 (low middle income country), according the
administrations of the International Monetary Fund (IMF); the World Bank (WB)
and the Central Intelligence Agency (CIA). Estimation budget is taken into
account the weakness of the countries incomes.
Standardized
rapport (R0)
Standardized rapport (R0),
among the GNI-PPP, CI and the number of the population, is calculated.
Standardization simplifies comparisons of GNI-PPP and cancer incidence rates
among populations.
Note:
For Radiotherapy equipment, R0 = GNI-PPP X POP / GNI-PPPst X 3 million peoples;
Senegal has installed two new radiotherapy machines in 2017. Radiotherapy
equipment is estimated to US$ 2,500,000.
For Prevention and
screening infrastructure, R0 =GNI-PPPX POP / GNI-PPPst X 3 million peoples.
·
R0=
Standardized rapport among the GNI-PPP, CI and the number of the population
·
GNI-PPPst=
Standard Gross National Income Per capita Purchasing Power Parity in Senegal
·
GNI-PPP=
Gross National Income Per capita Purchasing Power Parity of interest
·
CIst=
Standard Cancer Incidence in Senegal
·
CI=
Cancer Incidence of interest
·
POPst=
Standard Population in Senegal
POP= Population of interest
Table 1: GNI-PPP, Cancer incidence (CI) and the number of the Population.
Country |
GNI per capita Purchasing power parity (PPP) |
Population |
Cancer incidence (CI) |
|||
Ref. |
US$ |
Year |
Means of GNI-PPP (US$) |
|||
Namibia |
IMF |
11,903 |
2016 |
11,201
|
2,484,780 |
1,338 |
WB |
10,400 |
2016 |
||||
CIA |
11,300 |
2016 |
||||
IMF= International Monetary Fund; WB= World Bank; CIA= Central Intelligence Agency; GNI= Gross National Income; PPP=
Purchasing Power Parity; Ref=
Reference. |
Cancer Control |
Management |
Stand.
budget (S0) |
Stand. rapport
(R0) |
Account
per (R0) |
General
POP. budget |
Cancer primary prevention |
Development
of an information system |
50 |
4.14803 |
207.401 |
515.347 |
Against
Tobacco |
250 |
4.14803 |
1,037.007 |
2,576.735 |
|
Against
Infections |
500 |
4.14803 |
2,074.015 |
5,153.470 |
|
Against
carcinogenic substances |
125 |
4.14803 |
518.503 |
1,288.367 |
|
Against
environmental risks |
125 |
4.14803 |
518.503 |
1,288.367 |
|
Diet
or nutrition promotion |
250 |
4.14803 |
1,037.007 |
2,576.735 |
|
Sport
promotion |
200 |
4.14803 |
829.606 |
2,061.388 |
|
Cancer
risk factors survey |
50 |
4.14803 |
207.401 |
515.347 |
|
Cancer early detection and secondary prevention. |
Breast
cancer screening |
150 |
4.14803 |
622.204 |
1,546.041 |
Cervical
cancer screening |
125 |
4.14803 |
518.503 |
1,288.367 |
|
Prostate
cancer screening |
50 |
4.14803 |
207.401 |
515.347 |
|
Colorectal cancer screening |
50 |
4.14803 |
207.401 |
515.347 |
|
Others
cancers screening |
50 |
4.14803 |
207.401 |
515.347 |
|
Cancer institutional reinforcement |
Rise
of cancer professional |
125 |
4.14803 |
518.503 |
1,288.367 |
Development
of cancer research |
175 |
4.14803 |
725.905 |
1,803.714 |
|
Development
of cancer prevention courses |
100 |
4.14803 |
414.803 |
1,030.694 |
|
Cancer diagnosis and treatment
|
Assistance
for Palliative Care |
150 |
4.14803 |
622.204 |
1,546.041 |
Chemotherapy
equipment |
100 |
4.14803 |
414.803 |
1,030.694 |
|
Surgical
equipment |
175 |
4.14803 |
725.905 |
1,803.714 |
|
Radiotherapy
equipment * |
2,500 |
3.63675 |
9,091.875 |
9,091.875 |
|
Prevention
and screening infrastructure
** |
400 |
3.63675 |
1,454.7 |
1,454.7 |
|
Total |
|
5,700 |
|
|
39,406.012 |
Based on: World Health Organization. The National Cancer Control Programmes: policies and managerial
guidelines. 2nd ed. Geneva, 2002. |
|||||
S0= Standard budget for 5 years for a
population of 1,000,000 persons; R0= Standardized rapport among
the GNI-PPP, CI and the number of the population; *
Radiotherapy equipment among only GNI-PPP /GNI-PPPst
for each 3 million peoples; ** Prevention and screening
infrastructure among only GNI-PPP /GNI-PPPst,
for each 3 million peoples. |
Cancer has the most
devastating economic impact of any cause of death in the world. Incidence has
been increasing in most regions of the world, but there are huge inequalities
between rich and poor countries. Projections based on the GLOBOCAN 2012 estimates
predict a substantive increase to millions new cancer cases per year by 2030.
Rates of cancers will continue to rise by 2035 in Namibia, if preventive
measures are not widely applied. An urgent need in cancer control today is to
develop effective and affordable approaches. It is expected that additional
investment in resources and costs may be more dependent on income level of the
country than on the GNI group or the geographic region of the world. However,
in order to found the best cost-effective methods to prevent and treat cancer,
provisional budget against cancer is estimated to 39,406.012 (thousands of U.S
$) for a population of 2,484,780 persons in Namibia, according the GNI-PPP, the
cancer incidence and the number of population. It is very important for all
organizations to be aware of the complexity of cancer control. A flexible
approach is needed. This account must be added to the actual supply efforts of
cancer prevention and treatment. However, effective measures to reduce cancer
morbidity and mortality require the active participation of cancer survivors
and their local communities; the mobilization and appropriate allocation of
resources; the formulation of evidence-based policies and proven interventions;
and the commitment of organizations and institutions in the non-profit,
for-profit, and governmental sectors. Ultimately, cancer control goes hand in
hand with efforts to promote human and economic development and to improve
standards of health, education, and medical care throughout the world.