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; Nepal
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 123,745.222 (thousands of U.S
$) for a population of 29,384,297 persons in Nepal.
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. 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. It is estimated that more than half of all
cancer cases and deaths worldwide are potentially preventable. In Nepal, the
number of new cancer cases is estimated to 19,943 with 15,543 deaths in 2015.
By 2025, incidence is expected to grow to 25,834 with 20,396 deaths. Rates of
cancers will continue to rise to 32,907 new cancer cases by 2035 with 26,586
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 Nepal, 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)
Gross
national product is gross domestic product (GDP) plus net income (employee
compensation and investment income) from abroad. GNI, per capita is GNI divided
by mid-year population. 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. Nepal population is estimated to 29,384,297 persons. Population
compares estimates from the US Bureau of the Census based on statistics from
population censuses, vital statistics registration systems, or sample surveys
pertaining to the recent past and on assumptions about future trends [16].
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.
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 [17]. 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 [19]. A benchmark of between 400 and 500 patients per
treatment unit per year has been used to calculate machine throughput in
several reports [20,21]. 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 [22]. 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.
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 (CIst) in 2015
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$) |
|||
Nepal |
IMF |
2,474 |
2016 |
2,498 |
29,384,297 |
19,943 |
WB |
2,520 |
2016 |
||||
CIA |
2,500 |
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 |
1.16596 |
58.298 |
1,713.045 |
Against
Tobacco |
250 |
1.16596 |
291.49 |
8,565.226 |
|
Against
Infections |
500 |
1.16596 |
582.98 |
17,130.453 |
|
Against
carcinogenic substances |
125 |
1.16596 |
145.745 |
4,282.613 |
|
Against
environmental risks |
125 |
1.16596 |
145.745 |
4,282.613 |
|
Diet
or nutrition promotion |
250 |
1.16596 |
291.49 |
8,565.226 |
|
Sport
promotion |
200 |
1.16596 |
233.192 |
6,852.181 |
|
Cancer
risk factors survey |
50 |
1.16596 |
58.298 |
1,713.045 |
|
Cancer early detection and secondary prevention. |
Breast
cancer screening |
150 |
1.16596 |
174.894 |
5,139.136 |
Cervical
cancer screening |
125 |
1.16596 |
145.745 |
4,282.613 |
|
Prostate
cancer screening |
50 |
1.16596 |
58.298 |
1,713.045 |
|
Colorectal cancer screening |
50 |
1.16596 |
58.298 |
1,713.045 |
|
Others
cancers screening |
50 |
1.16596 |
58.298 |
1,713.045 |
|
Cancer institutional reinforcement |
Rise
of cancer professional |
125 |
1.16596 |
145.745 |
4,282.613 |
Development
of cancer research |
175 |
1.16596 |
204.043 |
5,995.658 |
|
Development
of cancer prevention courses |
100 |
1.16596 |
116.596 |
3,426.090 |
|
Cancer diagnosis and treatment
|
Assistance
for Palliative Care |
150 |
1.16596 |
174.894 |
5,139.136 |
Chemotherapy
equipment |
100 |
1.16596 |
116.596 |
3,426.090 |
|
Surgical
equipment |
175 |
1.16596 |
204.043 |
5,995.658 |
|
Radiotherapy
equipment * |
2,500 |
9.59127 |
23,978.17 |
23,978.17 |
|
Prevention
and screening infrastructure
** |
400 |
9.59127 |
3,836.508 |
3,836.508 |
|
Total |
|
5,700 |
|
|
123,745.222 |
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 Nepal, 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 123,745.222 (thousands of U.S
$) for a population of 29,384,297 persons in Nepal, 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 nonprofit,
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.