The cost-effectiveness of treating Childhood cancer in jimma medical Center

Abstract

Background: Establishing a childhood cancer treatment center is perceived as expensive by the decision-makers of LMICs. However, there is a paucity of knowledge on the actual cost and cost-effectiveness of pediatric cancer treatment in Ethiopia. Therefore, this study provides context-relevant evidence to guide priority setting in Ethiopia. Objective: To determine the cost-effectiveness of childhood cancer treatment in JMC, 2020/21. Methods: A Hospital-based; retrospective study design was employed. The case files/charts of children under the age of 15 who were admitted to the pediatric oncology ward in the year 2020/21 (2013 Ethiopian fiscal year) were reviewed. The cost analysis was conducted from the provider's perspective. The effectiveness was calculated based on the estimated 5 years of survival rates, using the output of the 1-year survival rate of Kaplan-Meir, and the life expectancy of the Ethiopian population. The effectiveness was determined by the DALY averted by the unit. The do-nothing was our comparator, and we assumed no cost (zero cost) will be incurred for the comparator. To account for sensitivity analyses, we varied the discount rate, 5-year survival rate and life expectancy, excess long-term morbidity, medical labor cost, and overhead costs. The collected data were analyzed using SPSS and MS-Excel. Results: In the unit 101 patients were treated. The total annual and average cost to give treatment to childhood cancer patients in JMC Jimma, Ethiopia was estimated at $279,648 and $2,7692 respectively. Among the major types of cancer in the treatment unit, the highest and the least annual average cost of treatment was Hodgkin's lymphoma ($6252) and Retinoblastoma ($1,520) for patients per year respectively. The incremental annual cost was the same as the annual cost of treatment because our comparator annual cost was assumed to be zero. Therefore, the incremental ICER which is a cost per DALY averted in the base case was $193, which is significantly less than Ethiopia’s GDP per capita ($936.3), thus meeting WHO-CHOICE criteria for being considered very cost- effective. In the sensitivity analyses, the results always remained very cost-effective. Conclusion: This study indicated that childhood cancer treatment is very cost-effective in Ethiopia as per WHO-CHOICE thresholds even in the highly conservative adjustment of assumptions. Therefore, to enhance and improve children's health in Ethiopia, childhood cancer should get a better concern in health priority settings because investing in this disease is very cost-effective