In a simulation-based analysis reported in The Lancet Oncology, Ward et al found that the scaling up of cancer treatment packages, imaging modalities, and quality of care to the levels found in high-income countries would markedly reduce cancer mortality in low- to middle-income countries, as well as yield a 12-fold increase in lifetime economic benefits per dollar invested in scale-up.
The study used a previously developed model of global cancer survival that estimated stage-specific cancer survival and life-years gained in 200 countries and territories among patients diagnosed with 1 of 11 cancers (esophageal, stomach, colon, rectal, anal, liver, pancreatic, lung, breast, cervical/uterine, and prostate cancers), representing 60% of all cancer diagnoses between 2020 and 2030. Estimated costs and health and economic benefits of scaling up treatment packages (chemotherapy, surgery, radiotherapy, and targeted therapy), imaging modalities (ultrasound, x-ray, computed tomography [CT], magnetic resonance imaging, positron-emission tomography, single-photon emission CT), and quality of care to the mean level of high-income countries were compared with no scale-up. Costs and benefits are in 2018 U.S. dollars, discounted at 3% annually.
For the 11 cancers included in the analysis, it was estimated that no scale-up would be associated with a global total of 76.0 million cancer deaths (95% uncertain interval [UI] = 73.9–78.6 million) among patients diagnosed between 2020 and 2030. More than 70% of these deaths would occur in low- to middle-income countries: 4.3 million (95% UI = 4.0–4.5 million) in low-income countries, 16.1 million (95% UI = 14.0–18.2 million) in lower middle-income countries, 34.3 million (95% UI =33.1–35.4) in upper middle-income countries, and 21.2 million (95% UI = 21.0–21.5 million) in high-income countries.
Comprehensive scale-up of treatment, imaging, and quality of care could avert 12.5% (95% UI = 9.0%–16.3%) of these deaths globally, including 38.2% (95% UI = 32.6%–44.5%) in low-income countries, 29.6% (95% UI = 17.0%–39.3%) in lower middle-income countries, 7.2% (95% UI = 4.1%–10.4%) in upper middle-income countries, and 2.8% (95% UI = 1.8%–4.3%) in high-income countries.
Imaging was found to be a critical part of scale-up, with proportion of cancer deaths averted declining from 12.5% to 7.0% (95% UI = 3.9%–10.3%) when only treatment and quality of care are scaled up.
It was estimated that comprehensive scale-up would cost an additional $232.9 billion (95% UI = $85.9–$422.0 billion) between 2020 and 2030—representing a 6.9% increase in current cancer treatment costs (ranging from 81% in low-income countries to approximately 5% to 6% in upper middle-income and high-income countries). The increase would be associated with $2.9 trillion (95% UI = $1.8–$4.0 trillion) in global economic gains over the lifetime of cancer survivors, yielding a return of $12.43 (95% UI = $6.47–$33.23) per dollar invested (range = $4 in high-income countries to > $50 in upper middle-income countries). Scaling up treatment and quality of care without imaging would yield a global return of $6.15 (95% UI =$2.66–$16.71) per dollar invested.
It was estimated that if comprehensive scale-up were to occur immediately in 2020, benefits would outweigh the costs within 4 to 5 years.
The investigators concluded, “Simultaneous investment in cancer treatment, imaging, and quality of care could yield substantial health and economic benefits, especially in low- to middle-income countries. These results provide a compelling rationale for the value of investing in the global scale-up of cancer care.”
Zachary J. Ward, PhD, of the Center for Health Decision Science, Harvard T.H. Chan School of Public Health, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the Harvard T.H. Chan School of Public Health and National Cancer Institute. For full disclosures of the study authors, visit thelancet.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.