The economic case for investing in cancer control
Authors: Rifat Atun, Sue Horton, Hellen Gelband, Prabhat Jha
Journal: The Lancet Global Health (2018)

Despite clear evidence of a historically large and growing cancer burden, cancer services have not generally been prioritised in low-income and lower-middle-income countries by national governments or external funders. The many reasons include the urgency of other calls on health budgets, but the lack of a coherent economic argument for a range of cancer interventions—from prevention to treatment to palliation—has contributed to the inertia. Here we explore the economic arguments for advancing cancer control in low-income and middle-income countries (LMICs), taking stock of existing analyses and enumerating the formidable remaining challenges and need for cancer control to meet the Sustainable Development Goals (SDGs) and drive forward universal health coverage. A starting point is the package of essential cancer interventions presented in the Disease Control Priorities, 3rd edition (DCP3), which meet effectiveness, cost-effectiveness, feasibility, and affordability criteria using analytical methods that are easily replicable for customising packages to local needs.1Gelband H Sankaranarayanan R Gauvreau CL et al.Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities.Lancet. 2016; 387 (3rd edition): 2133-2144Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar The package includes prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care (including opioid drugs). Once initial investments are in place for infrastructure and personnel, these interventions would cost an additional US$20 billion per year globally, or about 3% of current public sector health spending in LMICs. DCP3 presents the most detailed economic case for cancer control so far. However, it falls short of providing a firm foundation for financing and building the complex set of services needed for competent cancer control. The key components are trained personnel in many categories: pathology and imaging for diagnosis and monitoring; specialised surgery, radiotherapy, and medical oncology; palliative care; and other supportive services. Building and maintaining such a system will clearly take years or decades and will require a financial investment roadmap over the long term. Work to gather data to fill these gaps, particularly on the costs of capacity building in LMICs, is ongoing. The following questions merit consideration: (1) What more is needed to make the case for investing in cancer control, including the necessity of reducing cancer deaths in meeting the SDGs? (2) Do the commonly used economic prioritisation tools (cost-effectiveness analysis, cost-benefit analysis, extended cost-effectiveness analysis, etc) lead to appropriate priority-setting for cancer control? (3) What are the important opportunities to advance cancer control lending within global development funding or multilateral or related programmes? (4) How can prevention, treatment, and palliation (essential package) be integrated within funding plans for cancer control? (5) Which local capacities and global supportive capacities are needed to advance cancer control? (6) How can cancer services be built up through inclusion in universal health coverage? We declare no competing interests.