Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 29:16:38.
doi: 10.1186/s12962-018-0157-0. eCollection 2018.

Cost-effective interventions for breast cancer, cervical cancer, and colorectal cancer: new results from WHO-CHOICE

Ambinintsoa H Ralaidovy  1 , Chaitra Gopalappa  2 , André Ilbawi  3 , Carel Pretorius  4 , Jeremy A Lauer  5
Affiliations

Cost-effective interventions for breast cancer, cervical cancer, and colorectal cancer: new results from WHO-CHOICE

Ambinintsoa H Ralaidovy et al. Cost Eff Resour Alloc. .

Abstract

Background: Following the adoption of the Global Action Plan for the Prevention and Control of NCDs 2013-2020, an update to the Appendix 3 of the action plan was requested by Member States in 2016, endorsed by the Seventieth World Health Assembly in May 2017 and provides a list of recommended NCD interventions. The main contribution of this paper is to present results of analyses identifying how decision makers can achieve maximum health gain using the cancer interventions listed in the Appendix 3. We also present methods used to calculate new WHO-CHOICE cost-effectiveness results for breast cancer, cervical cancer, and colorectal cancer in Southeast Asia and eastern sub-Saharan Africa.

Methods: We used "Generalized Cost-Effectiveness Analysis" for our analysis which uses a hypothetical null reference case, where the impacts of all current interventions are removed, in order to identify the optimal package of interventions. All health system costs, regardless of payer, were included. Health outcomes are reported as the gain in healthy life years due to a specific intervention scenario and were estimated using a deterministic state-transition cohort simulation (Markov model).

Results: Vaccination against human papillomavirus (two doses) for 9-13-year-old girls (in eastern sub-Saharan Africa) and HPV vaccination combined with prevention of cervical cancer by screening of women aged 30-49 years through visual inspection with acetic acid linked with timely treatment of pre-cancerous lesions (in Southeast Asia) were found to be the most cost effective interventions. For breast cancer, in both regions the treatment of breast cancer, stages I and II, with surgery ± systemic therapy, at 95% coverage, was found to be the most cost-effective intervention. For colorectal cancer, treatment of colorectal cancer, stages I and II, with surgery ± chemotherapy and radiotherapy, at 95% coverage, was found to be the most cost-effective intervention.

Conclusion: The results demonstrate that cancer prevention and control interventions are cost-effective and can be implemented through a step-wise approach to achieve maximum health benefits. As the global community moves toward universal health coverage, this analysis can support decision makers in identifying a core package of cancer services, ensuring treatment and palliative care for all.

Keywords: Breast cancer; Cervical cancer; Colorectal cancer; Cost-effectiveness analysis; Expansion path; Impact modelling; Intervention costing; Priority setting; Resource allocation; Universal health coverage.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Cost effectiveness expansion path for Southeast Asia. Refer to Table 1 for interventions’ labels
Fig. 2
Fig. 2
Cost effectiveness expansion path for Eastern sub-Saharan Africa. Refer to Table 1 for interventions’ labels
See this image and copyright information in PMC

References

    1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: IARC CancerBase No. 11. France. 2013. http://globocan.iarc.fr. Accessed 5 May 2017. - PubMed
    1. Global health observatory: the data repository. World Health Organization. 2017. http://www.who.int/gho/database/en. Accessed 5 May 2017.
    1. Stewart BW, Wild CP. World cancer report 2014. Lyon: International Agency for Research on Cancer; 2014. - PubMed
    1. World Health Organization. Global action plan for the prevention and control of NCDs 2013–2020. In: Noncommunicable diseases and mental health. http://www.who.int/nmh/events/ncd_action_plan/en/. Accessed 2017.
    1. Sixty-ninth World Health Assembly. Prevention and control of noncommunicable diseases: responses to specific assignments in preparation for the third high-level meeting of the united nations general assembly on the prevention and control of non-communicable diseases in 2018. 2016. http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R6-en.pdf. Accessed 2017.