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. 2019 Jul:5:1-10.
doi: 10.1200/JGO.19.00059.

Microcosting Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi

Matthew S Painschab  1   2 , Racquel E Kohler  3 , Edwards Kasonkanji  1 , Takondwa Zuze  1 , Bongani Kaimila  1 , Richard Nyasosela  4 , Ruth Nyirenda  4 , Robert Krysiak  1 , Satish Gopal  1   2   5
Affiliations

Microcosting Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi

Matthew S Painschab et al. J Glob Oncol. 2019 Jul.

Abstract

Purpose: To describe the cost of treating diffuse large B-cell lymphoma (DLBCL) in Malawi under the following circumstances: (1) palliation only, (2) first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), (3) salvage etoposide, ifosfamide, and cisplatin (EPIC), and (4) salvage gemcitabine and oxaliplatin (GEMOX).

Methods: We conducted a microcosting analysis from the health system perspective in the context of a prospective cohort study at a national teaching hospital in Lilongwe, Malawi. Clinical outcomes data were derived from previously published literature from the cohort. Cost data were collected for treatment and 2-year follow-up, reflecting costs incurred by the research institution or referral hospital for goods and services. Costs were collected in Malawian kwacha, inflated and converted to 2017 US dollars.

Results: On a per-patient basis, palliative care alone cost $728 per person. Total costs for first-line treatment with CHOP chemotherapy was $1,844, of which chemotherapy drugs made up 15%. Separate salvage EPIC and GEMOX cost $2,597 and $3,176, respectively. Chemotherapy drugs accounted for 30% of EPIC and 47% of GEMOX.

Conclusion: To our knowledge, this is among the first published efforts to characterize detailed costs of cancer treatment in sub-Saharan Africa. The per-patient cost of first-line treatment of DLBCL in Malawi is low relative to high-income countries, suggesting that investments in fixed-duration, curative-intent DLBCL treatment may be attractive in sub-Saharan Africa. Salvage treatment of relapsed/refractory DLBCL costs much more than first-line therapy. Formal cost-effectiveness modeling for CHOP and salvage treatment in the Malawian and other low-resource settings is needed to inform decision makers about optimal use of resources for cancer treatment.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jgo/site/misc/authors.html.

No potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Microcosting analysis of first-line (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]) and second-line (etoposide, ifosfamide, and cisplatin [EPIC] or gemcitabine and oxaliplatin [GEMOX]) treatments for diffuse large B-cell lymphoma in Malawi. Prices in 2017 US dollars (USD) are shown on the y-axis. Percentage of total for each cost type is overlaid on the figure.
See this image and copyright information in PMC

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