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Wilson BE, Booth CM, Sullivan R, Aggarwal A, Sengar M, Jacob S, Bray F, Barton MB, Pearson SA. Global application of National Comprehensive Cancer Network resource-stratified guidelines for systemic treatment of colon cancer: a population-based, customisable model for cost, demand, and procurement. Lancet Oncol 2023; 24:682-690. [PMID: 37269845 DOI: 10.1016/s1470-2045(23)00183-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/06/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Resource-stratified guidelines (RSGs) can inform systemic treatment decisions in the face of limited resources. The objective of this study was to develop a customisable modelling tool to predict the demand, cost, and drug procurement needs of delivering National Comprehensive Cancer Network (NCCN) RSG-based systemic treatment for colon cancer. METHODS We developed decision trees for first-course systemic therapy for colon cancer based on the NCCN RSGs. Decision trees were merged with data from the Surveillance, Epidemiology, and End Results programme, the International Agency for Research on Cancer's GLOBOCAN 2020 national estimates for colon cancer incidence, country-level income data, and data on drug costs from Redbook (USA), the Pharmaceutical Benefits Scheme (Australia), and the Management Sciences for Health 2015 International Medical Products price guide to estimate global treatment needs and costs, and forecast drug procurement. Simulations and sensitivity analyses were used to explore the effect of scaling up services globally and the effect of alternative stage distributions on treatment demand and cost. We generated a customisable model, in which estimates can be tailored to local incidence, epidemiological, and costing data. FINDINGS First-course systemic therapy is indicated in 608 314 (53·6%) of 1 135 864 colon cancer diagnoses in 2020. Indications for first-course systemic therapy are projected to rise to 926 653 in 2040; the indications in 2020 might be as high as 826 123 (72·7%), depending on stage distribution assumptions. Adhering to NCCN RSGs, patients with colon cancer in low-income and middle income countries (LMICs) would constitute 329 098 (54·1%) of 608 314 global systemic therapy demands, but only 10% of global expenditure on systemic therapies. The total cost of NCCN RSG-based first-course systemic therapy for colon cancer in 2020 would be between about US$4·2 and about $4·6 billion, depending on stage distribution. If all patients with colon cancer in 2020 were treated according to maximal resources, global expenditure on systemic therapy for colon cancer would rise to around $8·3 billion. INTERPRETATION We have developed a customisable model that can be applied at global, national, and subnational levels to estimate systemic treatment needs, forecast drug procurement, and calculate expected drug costs on the basis of local data. This tool can be used to plan resource allocation for colon cancer globally. FUNDING None.
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Affiliation(s)
- Brooke E Wilson
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute and Department of Oncology, Queens University, Kingston, ON, Canada; Collaboration for Cancer Outcomes, Research and Evaluation, South-West Clinical School, University of New South Wales, Liverpool, NSW, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute and Department of Oncology, Queens University, Kingston, ON, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, UK; Department of Oncology, Guy's & St Thomas' National Health Service Trust, London, UK
| | - Ajay Aggarwal
- Department of Oncology, Guy's & St Thomas' National Health Service Trust, London, UK; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Susannah Jacob
- Collaboration for Cancer Outcomes, Research and Evaluation, South-West Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Cancer Research, Lyon, France
| | - Michael B Barton
- Collaboration for Cancer Outcomes, Research and Evaluation, South-West Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; NHMRC Medicines Intelligence Centre of Research Excellence, University of New South Wales, Sydney, NSW, Australia
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Wilson BE, Oar A, Rodin D, Bray F, Ferlay J, Polo A, Borras JM, Bourque JM, Malik M, Ynoe de Moraes F, Lievens Y, Stevens LM, Zubizarreta E, Yap ML. Radiotherapy prioritization in 143 national cancer control plans: Correlation with radiotherapy machine availability, geography and income level. Radiother Oncol 2022; 176:83-91. [PMID: 36113775 DOI: 10.1016/j.radonc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/24/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2015, the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) called for 80% of National Cancer Control Plans (NCCP) to include radiotherapy by 2020. As part of the ongoing ESTRO Global Impact of Radiotherapy in Oncology (GIRO) project, we assessed whether inclusion of radiotherapy in NCCPs correlates with radiotherapy machine availability, national income, and geographic region. METHODS A previously validated checklist was used to determine whether radiotherapy was included in each country's NCCP. We applied the CCORE optimal radiotherapy utilisation model to the GLOBOCAN 2020 data to estimate the demand for radiotherapy and compared this to the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres (DIRAC) supply data, stratifying by income level and world region. World regions were defined according to the IAEA. FINDINGS Complete data (including GLOBOCAN 2020, DIRAC and NCCP) was available for 143 countries. Over half (55%, n = 79) included a radiotherapy-specific checklist item within the plan. Countries which included radiotherapy services planning in their NCCP had a higher median number of machines (1.68 vs 0.75 machines/1000 patients needing radiotherapy, p < 0.001). There was significant regional and income-level heterogeneity in the inclusion of radiotherapy-related items in NCCPs. Low-income and Asia-Pacific countries were least likely to include radiation oncology services planning in their NCCP (p = 0.06 and p = 0.003, respectively). Few countries in the Asia-Pacific (18.6%) had a plan to develop or maintain radiation services, compared to 57% of countries in Europe. INTERPRETATION Only 55% of current NCCPs included any information regarding radiotherapy, below the GTFRCC's target of 80%. Prioritisation of radiotherapy in NCCPs was correlated with radiotherapy machine availability. There was regional and income-level heterogeneity regarding the inclusion of specific radiotherapy checklist items in the NCCPs. Ongoing efforts are needed to promote the inclusion of radiotherapy in future iterations of NCCPs in order to improve global access to radiation treatment. FUNDING No direct funding was used in this research.
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Affiliation(s)
- Brooke E Wilson
- Collaboration for Cancer Outcomes, Research and Evaluation, South-West Clinical School, University of New South Wales, Liverpool, NSW, Australia; Department of Oncology, Queens University, Kingston, Ontario, Canada.
| | - Andrew Oar
- Icon Cancer Centre, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Danielle Rodin
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Cancer Research, Lyon, France
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Cancer Research, Lyon, France
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Josep M Borras
- Department of Clinical Sciences and IDIBELL, University of Barcelona, Barcelona, Spain
| | - Jean-Marc Bourque
- Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada; Radiation Oncology, Montreal University Hospital Centre, Montreal, Canada
| | - Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Lisa M Stevens
- Programme of Action for Cancer Therapy, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarreta
- Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes, Research and Evaluation, South-West Clinical School, University of New South Wales, Liverpool, NSW, Australia; Liverpool Cancer Centre and Macarthur Cancer Therapy Centre, Western Sydney University, Campbelltown, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
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