Direct costs of cervical cancer management in Morocco

Mohammed Berraho; Adil Najdi

Direct costs of cervical cancer management in Morocco

Mohammed Berraho

Adil Najdi

2012, Asian Pacific journal of cancer prevention : APJCP

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For cervical cancer the epidemiological profile is poorly known in Morocco and no data is available concerning the direct medical costs. The purpose of this work is to estimate the direct cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco. The estimation of direct costs of medical management of invasive cervical cancer during the first year after diagnosis in Morocco is based on the estimation of individual cost in each stage which covers diagnosis, treatment and follow-up during first year. The cost was estimated per patient and whole cycle-set using the costs for each drug and procedure as indicated by the Moroccan National Agency for Health Insurance. Extrapolation of the results to the whole country was used to calculate the total annual cost of cervical cancer treatments in Morocco. Overall approximately 1,978 new cases of cervical cancer occur each year in Morocco. The majority (82.96%) of these cases were diagnosed at a lat...

Introduction

RESEARCH ARTICLE

Direct Costs of Cervical Cancer Management in Morocco

Mohamed Berraho 1 *, Adil Najdi 1 , Simone Mathoulin-Pelissier 2 , Roger Salamon 2 , Chakib Nejjari 1 cervical cancer (stage 0-0.5% and I -16.7%), and 82.8% were presented from intermediate to advanced stages: stage II in 43.7%, stage III in 31.8%, and stage IV only in 6.3% (Lalla Salma Association against Cancer, National Cancer Plan, 2009).

Financing cancer treatment is a major challenge for both developed and developing countries. The occurrence of the disease has a significant negative impact as the treatments are very expensive, quality of life is degraded and the disease leads too often to death. These deaths account for a significant number of potential years of life lost. Cancer also causes a loss of economic income available to the community. This consists of two elements: the cost of care, and production losses due to the impact of illness on employment (National Cancer Institute -France, 2007).

In reality, there are two different approaches to the fight against cancer: firstly, reducing forms of rationing, which limit access to higher quality of care, and secondly, strengthening policies of prevention, screening and research on cancer. This second approach raises questions of resource allocation that should be clarified through economic analysis in studies examining cost of care and cost-effectiveness (National Cancer Institute -France, 2007).

In Morocco, the epidemiological profile of cervical cancer is poorly known due to the absence of a national cancer registry, the rarity of epidemiological studies, as well as the absence of a screening program. To our knowledge, no data is available concerning direct medical costs of cervical cancer in Morocco. The purpose of this work is to estimate the direct cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco.

Materials and Methods

In order to estimate the cost of medical management of invasive cervical cancer during the first year after diagnosis we need the following data: the number of new cases of cervical cancer per year, the examinations and the complementary procedures indicated for the diagnosis, therapeutic indications by stage of diagnosis, examinations used in monitoring, the stages of diagnosis and the cost per step management (diagnosis, treatment and follow-up).

Estimation of cervical cancer incidence

According to the 2008 GLOBOCAN (IARC, 2008), the world age-standardized incidence of cervical cancer among women in Morocco was 14.1 new cases/100 000 inhabitants/year (1978 new cases/year).

Data on the stages of diagnosis

To estimate the stages of diagnosis, we used data from a recent study conducted as part of preparations for the implementation of the Cancer Plan in Morocco (Lalla Salma Association against Cancer, National Cancer Plan, 2009). This is a retrospective study on the basis of data from hospital records with 900 cases randomly selected, by systematic sampling (Lalla Salma Association against Cancer, National Cancer Plan, 2009). This study has been conducted to provide descriptive epidemiological and pathological characteristics of cervical cancer among patients attending the largest cancer care centres in Morocco (three public and one private).

Actions and therapeutic indications

We divided the management of cervical cancer into three parts: diagnosis, supportive care treatment and follow-up at 1 year after diagnosis. To determine the practices and current therapeutic indications for cervical cancer by stage of diagnosis, we conducted a study in the University Hospital of Fez (Table 1).

Table 1

*TH, Total hysterectomy; $PL, pelvic lymphadenectomy; ¥TCH, Total colpohysterectomy; £HDR, High Dose Rate DOI:http://dx.doi.org/10.7314/APJCP.2012.13.7.3159 Direct Costs of Cervical Cancer Management in Morocco

Regarding the necessary examinations for diagnosis and 1 year of follow-up after diagnosis we used clinical recommendations of AROME (Association of Radiotherapy and Oncology of the Mediterranean Area) (AROME, 2011). This classification takes into account availability of means and cultural aspects; they were developed for the most common cancer sites in countries around the Mediterranean area.

Cost estimation

The estimation of direct costs of medical management of invasive cervical cancer during the first year after diagnosis in Morocco is based on the estimation of individual cost in each stage which covers diagnosis, treatment and follow-up during first year. The cost was estimated per patient and whole cycle-set using the costs for each drug and procedure as indicated by the Moroccan National Agency for Health Insurance (Agence Nationale de l'Assurance Maladie -Morocco), and is reported in US dollars ($).

The cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco will be estimated as follows: in the first steps, we calculated the unit cost of care by stage of diagnosis per year, then we estimated the total cost of care by stage of diagnosis per year and finally we estimate the total cost of care of cervical cancer per year.

1. Estimation of per patient cost of care by stage of diagnosis per year In this step we calculated the unit cost of care for one patient with cervical cancer in stage (x) for one year.

For example, for one patient with cervical cancer in stage I, the cost will be estimated as follows:

Unit In this step we calculated the total cost of care of

Results

Estimation of incidence and stage of diagnosis of cervical cancer in Morocco

In table 2, we present the estimated distribution of new cases by stage of diagnosis (IARC, 2008; Lalla Salma Association against Cancer, National Cancer Plan, 2009). The majority (83.0%) of cases are diagnosed at a late stage (stage II or more).

Estimation of cost

Estimation of individual cost by stage of diagnosis and type of treatment: The cost of treatment of cervical cancer depends on stage of diagnosis. Indeed, the lowest cost is $98 for stage Cis followed by $2 668 for stage IA1 for young women. The highest cost is that of stage IV, which is $7 543. From stage IA1 for older women to stage III the cost does not change much. It ranges between $6 358 and $6 562 (Table 3).

Table 3

Cost of 1 Cancer Case by Stage of Diagnosis and Type of Treatment (USD$)

Depending on the type of treatment, brachytherapy, followed by radiotherapy, represented the largest share of the cost of treatment for cervical cancer (Table 3).

Estimation of individual management cost of one cancer patient by stage of diagnosis during the first year after diagnosis: The management cost of one case of cervical cancer depends on the stage of diagnosis. In fact, the lowest cost is $382 for stage Cis, followed by $2952 for stage IA1 for young women. The highest cost is that of stage IV, which is $7 827. For stage IA1 for older women to stage III the cost does not change considerably. It ranges between $6 642 and $6 846 ( Table 4).

Table 4

Estimation of annual cost by stage of diagnosis: In table 5, we present the estimation of the annual cost of cervical cancer in Morocco by stage of diagnosis. The annual cost of cervical cancer depends on the stage of diagnosis. The lowest annual cost is $3438 for stage Cis, followed by $17 712 for stage IA1 young women. The highest annual cost is that of stage IIB which is $4 618 493, followed by $3 703 686 for stage IIIB (Table 5).

Table 5

Estimation of annual cost of care for cervical cancer per year in Morocco: The total cost of cervical cancer care for one year after diagnosis (direct cost only) in Morocco is estimated at $13 589 360. The share allocated to treatment is the most important part of the global care budget with an annual sum of $13 027 609 (95.87%). Other cost components are represented as follows: $435 694 for annual follow-up activity and $126 057 for diagnosis and preclinical staging.

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Introduction

RESEARCH ARTICLE

Direct Costs of Cervical Cancer Management in Morocco

Materials and Methods

Estimation of cervical cancer incidence

Data on the stages of diagnosis

Actions and therapeutic indications

Cost estimation

Results

Estimation of incidence and stage of diagnosis of cervical cancer in Morocco

Estimation of cost

Table 4 .

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