Purpose
The purpose of this Notice is to encourage currently funded NCI extramural investigators to apply for administrative supplements to study cancer control and prevention in low- and middle-income country (LMIC) settings using economic or costing data and methods.
Background
The global health and economic burden of cancer is increasingly concentrated in LMICs, where economic factors at the individual, community and policy levels have substantial relevance for and impact on cancer outcomes. Costs can pose a substantial barrier to access to treatment, for example, which is likely to have a disproportionate impact in LMICs. Cancer diagnosis and treatment impose a high financial burden on patients and their families, including direct medical and non-medical costs, as well as indirect costs, such as lost income. Indeed, cancer is associated with the highest economic loss among leading causes of death worldwide. Development of the human, technical, and infrastructure resources needed to provide cancer care have the potential to place an enormous strain on already overstrained health systems. Moreover, implementation barriers for effective cancer control interventions in LMICs are often related to cost and economic conditions. Thus, global health experts have identified affordability of cancer care, value-based care, and health economics as key priority areas for cancer research in LMICs.
Evaluations of the economic costs of cancer and cancer control vary across countries and settings based on the disease burden, the availability of healthcare resources, access to care utilization and outcomes data, ability to measure financial burden or toxicity, and healthcare practices. There is a lack of data and rigorous research to address economic aspects of cancer and cancer control in LMICs. Little is known about the economic impact of a cancer diagnosis for patients and their families in LMICs. A 2016 bibliometric analysis estimated that at that time only 8% of published economic evaluations of health interventions addressed low- or lower-middle income countries. Additionally, most evidence regarding cost effectiveness of cancer screening and treatment comes from high- or upper-middle-income countries, and existing methods for health economic analyses are largely based on high-income populations and may not adequately account for different health and economic contexts. Economic modeling can also be used to guide policy decisions and inform selections between different cancer control strategies. But the lack of economic data from LMICs is a challenge for countries in the process of prioritizing interventions and programs for cancer control. An analysis of 158 national cancer control plans conducted in 2018 showed that only 16 plans provided details about costing and budgeting. More studies are needed in low- and lower-middle-income countries to generate data to inform and build the economic case for cancer control and prevention in LMICs.