1. World Health Organization
20 May 2018
Scaling up for treating cancers in LMIC: towards a comprehensive cancer treatment programme Andreas Ullrich MD MPH Geneva Switzerland

2. Cancer burden by type

3. Cancer Control Capacity (2011)

4. World Health Organization
Population per Radiotherapy Service

5. Health system for cancer control

6. The “cancer chapter” of the NCD action plan
Every country with a national NCD strategy which includes:
Behavioral risk reduction/ HPV/ HBV
Cervical cancer screening
Cancer registry

8. Projections NCD avoided
Four main non-communicable diseases
BAU %
Achieving
Targets %
Deaths avoided
Below Beyond 70
All cardiovascular diseases 18 34 ;
All cancers 3 7 ;
Chronic respiratory diseases 16
- 24 ;
Diabetes
+ 11 ;
Total
- 10
- 21 ;
BAU Business as usual
Achieving 6 NCD Targets

9. What we can learn:
Behavioural Risk Reduction alone will not achieve 25x25 Goal
Infectious /environmental factors are at the forefront in Low and Middle income Countries
Early detection + treatment: key element of additional contribution to 25 x 25 Goal
Strengthen health care systems is at stake

10. Comprehensive approach
PRIMARY PREVENTION
SECONDARY PREVENTION
TERTIARY PREVENTION
Comprehensive approach
Framework
New stakeholders and partners for cervical cancer prevention and control
Ministry of health: Immunization, sexual and reproductive health, adolescent health, cancer control, and HIV prevention partners,
Ministry of education: school health,
Women's groups
Community based group to reach girl out of school
Interdisciplinary stakeholders and solid in-country
coordination needed by MoH

11. Cancer Screening Cervical cancer Breast Cancer Colorectal cancer
Oral cancer

12. Success criteria • Feasibility in pilot • Governance and leadership.
• Health system
• Validated protocols and guidelines
• Quality assurance and information systems
• Regular monitoring
• Sufficient organizational and financial

13. A health system for cancer control
Using a building block framework
Integration into existing health care systems
Medicines
Workforce
Services
Governance

14. Challenges for service integration
Services
Challenges for service integration
Proposed linkages
HIV services
Increased access to cancer care
Expected outcome
Existing services
Provincial hospital
Almost absent
Tertiary care
Priority intervention:
Prevention / palliative care
Community
Reproductive
Primary Health Care

15. The cost of cancer
Method (1)* : costs of care ( 53%) + care givers (23%) + productivity loss (24%) *:
> 1.16 Trillion US $ = 2% GDP
Method (2)** statistical life approach + variety of individual costs
> 2.5 Trillion (1.7 HIC / 0.8 LMIC)
* Beaulieu Economist Intelligence (2010)
** WEF (2011)

16. Cancer Medicines: Sales & Market Share by region
* $ Million

17. Cost of Cancer Treatment: Breast Cancer

18. Fundamental tension(s) over how to solve the ‘cost crisis’: multiple lessons……
Human desire for health services
Accurately measure costs & link to outcomes, Robert Kaplan & Michael Porter, Sept, 2011 Harvard Business Revew
Implement Value Based Pricing
Convergence of ‘regulatory- acceptable’ efficacy & effectiveness: greater hurdles for all domains to demonstrate
Reduce / stop off label use
Mandatory integration of socio- economic studies into clinical research
Why do we love medicines so much? EMBO Reports :

19. The way forward
Political: UN NCD review July 2014: the opportunity for the professional cancer organizations to join the debate
Normative: Expansion of the WHO model essential medicines list for anti neoplastic medicines
Clinical: Collaboration with professional organizations (ESMO ASCO SLACOM): national treatment standards
Research: health system for cancer control, analysis of effectiveness /cost –effectiveness of cancer treatment regimens