The rising costs of health-care globally, and particularly for chronic conditions like cancer and other NCDs, present a significant challenge for many national governments. Added to this, the investments all governments are making in cancer control are often minimal, fragmented, or unbalanced across the cancer control continuum, which limits the effectiveness of the resources used.
Since 2011, it has been clear that the cost of inaction on NCDs far outweighs the cost of responding. For instance, it has been estimated that investing just USD 11.4 billion in a set of core prevention strategies in LMICs can result in savings of up to USD 100 billion in cancer treatment costs. In the global context, this shows that not only is investing in cancer feasible, it yields significant returns in terms of lives saved and potential economic growth. However, the global funding agenda has not yet caught up. NCDs receive less that 2% of the total global development assistance for health (DAH), despite accounting for more than 70% of global mortality. For cancer, the data, and funding, is even more limited.
Over the past few years, there has been a growing body of work reviewing a number of interventions that are both cost effective and that impact national cancer incidence and mortality. We know that it is possible to scale up these ‘best practice’ policies, programmes and services to reduce the burden of cancer across all resource settings. Moreover, these investments deliver significant returns and help to strengthen health systems overall, enabling governments to make the case for placing cancer control at the heart of their national health plans.
A number of key resources related to cost-effective health interventions are highlighted below, along with their key messages; however this is by no means an exhaustive list.
Initially developed as Appendix 3 to the Global NCD Action Plan 2013-2020 (GAP) on NCDs, the WHO ‘Best Buys’ were updated in 2017 to bring together the latest evidence on cost-effective, effective and other recommended actions. A list of options is presented for each of the four key risk factors for NCDs (tobacco, harmful use of alcohol, unhealthy diet and physical inactivity) and for four leading disease areas.
In addition to key prevention interventions, of particular note for cancer are recommendations for:
|Best buys||Vaccination against Human Papillomavirus (HPV) for girls aged 9 to 13
Cervical cancer screening for women aged 30 to 49 (using visual inspection with acetic acid (VIA), Pap smear, or HPV DNA testing) - linked to timely treatment of pre-cancerous lesions
|Effective interventions||Screening with mammography once every 2 years for women aged 50 and 69 - linked to time diagnosis and treatment
Treatment of stage I and II breast cancer with surgery +/- systemic therapy
Treatment of stage I and II cervical cancer with either surgery or radiotherapy +/- chemotherapy
Treatment of stage I and II colorectal cancer with surgery +/- radiotherapy and chemotherapy
Read more about the WHO 'Best buys and other recommended actions' here (available in all UN languages).
This joint WHO-Bloomberg report presents the economic and social benefits of investing in services for non-communicable diseases (NCDs), including cancer. The report draws on the WHO ‘Best Buys’ for NCDs and focuses on six policy areas, including tobacco control, reducing harmful use of alcohol, unhealthy diets, physical inactivity and cancer. Headlines from the report include:
The Taskforce report demonstrates the tight-knit connection between economic growth and tackling NCDs, in the context of the Sustainable Development Goals. The series of five papers show:
Radiotherapy is an essential technology for the treatment and care of the most common cancers globally, including cervical, breast, colorectal, head and neck cancers. On average, radiotherapy is recommended for 52% of cancer patients; however, amongst low- and middle income countries (LMICs), this figure is likely to be higher due to the prevelance of certain types of cancer in LMICs and the number of patients presenting with late-stage disease.
The Lancet Oncology Commission looked at how to expand global access to radiotherapy, and included in their analysis and assessment the estimated costs and returns of investment. Headlines from the commission include: