TY - JOUR
T1 - Expanding global access to radiotherapy
AU - Atun, Rifat
AU - Jaffray, David A.
AU - Barton, Michael B.
AU - Bray, Freddie
AU - Baumann, Michael
AU - Vikram, Bhadrasain
AU - Hanna, Timothy P.
AU - Knaul, Felicia M.
AU - Lievens, Yolande
AU - Lui, Tracey Y.M.
AU - Milosevic, Michael
AU - O'Sullivan, Brian
AU - Rodin, Danielle L.
AU - Rosenblatt, Eduardo
AU - Van Dyk, Jacob
AU - Yap, Mei Ling
AU - Zubizarreta, Eduardo
AU - Gospodarowicz, Mary
N1 - Funding Information:
DAJ reports grants or sponsored research agreements from Raysearch Laboratories, Philips Medical Systmes, Eletka, Varian Medical Systems, Siemens Medical, and IMRIS; presenter fees from the American Society for Radiation Oncology; and royalties from Modus Medical and Precision X-ray related to non-patentable inventions, outside the submitted work. Additionally he has pending patents (US 2013/026137 A1, US61/178 319, US61/157 738, and US2013/0113802 A1), issued patents (7399977, US11/867998, and PCT/US2007/067847), issued patents licensed to Elekta (8 039 790 [with royalties received], 20040234115, 20040096038, 20040218719, 7472765 [with royalties received], and 7 147 373 [with royalties received]), and issued patents licensed to iRT (US60/806842, PCT/CA2007/001209, and EP20070763872). TPH received non-financial support from the Canadian Association of Radiation Oncology during this work. FMK has received grants from GlaxoSmithKline, Pfizer, NADRO, Chinoin, Sanofi SA, Roche, Susan G Komen for the Cure, Fogarty International Center, the Pan-American Health Organization, WHO, and the International Development Research Center; and support from the National Institute of Public Health Mexico, Centro de Investigacion y Docencias Economicas Mexico, PISA, Celgene, and Grunenthal. She is director of the Secretariat of the Global Task Force on Expanded Access to Cancer Care and Control, a board member of the Union for International Cancer Control, and the founding President of Tómatelo a Pecho. YL is president-elect of the European Society for Radiotherapy and Oncology, an unpaid position. TYML's institution received funds from the Union for International Cancer Control to support her salary for time spent working on this Commission. JVD received travel support from the Canadian Organization of Medical Physicists to attend meetings related to the Commission. MG is a member of the board of directors of IBA, which manufactures proton therapy equipment. RA, MBB, FB, MB, BV, MM, BOS, DLR, ER, MLY, and EZ declare no competing interests.
Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26.6 billion in low-income countries, $62.6 billion in lower-middle-income countries, and $94.8 billion in upper-middle-income countries, which amounts to $184.0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14.1 billion in low-income, $33.3 billion in lower-middle-income, and $49.4 billion in upper-middle-income countries-a total of $96.8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26.9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278.1 billion in 2015-35 ($265.2 million in low-income countries, $38.5 billion in lower-middle-income countries, and $239.3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365.4 billion ($12.8 billion in low-income countries, $67.7 billion in lower-middle-income countries, and $284.7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16.9 billion in 2015-35 (-$14.9 billion in low-income countries; -$18.7 billion in lower-middle-income countries, and $50.5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104.2 billion (-$2.4 billion in low-income countries, $10.7 billion in lower-middle-income countries, and $95.9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits.
AB - Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26.6 billion in low-income countries, $62.6 billion in lower-middle-income countries, and $94.8 billion in upper-middle-income countries, which amounts to $184.0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14.1 billion in low-income, $33.3 billion in lower-middle-income, and $49.4 billion in upper-middle-income countries-a total of $96.8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26.9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278.1 billion in 2015-35 ($265.2 million in low-income countries, $38.5 billion in lower-middle-income countries, and $239.3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365.4 billion ($12.8 billion in low-income countries, $67.7 billion in lower-middle-income countries, and $284.7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16.9 billion in 2015-35 (-$14.9 billion in low-income countries; -$18.7 billion in lower-middle-income countries, and $50.5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104.2 billion (-$2.4 billion in low-income countries, $10.7 billion in lower-middle-income countries, and $95.9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits.
UR - http://www.scopus.com/inward/record.url?scp=84942115373&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942115373&partnerID=8YFLogxK
U2 - 10.1016/S1470-2045(15)00222-3
DO - 10.1016/S1470-2045(15)00222-3
M3 - Review article
C2 - 26419354
AN - SCOPUS:84942115373
VL - 16
SP - 1153
EP - 1186
JO - The Lancet Oncology
JF - The Lancet Oncology
SN - 1470-2045
IS - 10
M1 - 190
ER -