Niloy R Datta1, Susanne Rogers2, Stephan Bodis3. 1. Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland. Electronic address: nrdatta@yahoo.com. 2. Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland. 3. Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland.
Abstract
PURPOSE: In 2015, the United Nations proposed "The 2030 Agenda for Sustainable Development" goals, which envision reducing premature mortality from noncommunicable diseases by one third by 2030. Because >50% of patients with cancer require radiation therapy (RT), the existing gaps in RT infrastructure in low- and middle-income countries (LMICs) and additional requirements by 2030 were examined. Cost-effective strategies to address this challenge were explored. METHODS AND MATERIALS: Public domain databases of the United Nation organizations were accessed. RT requirements for 2030 were estimated according to the International Atomic Energy Agency recommendations. To explore a feasible cost-effective solution, a teleradiotherapy network (TRTNet) was conceived with 4 to 8 primary RT centers (PRTCs) (each with 1 teletherapy unit, US$2.05 million) linked to a secondary RT center (SRTC; 2 teletherapy units and 1 brachytherapy unit, US$5.05 million). RESULTS: Of the 137 LMICs, 51 (37.3%) presently lack RT facilities. The remaining 86 LMICs have 5084 teletherapy units (gap: -7741) and thus a mean access to RT of 33%. By 2030, an additional 12,133 teletherapy units would be required for 14.2 million patients with cancer. A TRTNet linked 4 to 8 PRTCs with 1 SRTC could yield a return of investment (ROI) between -181.1% and 757.6% depending on the TRTNet configuration, 2-year survival, gross national income per capita, and employment-population ratio of the individual LMICs. Sixty-five (47.4%) of these could be expected to attain a positive ROI (7.1% to 757.6%) with a 2-year survival of 50% and a TRTNet configuration of 1 SRTC and 8 PRTCs. CONCLUSION: Optimized TRTNets through resource sharing could be a cost-effective and financially viable option to create RT infrastructure and facilitate capacity building toward realizing the 2030 Agenda for Sustainable Development goals in most LMICs. Low-income countries and some LMICs not expected to gain positive ROI should be considered for external financial assistance.
PURPOSE: In 2015, the United Nations proposed "The 2030 Agenda for Sustainable Development" goals, which envision reducing premature mortality from noncommunicable diseases by one third by 2030. Because >50% of patients with cancer require radiation therapy (RT), the existing gaps in RT infrastructure in low- and middle-income countries (LMICs) and additional requirements by 2030 were examined. Cost-effective strategies to address this challenge were explored. METHODS AND MATERIALS: Public domain databases of the United Nation organizations were accessed. RT requirements for 2030 were estimated according to the International Atomic Energy Agency recommendations. To explore a feasible cost-effective solution, a teleradiotherapy network (TRTNet) was conceived with 4 to 8 primary RT centers (PRTCs) (each with 1 teletherapy unit, US$2.05 million) linked to a secondary RT center (SRTC; 2 teletherapy units and 1 brachytherapy unit, US$5.05 million). RESULTS: Of the 137 LMICs, 51 (37.3%) presently lack RT facilities. The remaining 86 LMICs have 5084 teletherapy units (gap: -7741) and thus a mean access to RT of 33%. By 2030, an additional 12,133 teletherapy units would be required for 14.2 million patients with cancer. A TRTNet linked 4 to 8 PRTCs with 1 SRTC could yield a return of investment (ROI) between -181.1% and 757.6% depending on the TRTNet configuration, 2-year survival, gross national income per capita, and employment-population ratio of the individual LMICs. Sixty-five (47.4%) of these could be expected to attain a positive ROI (7.1% to 757.6%) with a 2-year survival of 50% and a TRTNet configuration of 1 SRTC and 8 PRTCs. CONCLUSION: Optimized TRTNets through resource sharing could be a cost-effective and financially viable option to create RT infrastructure and facilitate capacity building toward realizing the 2030 Agenda for Sustainable Development goals in most LMICs. Low-income countries and some LMICs not expected to gain positive ROI should be considered for external financial assistance.
Authors: C Norman Coleman; Jeffrey C Buchsbaum; Pataje G S Prasanna; Jacek Capala; Ceferino Obcemea; Michael G Espey; Mansoor M Ahmed; Julie A Hong; Bhadrasain Vikram Journal: JNCI Cancer Spectr Date: 2021-05-17