Rima A Abdul-Khalek1, Ping Guo2, Forbes Sharp3, Adrian Gheorghe4, Omar Shamieh5, Tezer Kutluk6, Fouad Fouad7, Adam Coutts8, Ajay Aggarwal9, Deborah Mukherji1, Ghassan Abu-Sittah1, Kalipso Chalkidou10, Richard Sullivan11. 1. Global Health Institute, American University of Beirut, Beirut, Lebanon; Conflict and Health Research Group, School of Security Studies, King's College London, London, UK. 2. Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 3. Conflict and Health Research Group, School of Security Studies, King's College London, London, UK; Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK. 4. School of Public Health, Department of Infectious Disease Epidemiology and Global Health and Development Group, Imperial College London, London, UK. 5. Centre for Palliative and Cancer Care in Conflict, King Hussein Cancer Centre, Amman, Jordan. 6. Centre for Palliative and Cancer Care in Conflict, Hacettepe University, Ankara, Turkey. 7. Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. 8. Department of Sociology and Magdalene College, University of Cambridge, Cambridge, UK. 9. Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK. 10. School of Public Health, Department of Infectious Disease Epidemiology and Global Health and Development Group, Imperial College London, London, UK; Centre for Global Development, Washington, DC, USA. 11. Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK. Electronic address: richard.sullivan@kcl.ac.uk.
Abstract
BACKGROUND: Cancer represents a substantial health burden for refugees and host countries. However, no reliable data on the costs of cancer care for refugees are available, which limits the planning of official development assistance in humanitarian settings. We aimed to model the direct costs of cancer care among Syrian refugee populations residing in Jordan, Lebanon, and Turkey. METHODS: In this population-based modelling study, direct cost per capita and per incident case for cancer care were estimated using generalised linear models, informed by a representative dataset of cancer costs drawn from 27 EU countries. A range of regression specifications were tested, in which cancer costs were modelled using different independent variables: gross domestic product (GDP) per capita, crude or age-standardised incidence, crude or age-standardised mortality, and total host country population size. Models were compared using the Akaike information criterion. Total cancer care costs for Syrian refugees in Jordan, Lebanon, and Turkey were calculated by multiplying the estimated direct cancer care costs (per capita) by the total number of Syrian refugees, or by multiplying the estimated direct cancer costs (per incident case [crude or age-standardised]) by the number of incident cancer cases in Syrian refugee populations. All costs are expressed in 2017 euros (€). FINDINGS: Total cancer care costs for all 4·74 million Syrian refugees in Jordan, Lebanon, and Turkey in 2017 were estimated to be €140·23 million using the cost per capita approach, €79·02 million using the age-standardised incidence approach, and €33·68 million using the crude incidence approach. Under the lowest estimation, and with GDP and total country population as model predictors, the financial burden of cancer care was highest for Turkey (€25·18 million), followed by Lebanon (€6·40 million), and then Jordan (€2·09 million). INTERPRETATION: Cancer among the Syrian refugee population represents a substantial financial burden for host countries and humanitarian agencies, such as the UN Refugee Agency. New ways to provide financial assistance need to be found and must be coupled with clear, prioritised pathways and models of care for refugees with cancer. FUNDING: UK Research and Innovation Global Challenges Research Fund: Research for Health in Conflict-Middle East and North Africa region (R4HC-MENA).
BACKGROUND:Cancer represents a substantial health burden for refugees and host countries. However, no reliable data on the costs of cancer care for refugees are available, which limits the planning of official development assistance in humanitarian settings. We aimed to model the direct costs of cancer care among Syrian refugee populations residing in Jordan, Lebanon, and Turkey. METHODS: In this population-based modelling study, direct cost per capita and per incident case for cancer care were estimated using generalised linear models, informed by a representative dataset of cancer costs drawn from 27 EU countries. A range of regression specifications were tested, in which cancer costs were modelled using different independent variables: gross domestic product (GDP) per capita, crude or age-standardised incidence, crude or age-standardised mortality, and total host country population size. Models were compared using the Akaike information criterion. Total cancer care costs for Syrian refugees in Jordan, Lebanon, and Turkey were calculated by multiplying the estimated direct cancer care costs (per capita) by the total number of Syrian refugees, or by multiplying the estimated direct cancer costs (per incident case [crude or age-standardised]) by the number of incident cancer cases in Syrian refugee populations. All costs are expressed in 2017 euros (€). FINDINGS: Total cancer care costs for all 4·74 million Syrian refugees in Jordan, Lebanon, and Turkey in 2017 were estimated to be €140·23 million using the cost per capita approach, €79·02 million using the age-standardised incidence approach, and €33·68 million using the crude incidence approach. Under the lowest estimation, and with GDP and total country population as model predictors, the financial burden of cancer care was highest for Turkey (€25·18 million), followed by Lebanon (€6·40 million), and then Jordan (€2·09 million). INTERPRETATION:Cancer among the Syrian refugee population represents a substantial financial burden for host countries and humanitarian agencies, such as the UN Refugee Agency. New ways to provide financial assistance need to be found and must be coupled with clear, prioritised pathways and models of care for refugees with cancer. FUNDING: UK Research and Innovation Global Challenges Research Fund: Research for Health in Conflict-Middle East and North Africa region (R4HC-MENA).
Authors: Tezer Kutluk; Mehmet Koç; İrem Öner; İbrahim Babalıoğlu; Meral Kirazlı; Sinem Aydın; Fahad Ahmed; Yavuz Köksal; Hüseyin Tokgöz; Mustafa Duran; Richard Sullivan Journal: Confl Health Date: 2022-01-31 Impact factor: 2.723