Patrick Edwards

Developing and testing a cost data collection instrument for noncommunicable disease registry planning

BACKGROUND This article reports on the methods and framework we have developed to guide economic evaluation of noncommunicable disease registries. METHODS We developed a cost data collection instrument, the Centers for Disease Control and Preventions (CDCs) International Registry Costing Tool (IntRegCosting Tool), based on established economics methods We performed in-depth case studies, site visit interviews, and pilot testing in 11 registries from multiple countries including India, Kenya, Uganda, Colombia, and Barbados to assess the overall quality of the data collected from cancer and cardiovascular registries. RESULTS Overall, the registries were able to use the IntRegCosting Tool to assign operating expenditures to specific activities. We verified that registries were able to provide accurate estimation of labor costs, which is the largest expenditure incurred by registries. We also identified several factors that can influence the cost of registry operations, including size of the geographic area served, data collection approach, local cost of living, presence of rural areas, volume of cases, extent of consolidation of records to cases, and continuity of funding. CONCLUSION Internal and external registry factors reveal that a single estimate for the cost of registry operations is not feasible; costs will vary on the basis of factors that may be beyond the control of the registries. Some factors, such as data collection approach, can be modified to improve the efficiency of registry operations. These findings will inform both future economic data collection using a web-based tool and cost and cost-effectiveness analyses of registry operations in low- and middle-income countries (LMICs) and other locations with similar characteristics.

Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries

BACKGROUND The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. METHODS Using the Centers for Disease Control and Preventions (CDCs) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). RESULTS Host institution contributions accounted for 30%-70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US

Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors.

3.77 to US

Research for Actionable Policies: implementation science priorities to scale up non–communicable disease interventions in Kenya

15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US

Uganda experience—Using cost assessment of an established registry to project resources required to expand cancer registration

41.28 to US

Economic evaluation of Mumbai and its satellite cancer registries: Implications for expansion of data collection

113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US

Estimating the cost of operating cancer registries: Experience in Colombia

0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US

Economic analysis of the Nairobi Cancer Registry: Implications for expanding and enhancing cancer registration in Kenya

0.22] in Pasto, Colombia. CONCLUSION This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings.

Barriers to screening, diagnosis, and treatment of oral cancers in India:

Introduction The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients’ ability to pay for the services. Methods and findings We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center—a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets. Results compare public and private costs in U.S. dollars. NCD screening costs ranged from

Financial barriers to oral cancer treatment in India

4 to