OP0007 What if all cancer patients in Malaysia had access to the best available care: How many deaths are avoidable?

Abstract

Background Malaysia spends 4% of its gross domestic product (GDP) on health care despite its wealth (GDP per head in 2011 was PPP-US$15,589). There are no data for Malaysia’s spending on cancer care, only on anti-cancer medicines, which amounted to US$ 1900 per cancer patient (IMS 2012). By contrast, Australia spent US$ 4800 per patient. This could be one factor affecting cancer mortality; GLOBOCAN12 reported a mortality-to-incidence ratio of 60% for Malaysia (49% for breast cancer [BC]), whereas the corresponding ratio for Australia was 30% (16% for BC). This underinvestment in cancer care in Malaysia could be due to various reasons. There is room to improve our understanding and appreciation of the economic and health benefits of cancer care. Evidence of the potential effect of adequate cancer services on the health of the nation will help in the revision of priorities. To make the health benefits of cancer care more tangible, we aimed to estimate the number of deaths due to BC that would be avoidable if all Malaysian patients had access to the care provided by leading centres in Malaysia. Methods The number of avoidable deaths is the difference between the number of deaths estimated by GLOBOCAN12 and the expected number of deaths if all BC patients had experienced the age-ethnic-stage specific survival outcomes observed in leading cancer treatment centres in Malaysia. Data for age-ethnic-stage composition of the general BC population were from local cancer registries and public hospitals providing safety net services. Findings Of the 2572 deaths due to BC reported by GLOBOCAN12, 1299 (50%) were avoidable. Of these avoidable deaths, 647 (50%) were attributable to late-stage presentation and 652 (50%) were due to lack of access to optimum treatment. Interpretation Avoidable premature deaths were high in Malaysia, consistent with its high cancer mortality rate. Avoidable deaths were equally attributable to lack of early detection and access to treatment.