Abstract
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. 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 (€). 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). 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. UK Research and Innovation Global Challenges Research Fund: Research for Health in Conflict-Middle East and North Africa region (R4HC-MENA).
Highlights
In 2017, the UN Refugee Agency (UNHCR) recorded 68·5 million people of concern worldwide,[1] including 25·4 million refugees, 40·0 million internally displaced persons, and 3·1 million people seeking asylum
We considered using the density of radiotherapy equipment as a predictor of cost, but EUROSTAT data are reported from 2015 onwards and data were missing for seven countries; it was excluded.[23]
For prediction purposes, log-transformed gross domestic product (GDP) and log-transformed total population size values were included in the models
Summary
In 2017, the UN Refugee Agency (UNHCR) recorded 68·5 million people of concern worldwide,[1] including 25·4 million refugees, 40·0 million internally displaced persons, and 3·1 million people seeking asylum. The traditional humanitarian and refugee health response has focused on the provision of health-care services to address communicable diseases.[3] The millions of refugees and internally displaced persons moving in and out of war zones through the Middle East, Asia, and Europe illustrate the need to refocus the health response on NCDs. Among NCDs, cancer represents a particular challenge.[4] is it a leading cause of mortality, but the trajectory of care for many types of cancer requires a robust health system that can deliver and coordinate a wide range of services, such as screening programmes, diagnostic services, palliation, or treatment with surgery, radiotherapy, or chemotherapy.[5]
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