The Importance of Investment in Prevention: The Case of Cervical, Colorectal, and Breast Cancer in Low- and Middle-Income Countries

Abstract

The benefits (in terms of cost reduction and DALYs averted) of enhancing prevention and early diagnosis procedures for cervical, colorectal, and breast cancer in low- and middle-income countries (LMICs) are estimated. The study defines a focus person as someone who can develop cancer during his/her life. In each case, a “standard medical protocol” is established to determine the procedures used to screen, early diagnose, and treat the disease. The epidemiological model for each type of cancer is established based on its natural history and on its probability of developing during the person’s life. Each model establishes the relevant medical procedure associated with the development of the disease. The expected cost for each disease is obtained by linking this information with cost data for each procedure. DALYs are determined using the health state valuations reported by the GBD 2004 Update (WHO, 2008). Regional-level estimates are then obtained for each WHO region. Results show that total expected costs from cervical, colorectal, and breast cancer drop significantly as a result of strengthening prevention and early diagnosis. In the case of cervical cancer, the reduction in total costs created by moving from the non-preventive to the preventive scenario ranges from US$ 3.1 billion in region AMRO D to US$ 55.0 billion in region WPRO B. In the case of colorectal cancer, the total cost reduction ranges from US$ 1.3 billion in region AMRO D to US$ 37.0 billion in region WPRO B. Finally, in the case of breast cancer, the total cost reduction ranges from US$ 12 billion in region EMRO D to US$ 365 billion in region WPRO B. The paper also estimates a production possibility frontier for each cancer type, providing a comparison between expected cancer-associated medical costs for preventive scenarios and its economic benefits with an aim to illustrate the locations where public policy focusing on prevention and early diagnosis would have the highest outcomes.