Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis
Objectives This study aimed to quantify the health system cost of the first 2 years of a Breast Cancer Early Detection (BCED) programme in a rural district in Rwanda. We also aimed to estimate the cost of implementing the programme in other districts with different referral pathways and identify opp...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e062357.full |
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| author | Lydia E Pace Lawrence N Shulman Jean Claude Mugunga Parsa Erfani Kayleigh Pavitra Bhangdia Rashidah Nambaziira Lysa Carolle Niteka Jean Marie Vianney Dusengimana John Ruhumuriza Marie Louise Uwineza Vestine Rugema Cyprien Shyirambere Melany Rabideau |
| author_facet | Lydia E Pace Lawrence N Shulman Jean Claude Mugunga Parsa Erfani Kayleigh Pavitra Bhangdia Rashidah Nambaziira Lysa Carolle Niteka Jean Marie Vianney Dusengimana John Ruhumuriza Marie Louise Uwineza Vestine Rugema Cyprien Shyirambere Melany Rabideau |
| author_sort | Lydia E Pace |
| collection | DOAJ |
| description | Objectives This study aimed to quantify the health system cost of the first 2 years of a Breast Cancer Early Detection (BCED) programme in a rural district in Rwanda. We also aimed to estimate the cost of implementing the programme in other districts with different referral pathways and identify opportunities for enhanced cost efficiency.Design Retrospective, cross-sectional analysis using time-driven activity-based costing, based on timed patient clinical encounters, retrospective patient data and unit costs of resources abstracted from administrative and finance records.Setting The BCED programme focused on timely evaluation of individuals with breast symptoms. The study evaluated the health system cost of the BCED programme at seven health centres (HCs) in Burera district and Butaro Cancer Centre of Excellence (BCCOE) at Butaro District Hospital.Outcome measures Health system costs per patient visit and cost per cancer diagnosed were quantified. Total start-up and recurring operational costs were also estimated, as well as health system costs of different scale-up adaptations in other districts.Results One-time start-up costswere US$36 917, recurring operational costswere US$67 711 and clinical costswere US$14 824 over 2 years. Clinical breast examinations (CBE) at HCs cost US$3.27/visit. At BCCOE, CBE-only visits cost US$13.47/visit, CBE/ultrasound US$14.79/visit and CBE/ultrasound/biopsy/pathology US$147.81/visit. Overall, clinical cost per breast cancer diagnosed was US$1482. Clinicalcost drivers were personnel at HCs (55%) and biopsy/pathology supplies at BCCOE (46%). In other districts, patients experience a longer breast evaluation pathway, adding about US$14.00/patient; this could be decreased if ultrasound services were decentralised.Conclusion Clinical costs associated with BCED services at HCs were modest, similar to other general outpatient services. The BCED programme’s start-up and operational costs were high but could be reduced by using local trainers and virtual mentorship. In other districts, decentralising ultrasound and/or biopsies to district hospitals could reduce costs. |
| format | Article |
| id | doaj-art-36d921aa50b94133936036d801c205e9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-36d921aa50b94133936036d801c205e92025-02-01T10:45:11ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-062357Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysisLydia E Pace0Lawrence N Shulman1Jean Claude Mugunga2Parsa Erfani3Kayleigh Pavitra Bhangdia4Rashidah Nambaziira5Lysa Carolle Niteka6Jean Marie Vianney Dusengimana7John Ruhumuriza8Marie Louise Uwineza9Vestine Rugema10Cyprien Shyirambere11Melany Rabideau124 Medicine, Brigham and Women`s Hospital, Boston, Massachuset, USADepartment of Medicine (Hematology - Oncology Division), University of Pennsylvania, Philadelphia, Pennsylvania, USAMonitoring, Evaluation and Quality Improvement, Partners In Health, Arlington, Massachusetts, USAHarvard Medical School, Boston, Massachusetts, USA2 Institute for Health Metrics and Evaluation, Seattle, Washington, USAUniversity of Global Health Equity, Butaro, RwandaUniversity of Global Health Equity, Butaro, RwandaPartners In Health, Butaro, RwandaPartners In Health, Butaro, RwandaRwanda Ministry of Health, Butaro, RwandaRwanda Ministry of Health, Butaro, RwandaPartners In Health, Butaro, RwandaUniversity of Global Health Equity, Butaro, RwandaObjectives This study aimed to quantify the health system cost of the first 2 years of a Breast Cancer Early Detection (BCED) programme in a rural district in Rwanda. We also aimed to estimate the cost of implementing the programme in other districts with different referral pathways and identify opportunities for enhanced cost efficiency.Design Retrospective, cross-sectional analysis using time-driven activity-based costing, based on timed patient clinical encounters, retrospective patient data and unit costs of resources abstracted from administrative and finance records.Setting The BCED programme focused on timely evaluation of individuals with breast symptoms. The study evaluated the health system cost of the BCED programme at seven health centres (HCs) in Burera district and Butaro Cancer Centre of Excellence (BCCOE) at Butaro District Hospital.Outcome measures Health system costs per patient visit and cost per cancer diagnosed were quantified. Total start-up and recurring operational costs were also estimated, as well as health system costs of different scale-up adaptations in other districts.Results One-time start-up costswere US$36 917, recurring operational costswere US$67 711 and clinical costswere US$14 824 over 2 years. Clinical breast examinations (CBE) at HCs cost US$3.27/visit. At BCCOE, CBE-only visits cost US$13.47/visit, CBE/ultrasound US$14.79/visit and CBE/ultrasound/biopsy/pathology US$147.81/visit. Overall, clinical cost per breast cancer diagnosed was US$1482. Clinicalcost drivers were personnel at HCs (55%) and biopsy/pathology supplies at BCCOE (46%). In other districts, patients experience a longer breast evaluation pathway, adding about US$14.00/patient; this could be decreased if ultrasound services were decentralised.Conclusion Clinical costs associated with BCED services at HCs were modest, similar to other general outpatient services. The BCED programme’s start-up and operational costs were high but could be reduced by using local trainers and virtual mentorship. In other districts, decentralising ultrasound and/or biopsies to district hospitals could reduce costs.https://bmjopen.bmj.com/content/12/6/e062357.full |
| spellingShingle | Lydia E Pace Lawrence N Shulman Jean Claude Mugunga Parsa Erfani Kayleigh Pavitra Bhangdia Rashidah Nambaziira Lysa Carolle Niteka Jean Marie Vianney Dusengimana John Ruhumuriza Marie Louise Uwineza Vestine Rugema Cyprien Shyirambere Melany Rabideau Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis BMJ Open |
| title | Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis |
| title_full | Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis |
| title_fullStr | Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis |
| title_full_unstemmed | Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis |
| title_short | Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis |
| title_sort | health system costs of a breast cancer early diagnosis programme in a rural district of rwanda a retrospective cross sectional economic analysis |
| url | https://bmjopen.bmj.com/content/12/6/e062357.full |
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