On Wednesday 11 December 2019, the Research for Health in Conflict in the Middle East and North Africa (R4HC-MENA) programme, through consortium partners King Hussein Cancer Center (KHCC) and Imperial College London (ICL), organised a policy roundtable to discuss how economic evidence can inform better cancer spending decisions in Jordan and the MENA region. The meeting brought together clinicians, health systems experts, economists, and decision-makers from a range of Jordanian stakeholders (KHCC, Royal Medical Services, High Health Council, University of Jordan), as well as guest speakers from the World Health Organization (WHO), the Tunisian Authority of Assessment and Accreditation in Healthcare (INEAS) and the London School of Hygiene & Tropical Medicine (LSHTM).
The three thematic sessions of the roundtable explored a wide spectrum of topics, from the epidemiological burden of cancer through to the alignment of cancer control programmes with plans for progress towards universal health coverage. In the first session Dr Omar Nimri (Jordan Cancer Registry) and Dr Asem Mansour (KHCC) explored the magnitude and nuances of cancer burden in Jordan; their perspective was complemented by Dr Deborah Mukherji’s (American University of Beirut Medical Center, Lebanon) outline of the complex cancer care pathways in Lebanon. In the second session, Dr Mohammed Tarawneh’s (Jordan High Health Council) overview of Jordan’s health system priorities was followed by perspectives on the use of economic evidence at the global level (Dr Allison Colbert, WHO) and in the English National Health Service (Prof Kalipso Chalkidou, Imperial College London). Prof Richard Sullivan (King’s College London) concluded the session with an overview of data requirements for better cancer intelligence, particularly in settings affected by conflict and instability. The third session saw deep dives into case-studies of HTA application from Jordan (Dr Abeer Rabaiah, KHCC) and Tunisia (Dr Mouna Jameleddine, INEAS), as well as insights from the English experience of financing anti-cancer drugs (Prof John Cairns, LSHTM).
In the ensuing open discussion, roundtable participants brought to the fore a number of transversal issues, both conceptual and applied. One such issue related to the difficulty of making value for money judgements for cancer treatments in a setting with limited experience and data. What emerged from the discussion was the importance of using available support tools (e.g. guides, toolkits, country case-studies) and starting somewhere, however modestly, as only the practice of conducting and communicating such value assessments can generate awareness and stimulate local capacity.
The richness and breadth of discussions demonstrated the participants’ strong interest both towards using evidence for better cancer spending decisions and also towards learning from relevant institutional experiences, be they regional or global. R4HC’s Political Economy of Health workstream will build on this meeting towards developing more sustained engagement activities with a view to linking researchers, policymakers and clinicians in the region for pro-active co-generation of health economic evidence aligned with local priorities. The case is emerging for a co-developed programme of research around the political economy of cancer, which we will follow on during 2020.
Dr Adrian Gheorghe