Childhood cancer can be cured with appropriate diagnosis and therapy in place, but its economic and societal implications can be profound and long-lasting. First, there is the issue of ensuring that effective and cost-effective treatments are available and affordable. Secondly, even when the majority of treatment costs are covered from public funds, there are issues of substantial indirect costs incurred by parents for a number of years (e.g. with accommodation and transportation to and from treatment centres); job disruption leading to lost earnings and, potentially, poverty; strained relationships potentially leading to separation; and increased risk of chronic conditions in adulthood for childhood cancer survivors. As such, health decision-makers everywhere have a lot to consider when designing policies that aim to minimise the impact of childhood cancer. Economic evidence from their own settings is essential to inform these policies, but most of what is available comes from high-income settings.

We set out to understand what type of economic evidence is currently available in the R4HC space – Jordan, Lebanon, Palestine and Turkey – by reviewing the available academic and grey literature. What we found was that some evidence is available, but most of it refers to the availability of treatment inputs, such as medication, human resources, and registry data. Much less is known about how efficiently, effectively, cost-effectively, or equitably inputs are being converted into services and health outcomes. For example, we could not find any cost-effectiveness study examining a therapeutic intervention. We also found only one study quantifying the impoverishing effects on families – although several qualitative studies documented the spectrum of financial implications.

Despite cancer treatment being nominally free or mostly free in all four settings, the absence of economic evidence means it is very difficult to say if existing resources are well spent – in other words, could more be done with the same resources? – and what specifically could be the object of policy change. The knowledge gaps are even more serious for the refugee children receiving treatment, for whom charitable funds play an important role in covering access to care – particularly in Lebanon.

The misalignment between research and policy priorities may explain these knowledge gaps to an extent. Drug pricing is a telling example. Despite limited evidence on drug prices and their impact on the affordability of cancer care or on the efficiency of service delivery in general, the governments of Lebanon and Jordan have reduced list prices several times over the past years, presumably in response to perceiving drug prices as major cost drivers. The limited capacity for health economics research may also be a contributing factor to the limited evidence base.

Strengthening links between researchers and policymakers in Jordan, Lebanon, Palestine and Turkey must be an absolute priority if paediatric cancer spending decisions and treatment outcomes are to improve. Our specific recommendations relate to:

  • evidence generation (e.g., conduct detailed cost analyses and pilot cost-effectiveness analyses),
  • capacity building (e.g. invest in paediatric cancer registries, strengthen local health economics capabilities) and
  • governance (e.g. establish a mechanism that promotes the production and use of evidence for cancer decisions by bringing knowledge producers, knowledge brokers, and knowledge users together).

You can read more in our recent publication here.


Dr. Adrian Gheorghe