In sub-Saharan Africa (SSA) more people die of cancer than malaria or tuberculosis each year.(1) The World Health Organization estimates that cancer deaths in the region will increase by 85% over the next 15 years, with an estimated 1 million people in SSA dying of cancer annually.(1) While the most common cancers in SSA, (including breast, cervical and prostate tumors) are treatable, it is estimated that less than 10% of cancer patients receive treatment—even simple pain relief. This public health challenge is driven in part by a poorly functioning chemotherapy market. Countries in Africa have limited access to cancer treatments that have been used in high-income countries (HICs) for decades and they often suffer from persistent stock-outs of vital therapies. When available therapies are often unaffordable for most patients, this leads to a proliferation of counterfeit cancer drugs sold at premium prices, as was seen during the HIV/AIDs epidemic.
In late 2016, the philanthropic programme IBM Health Corps, the American Cancer Society (ACS) and the Clinton Health Access Initiative (CHAI) collaborated to remove market inefficiencies in the chemotherapy supply chain and improve affordability, access and quality to cancer treatment in SSA, taking lessons learned from the HIV/AIDS epidemic. IBM Health Corps and ACS developed and deployed ChemoQuant, a chemotherapy forecasting tool to help countries quantify their cancer treatment needs, prepare budgets and plan procurement, allowing for competitive pricing negotiations based on volumes, and in turn less stock-outs of medication. However, accurate forecasting for cancer therapies has some major challenges.
Forecasting in HICs is based largely on historical demand data collected over many months, years and decades. In SSA, there is limited data on cancer treatment demand. Additionally, cancer is not just one disease; the many different cancer types are each treated with different approaches, combining a variety of therapies together into regimens. This makes forecasting therapy demand much more challenging as medicines may be used across several cancer types and their use depends on the stage of the disease.
The ACS and IBM teams worked on developing a new model for chemotherapy forecasting centered on epidemiology that would produce a more accurate result based on the local population and cancer practice variation. ChemoQuant was built by bringing together cancer registry data on the distribution of expected cancer types and cancer stages in the specified population, with National Comprehensive Cancer Network (NCCN) and local guidelines for evidence based treatment pathways for the cancer type and cancer stage.
Each step of the ChemoQuant tool provides the user with evidence-based insight, but allows flexibility to adjust the forecast to align with local patient distributions and practice variations. It allows users to first forecast the expected number of patients to be treated for cancer for a given timeframe and for a given region based on historical data and future projections. The distribution of patients diagnosed with each cancer type and specific cancer characteristics, outlined by the NCCN, is then forecast using the Globocan dataset, local cancer registry data, if available, and published literature. Once the distributions within each cancer are finalised, ChemoQuant can calculate the number of patients predicted for each subtype of cancer and a list of treatment regimens required, which can be tailored to the local context. Finally, ChemoQuant calculates the total number of patients who will receive each drug and the total number of packs or vials needed to treat the volume of patients estimated. This information is summarised in reports and local and regional supplier data is given to estimate costs.
To add to these efforts, in June 2017, the ACS and CHAI agreed two separate groundbreaking market access agreements with Pfizer Inc. and Cipla Inc. to expand access to 16 essential cancer treatment medications, including chemotherapies, in Ethiopia, Nigeria, Kenya, Uganda, Rwanda and Tanzania. An estimated 44% of all cancer cases that occur in SSA each year occur in these six countries (1). The agreements will set competitive prices on the medicines, thus allowing African governments to realise substantial savings while improving the quality of available treatment.
With the increasing burden of cancer in SSA, we must ensure that every patient has access to timely and affordable care and is given the chance to survive and thrive. We hope that the model of collaboration underpinning the creation of ChemoQuant will serve as a template for a new approach to problem solving not just in cancer, but also in other fields where worldwide health disparities exist.
IBM Corporate Citizenship is the corporate responsibility and philanthropic arm of IBM focused on tackling pressing social and environmental issues across the world by leveraging IBM experts and technology. For more information about IBM Health Corps please visit www.ibmhealthcorps.org. Health Corps will be accepting proposals from organizations interested in working with IBM to tackle health disparities using data, technology, and design until February 13, 2018.
1. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 [Internet]. 2014 [cited 2014 May 12]. Available from: http://globocan.iarc.fr/Default.aspx
2. Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol. 2010 Feb;11(2):165–73.
3. World Health Organization. Global health estimates summary tables: Projection of deaths by cause, age and sex, by World Bank income group and WHO Region [Internet]. Geneva, World Health Organization; 2013 [cited 2017 Apr 28]. Available from: http://www.who.int/healthinfo/global_burden_disease/projections/en/
4. Institute for Health Metrics and Evaluation. Financing Global Health 2016: Development Assistance, Public and Private Health Spending for the Pursuit of Universal Health Coverage [Internet]. IHME, Seattle, WA; 2016 [cited 2017 Apr 28]. Available from: http://www.healthdata.org/sites/default/files/files/policy_report/FGH/2017/IHME_FGH2016_Technical-Report.pdf
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