Developing a Cost Data Collection Tool for Cancer Registry Planning

This monograph provides information on the costs of running cancer registries in five of the low- and middle-income countries in which CDC’s International Registry Costing Tool (IntRegCosting Tool) was tested.

Glossary

• Cost per case registered: The registry’s total expenses divided by the number of cancer cases.
• Cost per inhabitant: The registry’s total expenses divided by the number of people living in the area it serves.
• Fixed costs: Costs that stay the same, even if the number of cases changes.
• Variable costs: Costs that change as the number of cases changes.
• Core variable costs: Variable costs for activities that are required for the registry to operate.

Overview

This monograph provides information on the costs of running cancer registries in five of the low- and middle-income countries in which CDC’s International Registry Costing Tool (IntRegCosting Tool) was tested. The monograph reported that centralizing fixed costs at a single registry, possibly in a larger urban area, may have been an efficient strategy in at least three of the countries—India, Barbados, and Uganda. In these settings, the registry could be centralized in a larger urban area, and registries in outlying areas could serve as satellite operations.

Estimating how much it costs to register a single case for all registries was not possible because costs varied so much between registries in different countries, and even within the same country. Some of the factors affecting costs could be changed, such as how efficiently data were collected. Other costs were beyond the registries’ control, such as the size of the geographic area served. However, looking over the information across the countries’ experiences, some trends emerged.

• Affiliation with a host institution was helpful for some cancer registries. For example, the Indian Cancer Society hosts the Mumbai cancer registry.
• For registries that had host agencies, the host agency contributed between 30% and 70% of registry funding.
• The cost per cancer case registered in low-income and lower-middle-income countries ranged from $3.77 to $15.62 (all amounts are in 2013 United States dollars).
• In registries in different locations in Colombia, a middle- to higher-income country, the cost per case registered ranged from $41.28 to $113.39.
• The Mumbai registry in India, which serves more than 15 million people, had a lower cost per inhabitant (less than $0.01) than the Pasto, Colombia registry, which serves fewer than 500,000 people ($0.22).
• Electronic reporting and the use of electronic devices to transfer data to registries can lower labor costs.

Colombia

Five local registries provided information about the costs of running cancer registries in Colombia: Barranquilla, Bucaramanga, Cali, Manizales, and Pasto. Costs for registering cancer cases ranged from $41 to $113 per case and $0.05 to $0.22 per inhabitant (all amounts in 2013 United States dollars). The registries in Colombia did not collect the same data about cancer cases or use the same collection methods, which may explain some of the variation in costs. Between 20% and 45% of the total cost was due to fixed-cost activities.

Kenya

The Nairobi County cancer registry provided information about expenses and funding for cancer registries in Kenya. Of total funding, 70% came from grants, research studies, and international organizations. The greatest expenses were for administration, management, and training of staff; collecting the information on cancer cases; and recording and validating the data in the registries.

India

Information about expenses and funding for cancer registries in India came from the central state registry in Mumbai, and from satellite registries in Pune, Nagpur, and Aurangabad. The Indian Cancer Society provided almost 60% of funding for the Mumbai registry, and more than half of its expenses were related to collecting information on cancer cases. For all four registries combined, 93% of the expenses went to labor costs. The cost per case registered was a little less than $4.00.

Barbados

The Barbados Ministry of Health provided 56% of resources for the registries. Labor accounted for more than 70% of fixed costs, with management and administration having the highest costs, followed by the costs for collecting and analyzing the data. The two-year costs for registry operations were $382 per case registered.

Uganda

Cancer registries in Kampala-Kyadondo County, Gulu, and in rural northern Uganda provided information about expenses and funding for cancer registries in Uganda. The Kampala cancer registry used 42% of its budget on fixed-cost activities, 40% on core variable-cost activities, and the remaining 18% for other variable-cost activities. The total cost per case registered was about $10 in 2014 United States dollars. The Gulu cancer registry covers a much larger, mostly rural area, and serves a smaller population than the registry in Kampala. Because this increases the cost of collecting information on cancer cases, the Gulu registry needs as many resources as the Kampala registry to sustain operations.

Citations

This article summary highlights findings in the following papers published in Cancer Epidemiology.

Tangka FKL, Subramanian S, Edwards P, Cole-Beebe M, Parkin DM, Bray F, Joseph R, Mery L, Saraiya M, Cancer registration economic evaluation participants. Resource requirements for cancer registration in areas with limited resources: analysis of cost data from four low- and middle-income countries. Cancer Epidemiology 2016.

de Vries E, Pardo C, Arias N, Bravo LE, Navarro E, Uribe C, Yepez MC, Jurado D, Garci LS, Piñeros M, Edwards P, Cole-Beebe M, Tangka FKL, Subramanian S. Estimating the cost of operating cancer registries: experience in Colombia. Cancer Epidemiology 2016.

Saraiya M, Tangka FKL, Asma S, Richardson LC. Importance of economic evaluation of cancer registration in the resource limited setting: laying the groundwork for surveillance systems. Cancer Epidemiology 2016.

Subramanian S, Tangka FLK, Edwards P, Hoover S, Cole-Beebe M. Developing and testing a cost data collection instrument for noncommunicable disease registry planning. Cancer Epidemiology 2016.

Koyande S, Subramanian S, Edwards P, Hoover S, Deshmane V, Tangka FKL, Dikshit R, Saraiya M. Economic evaluation of Mumbai and its satellite cancer registries: implications for expansion of data collection. Cancer Epidemiology 2016.

Korir A, Gakunga R, Subramanian S, Okerosi N, Chesumbai G, Edwards P, Tangka FKL, Joseph R, Buziba N, Rono V, Parkin D, Saraiya M. Economic analysis of the Nairobi cancer registry: implications for expanding and enhancing cancer registration in Kenya. Cancer Epidemiology 2016.

H Wabinga, Subramanian S, Nambooze S, Amulen P, Edwards P, Joseph R, Ogwang M, Okongo F, Parkin D, Tangka FKL. Uganda experience—using cost assessment of an established registry to project resources required to expand cancer registration. Cancer Epidemiology 2016.

Martelly T, Rose A, Subramanian S, Edwards P, Tangka FKL, Saraiya M. Economic assessment of integrated cancer and cardiovascular registries: the Barbados experience. Cancer Epidemiology 2016.