Cancer control tools to
support costing cancer plans and benefit packages
Dr Melanie Bertram Dr Elena Fidarova Dr Cindy Gauvreau
Dr Scott Howard Dr. André Ilbawi Dr Ben Anderson
Dr Felipe Roitberg
Dr Sandra Luna-Fineman Dr Filip Meheus
Dr Roberta Ortiz Dr. Dario Trapani
Mr. Rory Watts
Context of WHO Cancer Priority Setting Tools
WHA70.12
2
Recalling also
United Nations Gen eral Assem
bly resolution 66/2 (2011
) on the
Political Declaration
of the High-level Meeting of the Gen
eral Assem bly on
the Prev ention
and Control of Non-communi
cable Diseases, which inc
ludes a ro ad map of
nationa l com
mitments from Heads of State and Governm
ent to address cancer and oth
er noncommuni cable dise
ases;
Recalling fur ther resolution
WHA66.10 (2013 ) endorsing the glob
al action plan for the prevention
and control of nonco mmuni
cable dise ases 2013
–2020, which provides guidance on how Member States can realize the co
mmitments they mad e in the Po
litical Declaration of the High-level Meeting
of the Gen eral
Assem bly on
the Prev ention an
d Cont rol of
Non-communi cable Dise
ases, includi
ng those related
to addr essing
cancer;
Recalling in addition
United Nations Gen eral Assembly res
olution 68/300
(2014) on the Outcome documen
t of the high-level m eeting
of the Gen eral Assembly on
the com prehensi
ve review and assessment of the prog
ress achiev ed in
the prevention and control of
non-communi cable dise
ases, which
sets out the continue d and incr
eased
commitments that are essential
in order to realize the road map of co
mmitmen ts to addr
ess cancer and othe r noncommunicabl
e diseases included in the Political Declaration
of the High-level Meeting of the Gen
eral Assem bly on
the Prev ention
and Control of Non-communi
cable Di seases
, including four time-bound national commitments for 2015 an
d 2016;
Mindful of the ex isting
moni toring tool that WHO
is usi ng to track
the extent to which
its 194 Me
mber Stat es are implem
enting these four time-bound
commitm ents to address can
cer an d other nonco
mmuni cable dise
ases, in acc ordan
ce with the techni
cal note1 pub lished
by W HO on
1 May 2015 pursuan
t to decision EB136(13) (2015
);
Mindful also of the W
HO Fram ework Conv
ention on Tobacc o Cont
rol;
Also mindf ul of
the Sust ainable Developm
ent Goals of the 2030 Agenda for Sustainable Developm
ent, sp ecifically Goal 3 (Ensur
e healthy lives and prom
ote wel l-being for
all at all ages) with its ta
rget 3.4 to reduce, by
2030, prem ature mor
tality from noncommuni
cable diseases by one th
ird, and target 3.8 on achieving
universal hea lth coverage;
Appreciating the efforts made by Me
mber States2 and inter
national pa rtners in
recent years to prevent an
d cont rol cancer, but
mindf ul of the nee
d for further action;
Reaffirming the global strategy and plan of action on pub
lic health, innov ation
and intellectual prope
rty;
Reaffirm ing also
the rights of Mem ber Sta
tes to the full use of the flex
ibilities in the WTO Agreemen
t on Trade -related Aspects of the
Intellectual Pro perty Rights (TRIPS) to
increase access to affordable, sa
fe, effective and qua lity m
edicines, noting that, inter alia, intellectua
l property rights are an impor
tant incent ive in the
developm ent of new
health prod ucts,
1 Available
at http://www.who.int/nmh/events/2015/technical-note-en.pdf?u
a=1 (accessed 19 May 2017).
2 And, where applicable, regional econom
ic integ ration organizations.
SEVENTIETH WORLD HEALTH ASSEMBLY
WHA70.12
Agenda item 15.6
31 May 2017
Canc er pre ventio n and contr ol in t he co ntext of an int egrat ed ap proac h
The Seventieth World Health Assembly,
Having considered the report on cancer prevention and control in the context of an integrated approach;1
Acknowledging that, in 2012, cancer was the second leading cause of death in the world with 8.2 million cancer-related deaths, the majority of which occurred in low- and middle-income
countries;
Recognizing that cancer is a leading cause of morbidity globally and a growing public health concern, with the annual number of new cancer cases projected to increase from 14.1 million in 2012
to 21.6 million by 2030;
Aware that certain population groups experience inequalities in risk factor exposure and in access to screening, early diagnosis and timely and appropriate treatment, and that they also experience poorer outcomes for cancer; and recognizing that different cancer control strategies are
required for specific groups of cancer patients, such as children and adolescents;
Noting that risk reduction has the potential to prevent around half of all cancers;
Aware that early diagnosis and prompt and appropriate treatment, including pain relief and palliative care, can reduce mortality and improve the outcomes and quality of life of cancer patients;
Recognizing with appreciation the introduction of new pharmaceutical products based on investment in innovation for cancer treatment in recent years, and noting with great concern the
increasing cost to health systems and patients;
Emphasizing the importance of addressing barriers in access to safe, quality, effective and affordable medicines, medical products and appropriate technology for cancer prevention, detection, screening diagnosis and treatment, including surgery, by strengthening national health systems and international cooperation, including human resources, with the ultimate aim of enhancing access for
patients, including through increasing the capacity of the health systems to provide such access;
Recalling resolution WHA58.22 (2005) on cancer prevention and control;
1 Document A70/32.
• Develop resource-stratified tool kits to establish and implement comprehensive programmes… leveraging work of other organizations
OP1
• Collect, synthesize and disseminate evidence on the most cost-effective interventions…and to make an
investment case for cancer
OP2
• Strengthen the capacity of the Secretariat to support implementation of cost-
effective interventions and country- adapted models…
OP3
(2) Member State Mandate
Set priorities / define UHC benefit package
>90% inefficiency in expenditure, breast ca
not included in UHC
Anticipates budget needs (eg, costs)
Only 10% MS cost cancer plans
Determines health system requirements
(eg, workforce)
>70% LMIC lack cancer system capacity
Generate business plan
No platform for national cancer business plans
(1) Meeting
Government Needs
Figure: Financial catastrophe due to the costs of
cancer treatment Source: Jan et al. 2018. Lancet 391(10134):2047-2058; Rajpal et al. 2018. PLoS ONE 13(2):
e0193320; Hoang 2017, BioMed Res Int, https://doi.org/10.1155/2017/9350147
• Large out-of-pocket spending puts a heavy burden on families, especially the poor; risk of
impoverishment due to catastrophic health spending.
• In many countries, patients bear the cost for
diagnosis and treatment of cancer and for those that can’t bear the cost they forgo treatment.
China 21%
Myanmar
India 50%
60%
Vietnam
57% Philippines Thailand 56%
24%
Indonesia 44%
Malaysia 45%
Iran 68%
Financial burden of cancer to households
Context of WHO Cancer Priority Setting Tools
WHA70.12
2
Recalling also
United Nations Gen
eral Assem
bly resolution 66/2 (2011
) on the
Political Declaration
of the High-lev el Me
eting of th
e Gen eral Assem
bly on the Prev
ention and C
ontrol of Non-communi
cable Diseases , which inc
ludes a road map of
nationa l com
mitments from Heads
of State and Gov
ernment to addr ess cancer an
d oth er noncom
municabl e diseases;
Recalling fur
ther resol ution
WHA66.10 (2013 ) endor
sing the glob al action
plan for the prevention
and co ntrol of nonco
mmuni cable
diseases 2013 –2020, which
provides guidan ce on how Member Stat
es can rea lize
the co mmitmen
ts they mad e in the Po
litical Dec laration
of the High-level Meeting
of the Gen eral Assem
bly on the Prev
ention an d Cont
rol of Non-com
municabl e Dise
ases, includi
ng those related
to addr essing
cancer;
Recalling in
addition United
Nations General
Assembly res olution
68/300 (2014)
on the Outcom
e documen
t of the high-level m eeting
of the Gen eral Assem
bly on the com
prehensi ve review and assessm
ent of the progress achiev
ed in the prevention
and control of non-communi
cable dise ases, which
sets out the continue d and increased
commitments that are ess
ential in order to
realize the road map of co
mmitments to
address cancer and other non
communi cable dise
ases included in the Political Declaration
of the High-level Me
eting of the Gen
eral Assem bly on
the Prev ention
and C ontro
l of Non-com
municable Di seases
, including fou r tim
e-bound national commitments
for 2015 an d 2016;
Mindful of the ex isting
moni toring tool
that WHO is usi
ng to track the exten
t to which its 194 Me
mber Stat es are
implem enting the
se four time-bound
commitments to ad dress can
cer an d other nonco
mmuni cable dise
ases, in accordan
ce with the techni
cal note1 pub lished
by W HO on
1 May 2015 pursuan
t to decision EB136 (13) (2015
);
Mindful also of the W
HO Framewo rk Conv
ention on Tobacc o Cont
rol;
Also mindf
ul of the Sust
ainable Developm ent Goals
of the 2030 Agenda for
Sustainable Developm
ent, sp ecifically G
oal 3 (Ensur e healthy lives
and prom ote wel
l-bei ng for
all a t all ages) with its ta
rget 3.4 to reduce, by
2030, prem ature mor
tality from nonco
mmuni cable dise
ases by o ne third, and tar
get 3 .8 on ach
ieving universal hea
lth coverage;
Appreciating th e efforts m
ade by Me mber States2
and internationa l partners in
recent yea rs to prevent an
d control ca ncer, but
mindf ul of the nee
d for further action;
Reaffirm ing th
e glob
al strategy and plan of
action on pub lic hea
lth, innov ation
and intellectual prope
rty;
Reaffirm ing also
the rights of Mem
ber Sta tes to
the full use of th
e flex ibilities in
the WTO Agreemen
t on Trade
-related Aspec ts of the Intel
lectual Pro
perty Rights (TRIPS
) to increase access to
affordable, sa fe, ef
fective and qua lity m
edicines, noting that, int
er alia, intellectua
l prop erty right
s are an impor
tant incent ive in the
developm ent of new
health prod ucts,
1 Available at http://www
.who.int/nmh/ev ents/2
015/techn ical-n
ote-en .pdf?u
a=1 (access ed 19
May 2017).
2 And, where applicable, re
gional econom ic integ
ration organiza tions.
SEVENTIETH WORLD HEALTH ASSEMBLY
WHA70.12
Agenda item 15.6
31 May 2017
Canc er pre ventio n and contr ol in t he co ntext of an int egrat ed ap proac h
The Seventieth World Health Assembly,
Having considered the report on cancer prevention and control in the context of an integrated approach;1
Acknowledging that, in 2012, cancer was the second leading cause of death in the world with 8.2 million cancer-related deaths, the majority of which occurred in low- and middle-income
countries;
Recognizing that cancer is a leading cause of morbidity globally and a growing public health concern, with the annual number of new cancer cases projected to increase from 14.1 million in 2012
to 21.6 million by 2030;
Aware that certain population groups experience inequalities in risk factor exposure and in access to screening, early diagnosis and timely and appropriate treatment, and that they also experience poorer outcomes for cancer; and recognizing that different cancer control strategies are
required for specific groups of cancer patients, such as children and adolescents;
Noting that risk reduction has the potential to prevent around half of all cancers;
Aware that early diagnosis and prompt and appropriate treatment, including pain relief and palliative care, can reduce mortality and improve the outcomes and quality of life of cancer patients;
Recognizing with appreciation the introduction of new pharmaceutical products based on investment in innovation for cancer treatment in recent years, and noting with great concern the
increasing cost to health systems and patients;
Emphasizing the importance of addressing barriers in access to safe, quality, effective and affordable medicines, medical products and appropriate technology for cancer prevention, detection, screening diagnosis and treatment, including surgery, by strengthening national health systems and
international cooperation, including hum
an resources, with the ultimate aim of enhancing access for
patients, including through increasing the capacity of the health systems to provide such access;
Recalling resolution WHA58.22 (2005) on cancer prevention and control;
1 Document A70/32.
