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NAACCR/IACR Combined Annual Conference Vancouver, BC, Canada June 13, 2019

Costs and Resources used by Population-Based Cancer Registries in the U.S.-Affiliated Pacific Islands. NAACCR/IACR Combined Annual Conference Vancouver, BC, Canada June 13, 2019. Patrick Edwards, MSc. Contributors. Outline. Background & Motivation. Background.

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NAACCR/IACR Combined Annual Conference Vancouver, BC, Canada June 13, 2019

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  1. Costs and Resources used by Population-Based Cancer Registries in the U.S.-Affiliated Pacific Islands NAACCR/IACR Combined Annual Conference Vancouver, BC, Canada June 13, 2019 Patrick Edwards, MSc

  2. Contributors

  3. Outline

  4. Background & Motivation

  5. Background • The Pacific Regional Central Cancer Registry (PRCCR) was established in 2007 in response to the lack of high-quality data collection in the USAPI region. • The PRCCR faces many unique challenges in monitoring the Pacific Region’s cancer burden, including limited resources, geography, and variation in infrastructure/capacity across the jurisdictions. • No study has been conducted on the specific economic costs incurred by central and jurisdictional cancer registries located in the USAPI.

  6. Structure of the U.S.-Affiliated Pacific Islands’ Central and Jurisdictional Registries

  7. US-Affiliated Pacific Islands Registries’ Coverage Area

  8. Age-standardized incidence (per 100,000) for the five major cancers of each sex in the U.S.-Affiliated Pacific Islands, 2007-2014

  9. Need for Costing

  10. U.S. NPCR Registries’ Cost per case by case volume Data from 40 NPCR registries. Excludes data from registries in states also supported by SEER (CA, GA, LA, KY, MI, NJ, WA). Also excludes data from PIJ due to low case volume.

  11. Project Objectives • To estimate jurisdictional, central, and overall cost • Per cancer case registered • Per inhabitant served by cancer registry • To identify sources of support (monetary and nonmonetary) for cancer registries’ operations • To estimate the distribution of registry resources that goes towards budget categories and various cancer registry activities • To identify potential barriers and facilitators to registry operations

  12. Methods

  13. Methods

  14. IntRegCosting Tool • The Web-based IntRegCosting Tool was designed to collect and analyze data on the costs of population-based cancer registries all around the world. • Registry staff were able to input information directly into the Web tool relating to their resources and registry operations and received instant summary reports. • This tool was used to help registries assess their resources required for operation, which can support planning and funding decision making. • The tool was funded by CDC and builds on our experiences and lessons learned from multiple rounds of data collection in the US and in international settings.

  15. Data entry modules

  16. Timeframe • Costs were collected for a 1-year time frame: June 30, 2016 through June 29, 2017. • Registries provided the number of cancer cases that were reported during 2014. • Costs were reported for all 11 registries, although only the registries that performed data collection (all except PRCCR and FSM) reported cancer cases.

  17. Cost-allocation to cancer registry activities

  18. Costing Tool Outputs • Distribution of total registry resources by budget category • Distribution of total registry resources by source type • Distribution of total registry resources by specific & broad activities along with by fixed and variable costs • Cost per cancer case registered and cost per inhabitant served by registry • General registry characteristics

  19. Results

  20. Characteristics of the U.S.-Affiliated Pacific Islands PBCR

  21. U.S.-Affiliated Pacific Islands Registries’ Resources by Source

  22. Resources by Budget Category

  23. Distribution of Resources by Cancer Registry Activity

  24. Cost per Case & Cost per Inhabitant

  25. Key Findings • The total cost per case across all registries was about $1,413 • The total cost per inhabitant was about $1.77 • The USAPI likely faces higher costs per case than other registries because of their unique circumstances as island territories.

  26. Potential Factors Affecting Registries’ Operations

  27. Conclusions • The burden of surveilling a geographic area almost twice the size of the continental United States requires substantial resources to support a large number of satellite registries. • Each registry faces significant fixed costs, including rent for office space and equipment. • Another primary factor driving the higher cost per case among the USAPI registries is likely the small number of cancer cases processed within the USAPI.

  28. Policy Implications

  29. Project Limitations & Strengths Limitations • Estimation of indirect costs • Retrospective data collection Strengths • Use of a validated web-based costing tool • Inclusion of indirect costs and in-kind contributions • Cost and factors entered directly by registry representatives

  30. Thank you to the USAPI cancer registrars and their administrative colleagues for contributing detailed time and cost information for this study!

  31. More Information Patrick Edwards, MSc Health Economist pedwards@rti.org Lee Buenconsejo-Lum, MD PI, PRCCR lbuencon@Hawaii.edu Sujha Subramanian, PhD Fellow Ssubramanian@rti.org Florence Tangka, PhD Senior Health Economist Ftangka@cdc.gov

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