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Finding 1:Latin America has substantial room

to improve cancer care

Improving cancer outcomes:Key reforms

people will develop cancer in 2020 alone, leading to

Costs to publichealth systems

While global cancer deaths are rising, age-standardized cancer death rates are falling

The relative number of deaths is nearly double that of the US and other developed countries, due to insu�cient access to prevention, screening and key treatments like immunotherapy and precision radiotherapy.

Countries with strong decision-making systems, that leverage the best data, evidence and guidelines, will lower mortality

Health Technology Assessment agencies (HTAs) evaluate

cost-e�ectiveness. Argentina, Brazil and Mexico actively use HTAs for drug

approval and funding but regionally these are often absent or under-resourced.

Cancer care registries guide planning. Latin America has roughly 90, covering 20% of the population. Only 7% have

high quality information.

Mexico has the strongest vital registration data of the EIU’s study.

Cancer control plans provide strategic vision but only 11 out of out of

19 Latin American countries had cancer control plans

Peru’s Plan Esperanza integrates services and includes

marginalised groups.

Global death rates from cancer declined 17% between from 1990 to 2016. Cancer deaths, rate and age-standardized rate index, World Index of absolute number of

cancer deaths, the all ages death rate (measured as the number of deaths per 100,000) and age-standardized death rate (assuming a constant population age structure). Figures are indexed to the year 1990, where deaths and rates in 1990 are equal to 100.

1 milliondeaths.

regional increase in cancer incidence by 2030

Direct costs of lung cancer in the region

Annual cost of prostate cancer in Brazil by 2022, a 50% increase

ranges from 42% (Brazil) to 61% (Bolivia) among countries in this study

67%67%

$1.36bn$1.36bn $1.8bn$1.8bn

17%17%

1.7million

Health spending is low relative to GDP.

South America’s spending on cancer care is 0.125% of gross national income per capita (ranging from 0.06% in Venezuela to 0.29% in Uruguay) as compared with 0.51%, 0.6%, and 1.02% for the United Kingdom, Japan, and the US.

Ministries of Health

(& National Cancer Institutes)

RegulatoryBodies

HTA Bodies

Academic Partners

Payers and SocialSecurity

Legal Systems ( Judicialisation)

Regional & International

Bodies

Strengthen population-based cancer registries

Encourage data-sharing between government, pharmacies, hospitals and companies.

Support HTAs to accommodate emerging therapies

Develop evidence-based clinical guidelines

Twinning with global centres of excellence can improve sharing of best practices

Countries can lower costs by pool-purchasing drugs

NGOs can drive progress in fighting tobacco and supporting program monitoring

Greater academic participation can support policy; >80% of researchers in Argentina have

never contributed to decision-making but over 90% would like to.

0.125%South America1.02%

US

1990 1995 2000 2005 2010 20160

20

40

60

80

100

120

140

Total deaths

Death rate(all ages)

Death rate(age-standardized)

Source: OurWorldinData based on IHME, GBD CC BY

100

83

1990 2016

70%60%50%40%30%20%10%0%

All-Cancer Mortality-to-Incidence Ratios, 2018.

Argentina

Bolivia

Brazil

Chile

Colombia

Mexico

Panama

Peru

USA

Canada

Latin America (average)

Global(average)

The decision-makers

0.6%Japan

49%

Chile’s mortality- to-incidence ratio

compared to peer average of 23%.

Nodes ofdecision-making

Existingsources

Foundation

Informed decision-makers, institutions and processes

Robust Data

A model for understanding cancer care decision-making.

Population-based cancer

registries

Interoperableelectronic health

records

Real-world andclinical evidence

Balanceddecisioncriteria

Healthtechnologyassessment

Economicevaluation

Cancer controlplans

Care standardsand guidelines

Incentives

E�ective Assessment

Integrationinto care

Multi-stakeholder collaboration

Managing misperceptions, bias and influence

Cancer care in Latin America:Closing the gapLatin America's health systems are failing to support cancer patients, leading to high mortality rates. The Economist Intelligence Unit, sponsored by Varian, examines the key decisions that determine care quality and outcomes.

Latin America and the Caribbean is set for rising cancer incidence in the

coming decade

© The Economist Intelligence Unit, 2019

Cancer control:

Prudent investment

Greater collaboration

Invest in data and clinical protocols

In Argentina, fewer than half of patients withliver cancer received recommended treatment

Country Decision-MakingEnvironment

Brazil Moderately Strong

Chile Moderate

Moderate

Moderate

Moderately Weak

Moderately Weak

Weak

Weak

IncomeGroup

Upper-Middle Income

High-Income

Upper-Middle Income

Upper-Middle Income

Upper-Middle Income

Upper-Middle Income

High-Income

Lower-Middle Income

Mexico

Colombia

Argentina

Peru

Panama

Bolivia

Summary ranking of enabling environments for cancer caredecision-making

Weak

Moderately weak

Moderately strong

Moderate

Not studied

Decision-making environments for optimisation of cancer care.

Overview of enablers and resisters to evidence-based decision-making for cancer care in Latin America.

Enablers Resistors

RobustData

Data Sources: Prioritisation of quality improvement and expansion of population-based cancer registries, electronic health records, and other sources of quality health data to inform more strategic decisions

Research: Strong health services research and public health workforce in the region to be better integrated into decision-making processes

Research: Research agenda often dictated by foreign donors which makes it di�cult to focus on regional priorities

Data Sources: Limited information in terms of real world evidence causes decisions to be made from “10,000 feet away”’ and make it challenging to hold decision-makers accountable

E�ectiveAssessment

Health technology assessment infrastructure: Growing regional collaboration for health technology assessments and other forms of assessment through RedETSA, ICES, ICES, LatAm HTAi Policy Forum, etc.

Workforce capacity: Emergence of educational programs and curriculum in medical training for health technology assessments, pharmacoeconomics, economic evaluations, etc.

Segmentation: Disparate agencies and bodies cause confusion and delay in health technology assessments and other assessments, with some agencies lacking independence

Judicialisation: In countries with rights to health, courts frequently do not consider cost-e�ectiveness analyses, health technology assessments, or resource allocation assessments already conducted in decisions

Integrationinto care

Planning: National cancer control plans largely in e�ect or being developed, with building recognition of their value

Localisation: Growing recognition of the value of localised cancer guidelines

Collaboration: Stronger inter-institutional and regional multi-stakeholder collaboration across the region to solve common challenges

Equity: Centralisation of cancer resources in large urban areas creating access issues for rural population

Fragmentation: Complex bureaucracy and regulation caused by fragmented health systems

Influences: Conflicting interests, misperceptions, and fragmentation influence decision processes, particularly in the absence of accessible, high-quality data

Immunotherapy and targeted agents are una�ordable to most patients in the region.

Six countries across the region of Latin America lack access to radiotherapy, a key treatment at curative and palliative stages. Across eight countries in the EIU study, coverage is only 50-75% of the need, with significant disparities between urban and rural.

0.51%United Kingdom

42%61% BrazilBolivia