The cost of providing high-quality radiotherapy services in a resource-limited setting: A case study of the Cameroon Oncology Center

Background : Understanding the cost of delivering radiotherapy in a resource-limited setting such as Cameroon in sub-Saharan Africa (SSA) is critical not only for expanding radiotherapy services in low- and middle-income countries (LMICs) but also for shaping future policy decisions. The Cameroon Oncology Center (COC), a privately owned oncology center located in Cameroon, has treated over 1000 patients on its sole medical linear accelerator since it began clinical operations in 2019. This work aimed to determine the operating cost estimate for providing radiotherapy in a private oncology center in the Republic of Cameroon, a study that could significantly impact and shape urgent policy decisions in the healthcare sector in this region. Methods : This cost estimate was calculated based on our experience over the course of one calendar year, specifically 2021. We focused on the ongoing operating costs of the radiotherapy facility, excluding capital expenditures (building and equipment). Our calculations assumed that 300 patients were treated in 2021, a number that did not significantly affect the ongoing operating costs, even though only 215 patients received radiation therapy at our institution that year. These assumptions were made to provide a comprehensive estimate of the operating costs, ensuring a high level of transparency and trust in our methodology. Results and conclusion : The average operating cost per patient was approximately $1750·00 for curative intent radiotherapy, which consisted of at least 25 fractions. The top three drivers of operating costs are labor at 41·1%, linear accelerator parts and service cost (17·7%), and power (14·8%). For a public radiotherapy facility, the minimum cost to patients is $1750 (1.1 million FCFA in the local currency) per course of curative radiotherapy. If one factor in the repayment plan (capital costs) is amortized for 12 years, the total cost per patient would be currently $3651 or 2.2 million FCFA locally. These findings highlight the need for cost-effective strategies to maintain high-quality radiotherapy services in LMICs.