P030 – Prioritizing Cancer Services in Low- And Middle-Income Settings: Challenges and Lessons Learned from Benefits Package Design in Rwanda

Approximately three-quarters of cancer deaths are expected to occur in LMICs by 2030 , and cancer funding from global health donors is disproportionately low compared to other diseases. Many low- and middle-income countries are under increased pressure to cover cancer interventions and include them in their health benefits package (HBP). Rwanda is one country seeking to develop a robust priority-setting system to help navigate choices around cancer services. This session will outline how the Government of Rwanda, academia, and development partners sought to prioritize a set of 40 cancers for its community-based health insurance scheme, within limited resources; and present the results from that prioritization process.

Priority setting for cancer services presents some specific challenges to nascent priority setting systems. First, recommended cancer services for resource-constrained settings focus on cancers which are most prevalent and when caught early, can be treated with curative intent . However, the distinction between treatment with curative intent and palliative intent is opaque and varies by context. Further, rare cancers are often excluded from recommended HBPs, which raises ethical challenges around equity of access. Second, cancer requires complex clinical pathways and treatment options depending on staging, disease mutations, available diagnostics, patient performance and preference, and facility and human resource capacity. While there are globally stratified treatment guidelines for some cancers , defining cancer services in countries with limited capacity is not straightforward. Third, clinical and cost-effectiveness research on cancer is disproportionately undertaken in high-income countries; many of these studies may not be relevant to the health systems, patient characteristics, or drugs available in LMIC settings , leaving considerable evidence gaps.