Toward Expanded Access to Cancer Care With Cost Awareness: An Optimization Modeling Analysis of Rwanda.

Purpose: Cancers are a growing cause of mortality especially in low- and middle-income countries in Africa. Rwanda is no exception. Two cancer centers currently provide care to the public, but there are both political and human interest in expanding access to tertiary cancer care. Improved geographic access could lead to both better patient outcomes and a better understanding of the existing cancer burden across Rwanda.

Methods: To identify cost-aware ways of expanding geographic access, we adopt an optimization approach and identify expansion plans that minimize the average travel time to a cancer center across the country while remaining under a given monetary budget.

Results: Three additional hospitals could reduce average travel times by 40%, with the largest decrease in travel times observed in populations with long travel times. However, such an expansion would require a 50% increase in the number of in-country oncologists. We find that oncologist scarcity, as opposed to monetary constraints, is likely to be a limiting factor for improved access to cancer care.

Conclusion: We present an array of expansion plans and suggest that further modeling approaches that incorporate oncologist scarcity can help deliver better policy recommendations.