Forecasted Global Brachytherapy Shortfall by 2040: Investments Needed to Overcome this Deficit

• Published in: International journal of radiation oncology, biology, physics Vol. 120; no. 2; pp. e754 - e755
• Main Authors: Gouveia, A.G., Viani, G., DelRosso, D., Marta, G.N., Tsakiridis, T., Quan, K., Hanna, S.A., de Sousa, C.F.P.M., Starling, M.T.M., Silva, M.F., Rosa, A.A., Moraes, F.Y.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-10-2024
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2024.07.1657

Between 2020 and 2040, it is estimated that there will be a significant worldwide increase of 34.1% in the annual incidence of cervical and endometrial cancers. This research assesses the need to enhance existing brachytherapy facilities and the corresponding financial implications to ensure sufficient medical capacity.
The projections for cervical and endometrial cancer cases in 2020 and 2040 were extracted from the GLOBOCAN database. The demand for brachytherapy for these specific cancers was determined using the methodology previously established by Thompson et al. (in 2006 and 2008). Data regarding radiotherapy infrastructure were collected from the DIRAC database. Estimates for the construction and equipment costs required to meet the brachytherapy demand were calculated using the VanDyk model. The economic classification of countries was obtained from the World Bank database. To compare the necessity of expanding brachytherapy services across different income levels, the exact Fisher test was employed, using a one-sided test with alpha set at 0.05.
In 2020, 19 out of 145 countries (13.1%) did not have any brachytherapy units, while 35 out of 145 countries (24.1%) lacked sufficient brachytherapy capacity for cervical and endometrial cancer. Additionally, to meet the anticipated brachytherapy requirements for these cancers by 2040, 29.6% of countries (43 out of 145) will need to expand their brachytherapy capacity. According to the World Bank classification, 100% of low-income nations, 57.9% of lower-middle-income countries, 11.3% of upper-middle-income nations, and 6.0% of high-income countries require an expansion of their brachytherapy services (p < 0.001). These countries are distributed across different regions, including 22 in Africa, 12 in Asia, 4 in the Middle East, 2 in Europe, 1 in Central America, 1 in South America, and 1 in Oceania. The estimated global cost to meet the demand for brachytherapy services by 2040 is 354.8 million USD, with an average cost of 2.45 million USD per country (95% CI = 1.45-15.05 million USD).
To meet the brachytherapy requirements for cervical and endometrial cancer by 2040, approximately 29.6% of nations will need to expand their services, encountering a median cost of about 2.45 million USD per country. This challenge disproportionately impacts low- and lower-middle-income countries.