Unlocking the Economics of Cancer Control in Uganda Using KeyScope

PROJECT SUMMARY / ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA-23-052. Surgery is the foundation of cancer treatment, but patients in low- and middle-income countries (LMICs) have limited surgical access due in part to inaccessibility of equipment and substantial out-of-pocket (OOP) healthcare costs. An estimated

33 million individuals in LMICs face catastrophic health expenditures (CHE) related to direct OOP surgical costs. In this context, household protection against CHE has emerged as a leading policy goal, with the World Bank and WHO setting targets of 100% protection from financial hardships arising from OOP payments. Laparoscopic (keyhole) surgery has the

potential to provide protection against CHE and is the standard of care in high-income countries for many cancer excisions in the chest and abdomen. It avoids large incisions by using a camera and instruments manipulated through tiny incisions, and therefore advantages include: smaller incisions, decreased pain, improved recovery time, minimized post-surgical infections,

and shorter hospital stays, reducing CHE. Our team in Uganda has developed a low-cost, durable laparoscopic system (KeyScope) for use in LMICs through a unique multi-disciplinary collaboration. The proposed project aims to measure the risk of CHE due to OOP costs among individuals seeking surgical care for cancers in the chest and abdomen at the Uganda Cancer

Institute and measure the cost-benefit of using KeyScope versus the standard of care (open surgery) among a simulated cohort of patients with cancer needing surgery. In our current U01 study, we are performing a First-In-Human study of KeyScope at the Uganda Cancer Institute. The proposed study is a direct extension of this project and will complement the U01 by

measuring the economic impact of KeyScope within the same population of cancer patients at the Uganda Cancer Institute.