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J Glob Oncol. 2018 Sep;(4):1-7. doi: 10.1200/JGO.17.00003. Epub 2017 Jul 17.

Cost of Providing Quality Cancer Care at the Butaro Cancer Center of Excellence in Rwanda.

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Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.



The cost of providing cancer care in low-income countries remains largely unknown, which creates a significant barrier to effective planning and resource allocation. This study examines the cost of providing comprehensive cancer care at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda.


A retrospective costing analysis was conducted from the provider perspective by using secondary data from the administrative systems of the BCCOE. We identified the start-up funds necessary to begin initial implementation and determined the fiscal year 2013-2014 operating cost of the cancer program, including capital expenditures and fixed and variable costs.


A total of $556,105 US dollars was assessed as necessary start-up funding to implement the program. The annual operating cost of the cancer program was found to be $957,203 US dollars. Radiotherapy, labor, and chemotherapy were the most significant cost drivers. Radiotherapy services, which require sending patients out of country because there are no radiation units in Rwanda, comprised 25% of program costs, labor accounted for 21%, and chemotherapy, supportive medications, and consumables accounted for 15%. Overhead, training, computed tomography scans, surgeries, blood products, pathology, and social services accounted for less than 10% of the total.


This study is one of the first to examine operating costs for implementing a cancer center in a low-income country. Having a strong commitment to cancer care, adapting clinical protocols to the local setting, shifting tasks, and creating collaborative partnerships make it possible for BCCOE to provide quality cancer care at a fraction of the cost seen in middle- and high-income countries, which has saved many lives and improved survival. Not all therapies, though, were available because of limited financial resources.

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