Dr D Stephan - Dr DC Stefan Prof D Stones Dr A Dippenaar Prof PB by gyvwpsjkko

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									Dr DC Stefan
Prof D Stones
Dr A Dippenaar
Prof PB Hesseling
Prof G Wessels


                    May 2008
Common B cell childhood neoplasm
8,190 cases of Hodgkin lymphoma / 2007 in
USA
High incidence in 0-13 years age group in
developing countries compared to developed
countries
Diagnosed at earlier age; high association
with EBV
In South Africa: underreported and under
diagnosed
High cure rate by chemotherapy and
radiotherapy
79% survival OS (all stages) in 2 units in SA
Depending on stage and symptoms
Most diagnosed cases are in stage 2
Most used chemotherapy- ABVD (50%)
            70
                 Histogram of Stage (138 cases)

                               45%
            60



            50



            40
No of obs




                                            24%

            30

                                                  17%
                  14%
            20



            10



            0
                   1            2            3     4
Complete blood count
Liver function tests
Renal function tests
Chest radiograph
Abdominal ultrasound
CT scan chest
CT scan abdomen
Tc99 bone scintigram
Serum copper
Fibrinogen
Haptoglobin
Immunoglobulin
Serum ferritin and transferin
Gallium scintigram
PET
Diagnosing and staging cost - same for all
stages
Calculated for stage 2
Treatment cost: calculated for ABVD protocol
(most used)
Did not include hospitalization cost and
materials (needles, syringes, etc)
Lymph node biopsy R 1505

Histology
  Processing 1 block and 1 stained Haematoxylin and Eosin
  slide (R200)
  Immunochemistry (R350 per antibody )
  CD45 CD30 CD15 CD20
  CD3

  TOTAL: (+/- R2000)
Cytology
 FNAB 4 slides stained with Papanicolaou
 and Giemsa stains R400
 Immunochemistry-if enough cells aspirated
 R 1750
 CD45 CD30 CD15 CD20 CD3
 TOTAL 2200R
FBC R 113.90
LFT R 385.20
Èlectrolytes R173.90
Ferritin R45,20
EBV R 175.70
CMV R 175.70
Hepatitis R 188.40
Copper R 121.20
HIV Elisa R 87.20
HIV PCR R365
LDH R 34.10
Mantoux test R 141.00
Haematology
 Bilateral trephine biopsies = R 246,10 X2
 Bone marrow needle          =R 358.10
 Material cost bone marrow =R 358.10
CXR = R 114
CT chest R1900
Abdominal US R 342
Echo heart R 431,00
CT abdomen R1900
Tc 99 bone scintigram
Gallium scintigram R317+ R946 (substance)
PET R 3557
OPPA Adriamycin ,Vincristine ,
Procarbazine, Prednisolone
OEPA Adriamycin, Vincristine, Etoposide,
Prednisolone
COPP Cyclophosphamide,Vincristine,
Procarbazine, Prednisolone
CLVPP Chlorambucil, Procarbazine,
Prednisone, Vinblastine
CCNU (Lamustine, VP 16,Chlorambucil,
Prednisolone)- rescue protocol
ABVD Adriamycin, Bleomycin, Vinblastine,
DTIC
                           Histogram of Chemotherapy
                             Spreadsheet9 1v*138c
            80


            70             69, 50%


            60


            50
No of obs




            40

            30                         29, 21%


            20                                         19, 14%
                 15, 11%

            10
                                                                 6, 4%

             0
                 CLVPP               MOPP/COPP                     ?
                           ABVD                     OEPA/OPPA
                                     Chemotherapy
OEPA (boys) (x6) R3557.44
OPPA (girls) (x6) R3975.56
CLVPP (x6) R 4609.98
ABVD (x4) R3985.92
      (x6) R 5978.88
CLVPP (x6) R 4609.98
CEP (x6) R18.213.42 –second line
Diagnosing cost + Staging (stage 2) +
  Chemotherapy protocol (ABVD X 4)



   R 22 470 = $ 2956 = € 1872
       ($1 =R7,6; €1= R12)
Repeat all relevant investigations after 2
courses and at the completion of treatment
Then : 3 monthly X 2,
 6monthly X 4Years,
 12 monthly X 5
For 2 years all relevant investigations + at
the end of therapy
 R 18.485 X 4/year
Did not include hospitalization cost and
materials (needles, syringes, etc)
 Total cost Hodgkin stage2
R166.365= $21.890= €13.863

 Total cost Hodgkin stage 4
R188.365 = $24.784 = €15.697
Gross domestic product (GDP) in $ at
purchasing power parity (PPP) per capita

 Congo, Rep - 3730
 Ethiopia - 806
 Guinea-Bissau - 484
 Congo, Dem. Rep - 309
 Burundi - 372
 Tanzania - 1256
 Malawi - 785
                         IMF: World economic outlook database, April 2008
   GDP at PPP in $ per capita (2)

Central African Republic -726
Mozambique -830
Kenya -1699
Mali - 1031
Nigeria - 2035
Zambia - 1309
Niger - 667
South Africa – 9761
                        IMF: World economic outlook database, April 2008
No previous cost study done in Africa
Certain tests can be omitted to reduce
costs
No major advantage: copper, ferritin,
immunoglobulins
Important-HIV, TB screen, EBV
FNA – same value as lymph node biopsy
Treatment as out patients
IN AFRICA 2

 Replace CT scan with ultrasound
 Replace PET scan with Gallium
 Diagnose early so no need for radiotherapy
 Less follow up with investigations but with
 more clinical examinations
 Hodgkin lymphoma can be treated and good
 results can be achieved in Africa

								
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