Economically Country Classification

The economics states are established among the means of GNI-PPP according the administrations of the International Monetary Fund (IMF); the World Bank (WB) and the Central Intelligence Agency (CIA) [13-15]. The difference concerning the same country can be considerable among the data origin. These variations are explaining by:

• GNI-PPP is estimated
• Anterior projection of an economic crisis changes GNI-PPP data
• The estimation of the population included in the local population
• The choice elements for GNI-PPP evaluation have some subjective part.

These data must be taken with precaution

Economically Country is divided according to the gross national income (GNI) per capita 2016, Atlas method and PPP [15].

• Estimated to be low income ($1,005 or less)
• Estimated to be lower middle income ($1,006 to $3,995)
• Estimated to be upper middle income ($3,956 to $12,235)
• Estimated to be high income ($12,236 or more).

Gross National Income (GNI), Per Capita, Purchasing Power Parity (PPP)

Gross national product is gross domestic product (GDP) plus net income (employee compensation and investment income) from abroad. GNI, per capita is GNI divided by mid-year population. 

PPP is purchasing power parity; an international dollar has the same purchasing power over GNI as a U.S. dollar has in the United States. PPP exchange rates are used to account for the local prices of goods and services not traded internationally. However, PPP is used to compare across national accounts, not for making international poverty comparisons [15].

Cancer Incidence

Incidence is the number of new cases that occurs during a given period of time in a specified population. It can be expressed as an absolute number of cases per year or as a rate per 100,000 persons per year. The rate provides an approximation of the average risk of developing a cancer. Cancer incidence data presented are based on the most recent data available at IARC. GLOBOCAN 2012 provides a global profile of cancer that has been developed using a number of methods that are dependent on the availability and the accuracy of the data. National sources are used where possible, with local data and statistical modeling used in their absence [3-5]. 

Population

Standard population (POPst) is determining to Senegal population (Western Africa) with 14,668,522 persons.Nepal population is estimated to 29,384,297 persons. Population compares estimates from the US Bureau of the Census [16] based on statistics from population censuses, vital statistics registration systems, or sample surveys pertaining to the recent past and on assumptions about future trends: https://www.cia.gov/library/publications/the-world-factbook/geos/np.html

Provisional Budget (thousands of U.S $)

The World Health Organization (WHO) emphasizes that, when developing national strategies for controlling cancer, countries should consider the following four broad approaches based on their economic development: 

• The primary prevention
• The early detection and secondary prevention
• The diagnosis and treatment
• The palliative care. 

The provisional budget is establishing among the guidelines developed by WHO for regional and national cancer control programs according to national economic development [11]. However, an International Atomic Energy Agency [17] report suggested that in developing countries at least 60% of cancer patients require radiation treatment. Radiotherapy is one of the main components of modern cancer treatment and requires substantial capital investment, trained professionals in several disciplines, high precision equipment and a particular external and internal organizational structure. In High Incomes Countries, the healthcare costs can be as much as 8.4% (UK in 2007) to 18% (USA in 2009) of a country’s gross domestic product [18]. Cancer consumes about 5-10% of the global healthcare budget, of which radiotherapy only consumes about 5% [18,19]; thus, more than 50% of cancer patients requiring radiotherapy in low and middle-income countries lack access to treatment. A benchmark of between 400 and 500 patients per treatment unit per year has been used to calculate machine throughput in several reports [17,20-21]. The benchmark of 450 patients per machine, which corresponds to about 8 operating hours per day, seems adequate for High Incomes Countries. For scenarios where radiotherapy demand is not satisfied, a treatment day of 10 h optimizes the utilization of equipment and decreases the number of machines needed. But, the range of needs currently covered varies from 0% and 3-4% in Low Incomes Countries in Latin America and Africa up to 59-79% in Up-Middle Incomes Countries in Europe-Central and Asia [22]. However, in this study, in order to found the best cost-effective methods to prevent and treat cancer, the number of machines needs is establishing among 3 millions of peoples and not by the number of cancer cases, according to the weakness of the countries incomes.

Standard Budget for 5 years (S0)

Standard budget for 5 years (S0) is estimated using a population of 1,000,000 persons in Senegal (POPst). Senegal has 8361 new cancer cases (CIst) in 2015 [3-5] with a means GNI-PPPstof US$ 2,551 referred to the year 2016 (low middle income country), according the administrations of the International Monetary Fund (IMF); the World Bank (WB) and the Central Intelligence Agency (CIA)[13-15]. Estimation budget is taken into account the weakness of the countries incomes. 

Standardized Rapport (R0) 

Standardized rapport (R0), among the GNI-PPP, CI and the number of the population, is calculated. Standardization simplifies comparisons of GNI-PPP and cancer incidence rates among populations.

              GNI-PPPXCI/POP
R0= ______________________
           GNI-PPPstXCIst /POPst

Note:

* For Radiotherapy equipment, R0 = GNI-PPP X POP / GNI-PPPst X 3 million peoples;

Senegal has installed two new radiotherapy machines in 2017. Radiotherapy equipment is estimated to US$ 2,500,000.

** For Prevention and screening infrastructure, R0 =GNI-PPPX POP / GNI-PPPst X 3 million peoples. 

Table 1: GNI-PPP, Cancer incidence (CI) and the number of the Population.