DOES NHIF IMPROVE SURVIVAL OF WILMS

TUMOR KENYA ?

Dr F. K. Abdallah

Photo courtesy of Dr. Russ White, Tenwek Mission Hospital, Kenya

hugevascular

advanced stageWilms tumor

Abdallah et al. East African Medical Journal, July 2001

Stage of Wilms tumor in Kenya by age

Data collected from 1990-96

84%

Relapse 6 months post-resectionHIV+

38 month old girl with Wilms tumordiagnosed at 12 months of ageresection in December 2010palliative chemo

Photos courtesy of Dr. Jason Axt: taken at Kenyatta National Hospital, Nairobi, Kenya

East African Medical Journal, July 2001

late presentationlate presentationpoor availability of chemopoor availability of chemo

frequent treatment frequent treatment interruptionsinterruptions

loss to follow-uploss to follow-upno alternative agents for relapseno alternative agents for relapse

late presentationlate presentationpoor availability of chemopoor availability of chemo

frequent treatment frequent treatment interruptionsinterruptions

loss to follow-uploss to follow-upno alternative agents for relapseno alternative agents for relapse

Disclosures

– I want to make a difference in outcomes of pediatric surgical disease worldwide

– I want to engage you in this effort also– There is no financial benefit– It may cost you money

– I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity

KNHKMH

Moi

Established Kenya WT Consortium

• January 1, 2008 – April 1, 2012January 1, 2008 – April 1, 2012

• Multiple visits to each institution over a 6 Multiple visits to each institution over a 6 week periodweek period

• 221 candidate patients221 candidate patients

• 133 met all criteria:133 met all criteria:• kidney mass, histologic diagnosis, andkidney mass, histologic diagnosis, and

files could be foundfiles could be found

Data Entry

National Hospital Insurance Fund (NHIF)

• Primary provider of health insurance in Kenya

• Compulsory membership for all salaried employees

• Cost $2 – $4 monthly

National Hospital Insurance Fund

• The National Hospital Insurance Fund (NHIF) is the primary provider of health insurance in Kenya, with a mandate to enable all Kenyans to access quality and affordable health services.

• The NHIF requires compulsory membership for all salaried employees with premium contributions automatically deducted through payroll: 30-320 KES monthly (salary-dependent)

• For self-employed, 160 KES monthly

Gender Distribution of Wilms

Renal Mass Frequency

Wilms Tumor Staging

Adherence to treatment

Effect of enrollment in NHIF on vital status

Kenyan National Hospital Insurance Fund

Effect of enrollment in NHIF on vital status

Kenyan National Hospital Insurance Fund

p=0.002

Overall Survival

52.7%

In contrast to 35% in 2001

NHIF enrollment and level of care completed

12.3% difference in completion of all therapy

NHIF enrollment and 2-year event-free survival

Care completion and 2-year event-free survival

Summary

– 52.7 % 2-year event free survival– 94% of those completing all therapy are alive

and without recurrence at 2 years– Enrollment in NHIF is associated with

• Greater completion of therapy• Greater survival

– Small interventions to reduce loss to follow up and boost NHIF enrollment can result in large increases in patient survival

AcknowledgementsAcknowledgements

• Harold Lovvorn IIIHarold Lovvorn III

• Vanderbilt CTSA grant, UL1 RR024975Vanderbilt CTSA grant, UL1 RR024975• National Cancer Institute grant, 5T32CA106183- National Cancer Institute grant, 5T32CA106183-

06A106A1• NCI grant 1R21CA155946-01 (HNL)NCI grant 1R21CA155946-01 (HNL)

ACKNOWLEDMENTS

• Axt, Jason; Axt, Meridith; Githanga, Jessie; Hansen, Erik; Lessan, Joel; Li, Ming; Musimbi, Joyce; Mwachiro, Michael; Newton, Mark; Ndung’u, James; Njuguna, Festis; Nzioka, Ancent, ; Oruko, Oliver; Patel, Kirtika; Tenge, Robert; Ukoli, Flora; White, Russel; O’Neill, James; Lovvorn, Harold

THANK YOU!!!