Designing Tertiary Cancer Services Under Burden Uncertainty

Abstract

Cancers are a growing cause of morbidity and mortality in low- and middle-income countries (LMICs). Geographic access plays a key role in both treatment and diagnosis  - however, a dearth of existing facilities often means that the demand for cancer services is not well understood. Further, resources such as funding, pharmaceuticals, and skilled medical professionals are often scarce. Using Rwanda as a case study, we present a novel-path-based formulation of two stage decision problem modeling the expansion of cancer services. In this problem's first stage a decision maker must simultaneously choose a set of facilities at which to add a set of tertiary cancer services and design a transportation network to improve patient access. In the second stage, patients use the transportation network to seek care at the place facilities. We then extend this formulation to instances in which demand is unknown and present preliminary work on solving large-scale instances of this problem using Branch, Price and Cut.