Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidence

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Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidence


JournalEClinical Medicine
Article typeJournal research article – Clinical research
Publication date – Nov – 2022
Authors – Ranin Soliman, Jason Oke, Iman Sidhom, Nickhill Bhakta, Nancy S. Bolous, Nourhan Tarek, Sonia Ahmed, Hany Abdelrahman, Emad Moussa, Manal Zamzam, Mohamed Fawzy, Wael Zekri, Hanafy Hafez, Mohamed Sedky, Mahmoud Hammad, Hossam Elzomor, Sahar Ahmed, Madeha Awad, Sayed Abdelhameed, Enas Mohsen, Lobna Shalaby, Wael Eweida, Sherif Abouelnaga, Alaa Elhaddad, Carl Heneghan
KeywordsChildhood cancer, cost effectiveness, DALYs, Economic evaluation, Egypt, Global Health
Open access – Yes
SpecialitySurgical oncology
World region Northern Africa
Country: Egypt
Language – English
Submitted to the One Surgery Index on November 28, 2022 at 4:55 am
Abstract:

Background
Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resource-limited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status.

Methods
Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disability-adjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality.

Findings
For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO–CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1–1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio <3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers.

Interpretation
Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote high-value in care delivery, with implications on practice and policy.

Funding
Egypt Cancer Network; NIHR School for Primary Care Research; ALSAC.

OSI Number – 21824

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