Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in context
Summary: 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...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-01-01
|
| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S258953702200459X |
| _version_ | 1811243542560899072 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Ranin Soliman |
| collection | DOAJ |
| description | Summary: 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. |
| first_indexed | 2024-04-12T14:10:13Z |
| format | Article |
| id | doaj.art-dc6f145b5f304f969728869d96480942 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-12T14:10:13Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-dc6f145b5f304f969728869d964809422022-12-22T03:29:56ZengElsevierEClinicalMedicine2589-53702023-01-0155101729Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in contextRanin Soliman0Jason Oke1Iman Sidhom2Nickhill Bhakta3Nancy S. Bolous4Nourhan Tarek5Sonia Ahmed6Hany Abdelrahman7Emad Moussa8Manal Zamzam9Mohamed Fawzy10Wael Zekri11Hanafy Hafez12Mohamed Sedky13Mahmoud Hammad14Hossam Elzomor15Sahar Ahmed16Madeha Awad17Sayed Abdelhameed18Enas Mohsen19Lobna Shalaby20Wael Eweida21Sherif Abouelnaga22Alaa Elhaddad23Carl Heneghan24Department of Continuing Education, University of Oxford, UK; Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt; Corresponding author. Department for Continuing Education, Kellogg College, University of Oxford, UK; Health Economics and Value Unit, Children's Cancer Hospital 57357–Egypt (CCHE), Cairo, Egypt.Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptGlobal Paediatric Medicine Department, St. Jude Children's Research Hospital, USAGlobal Paediatric Medicine Department, St. Jude Children's Research Hospital, USAHealth Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Clinical Oncology Department, Menoufia University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatrics Department, National Research Centre, Cairo, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, Nasser Institute for Research and Treatment, Cairo, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Clinical Oncology Department, Beni-suef University, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptChief Operating Office, Children's Cancer Hospital Egypt – 57357, EgyptPaediatric Oncology Department, National Cancer Institute, Cairo University, Egypt; Chief Executive Office, Children's Cancer Hospital Egypt – 57357, EgyptPaediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, EgyptCentre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKSummary: 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.http://www.sciencedirect.com/science/article/pii/S258953702200459XChildhood cancerCost-effectivenessEconomic evaluationDALYsEgyptGlobal health |
| spellingShingle | 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 Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in context EClinicalMedicine Childhood cancer Cost-effectiveness Economic evaluation DALYs Egypt Global health |
| title | Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in context |
| title_full | Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in context |
| title_fullStr | Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in context |
| title_full_unstemmed | Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in context |
| title_short | Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidenceResearch in context |
| title_sort | cost effectiveness of childhood cancer treatment in egypt lessons to promote high value care in a resource limited setting based on real world evidenceresearch in context |
| topic | Childhood cancer Cost-effectiveness Economic evaluation DALYs Egypt Global health |
| url | http://www.sciencedirect.com/science/article/pii/S258953702200459X |
| work_keys_str_mv | AT raninsoliman costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT jasonoke costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT imansidhom costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT nickhillbhakta costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT nancysbolous costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT nourhantarek costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT soniaahmed costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT hanyabdelrahman costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT emadmoussa costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT manalzamzam costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT mohamedfawzy costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT waelzekri costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT hanafyhafez costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT mohamedsedky costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT mahmoudhammad costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT hossamelzomor costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT saharahmed costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT madehaawad costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT sayedabdelhameed costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT enasmohsen costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT lobnashalaby costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT waeleweida costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT sherifabouelnaga costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT alaaelhaddad costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext AT carlheneghan costeffectivenessofchildhoodcancertreatmentinegyptlessonstopromotehighvaluecareinaresourcelimitedsettingbasedonrealworldevidenceresearchincontext |