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

Soliman, R; Oke, J; Sidhom, I; Bhakta, N; Bolous, NS; Tarek, N; Ahmed, S; Abdelrahman, H; Moussa, E; Zamzam, M; Fawzy, M; Zekri, W; Hafez, H; Sedky, M; Hammad, M; Elzomor, H; Ahmed, S; Awad, M; Abdelhameed, S; Mohsen, E; Shalaby, L; Eweida, W; Abouelnaga, S; Elhaddad, A; Heneghan, C

Neuroscience & Neuroimaging Research Collection

Journal article

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

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.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Soliman, R., Oke, J., Sidhom, I., Bhakta, N., Bolous, N. S., Tarek, N., Ahmed, S., Abdelrahman, H., Moussa, E., Zamzam, M., Fawzy, M., Zekri, W., Hafez, H., Sedky, M., Hammad, M., Elzomor, H., Ahmed, S., Awad, M., Abdelhameed, S., … Heneghan, C. (2022). Cost-effectiveness of childhood cancer treatment in Egypt: lessons to promote high-value care in a resource-limited setting based on real-world evidence. EClinicalMedicine, 55.

MLA Style

Soliman, R, et al. “Cost-Effectiveness of Childhood Cancer Treatment in Egypt: Lessons to Promote High-Value Care in a Resource-Limited Setting Based on Real-World Evidence.” EClinicalMedicine, vol. 55, 2022.

Chicago Style

Soliman, R, J Oke, I Sidhom, et al. 2022. “Cost-Effectiveness of Childhood Cancer Treatment in Egypt: Lessons to Promote High-Value Care in a Resource-Limited Setting Based on Real-World Evidence.” EClinicalMedicine 55.
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