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

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

EClinicalMedicine (Jan 2023)

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

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

Affiliations

Ranin Soliman: Department 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.
Jason Oke: Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Iman Sidhom: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Nickhill Bhakta: Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
Nancy S. Bolous: Global Paediatric Medicine Department, St. Jude Children's Research Hospital, USA
Nourhan Tarek: Health Economics and Value Unit, Children's Cancer Hospital Egypt – 57357, Egypt
Sonia Ahmed: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Hany Abdelrahman: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Emad Moussa: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Clinical Oncology Department, Menoufia University, Egypt
Manal Zamzam: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Mohamed Fawzy: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Wael Zekri: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Hanafy Hafez: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Mohamed Sedky: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatrics Department, National Research Centre, Cairo, Egypt
Mahmoud Hammad: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Hossam Elzomor: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Sahar Ahmed: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Madeha Awad: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, Nasser Institute for Research and Treatment, Cairo, Egypt
Sayed Abdelhameed: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Enas Mohsen: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Clinical Oncology Department, Beni-suef University, Egypt
Lobna Shalaby: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Wael Eweida: Chief Operating Office, Children's Cancer Hospital Egypt – 57357, Egypt
Sherif Abouelnaga: Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt; Chief Executive Office, Children's Cancer Hospital Egypt – 57357, Egypt
Alaa Elhaddad: Paediatric Oncology Department, Children's Cancer Hospital Egypt – 57357, Egypt; Paediatric Oncology Department, National Cancer Institute, Cairo University, Egypt
Carl Heneghan: Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Journal volume & issue: Vol. 55
p. 101729

Abstract

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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.

Published in EClinicalMedicine

ISSN: 2589-5370 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://www.thelancet.com/journals/eclinm/home

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