Health economic evaluation of cancer costs in the MENA region: A systematic review and costs transferability analysis among countries

Abstract

Objective: Taking into consideration the increasing burden of cancer on one hand, and the limited healthcare resources in the Middle East and North Africa (MENA) region on the other, this research aims to evaluate the methodological quality of cancer health economic evaluation and assessing the quality of cancer costs reporting in the region, to explore the potentials for transferability of retrieved cancer costs within the region, and how they can be utilized to enhance evidence-based oncology decisions and future research in the MENA. Methods: First, a systematic literature review was conducted to obtain all health economic evaluation studies from the region between the years 1995 and 2019, following the PRISMA guidelines. Eligible studies from previous systematic reviews from MENA were also included. Then all cancer health economic evaluations were identified and reviewed, risk of bias of certain studies was appraised using the CHEERS guidelines, and common cancer costs among the countries were first adjusted to 2020 value, then explored through comparative regression analysis to assesses their quality and identify the key parameters that drive their heterogeneity. Results: From 1646 citations of fulltext English articles and four systematic reviews, 206 eligible papers reporting healthcare costs from the MENA region were identified. Out of these, 18 cancer health economic publications were found, reporting 260 cancer costs between the years 2007 and 2019. Appraising the five cervical cancer studies’ quality, using CHEERS checklist, showed relatively good scores. 5 common costs were found among these studies, which is the annual cost of cervical cancer management per woman. The mean for these 5 costs after the adjustment to the base year (2020) was 3244.52 USD. In the regression analysis, neither GDP, nor time, nor reporting quality, nor reported treatment components explained variance in the costs among the countries. Conclusion: In order to provide policymakers and stakeholders of the region with more reliable and comparable cancer cost data, it’s vital at this stage to enforce the role of health economic evaluation and standardize the economic methods when estimating healthcare resources. Finally, when transferring costs among jurisdictions of the MENA region, it’s recommended to take the average of the same cancer cost that was already reported in different countries within the MENA, and estimating the new cost using sensitivity analysis and a certain standard deviation, in order to provide more accurate cost estimates, rather than relying only on the estimates of one country as it was done by previous studies.