Efficient treatment policies and its impact on the economic burden for CRC in low-middle income countries: the Egypt Case

The growing burden of cancer in low–resource environments, is increasing the impact on morbidity, mortality and economic cost due to cancer for the next 20 years. According to world cancer report, this growth might influence health policies and decision-making for cancer Colorectal cancer (CRC) is the third most common cancer. Two-thirds of all colorectal cancers occur in the more developed regions of the world. Efficient treatment policies may play a major role in the enhancement of patient outcomes including quality of life, economic value, clinical effectiveness, and better resource utilization. At low-middle income, Egypt with a population with 100 million people with CRC may represent a source of pressure on the healthcare system, prompting significant questions: Are the policies for CRC treatment efficient for the health care system? Does the healthcare system need new treatments? What is the outcome for present treatment policies? The objective of this study was to measure the effect of treatment policies on patient outcomes including quality of life, economic value and clinical effectiveness.

Data from patients aged (18-60 years) for the last 3 years including direct and indirect health care costs for conventional treatment were obtained, not including cost of treatment, and complications including rehabilitation, metastasis, and outpatients costs. A total of 20389 patients enrolled in the national database. A weighted average method was used for calculations for cost and consequences. The value of lost productivity using Egyptian estimates for the value of a statistical life year (VSLY) outcomes was calculated in the form of QALY. Several methods were employed to reach an average value for a QALY: (SF 36) questionnaire was conducted to measure quality of life. Treatment policy analysis was conducted comparing tow payers policies. Economic, clinical, quality of life was the scope of analysis. Uncertainty Analyses: To test the stability of our results to variation in the estimates of the input model parameters, one-dimensional sensitivity analyses was performed.

For the first payers, 80% of total expenditures where chemotherapy, second-lines represents 44%. From total expenditures, surgery represented 4.7 % of expenditures and radiotherapy represented 1.7 %. Costs increased more in the metastatic phase than in the primary phase. QALY gained was .4 with conventional chemotherapy. No biological treatment was 11not implemented For the second payer, mean direct cost for CRC amounted to 410 dollars per year, with 66% of total expenditures due to chemotherapy, while second-lines represented 21%. For total expenditures, surgery represented 15% and radiotherapy represented 10%. Follow-up tests represented 8%. QALY gained was 1.8 when biological treatment was implemented.

There is a need to reform treatment policies for CRC in Egypt, which should include early detection programs, and reimbursement of biological products after establishing treatment guidelines based on multiple criteria including socioeconomic impact, economic values, and efficacy parameters.