Economic Burden of Gynecological Cancers in Iran

Socioeconomic Burden of Ovarian Cancer in 11 Countries

PURPOSE

Ovarian cancer remains among the most aggressive tumors with the lowest survival probability. Projections are that ovarian cancer will claim more than 8 million lives between 2022 and 2050 without better prevention or control measures.

METHODS

We built an Excel-based instrument that uses a prevalence-based cost-of-illness approach and a societal perspective to estimate the burden of ovarian cancer. The instrument leverages data from editions of the World Ovarian Cancer Coalition's Every Woman Study, contains a micro-costing framework to assess the resources and costs of providing care, and uses data from novel systematic reviews and meta-analyses conducted to estimate the effect of ovarian cancer on patient labor productivity outcomes and the time caregivers devote to caring for people living with the disease.

RESULTS

Across 11 countries, we estimated US dollars 70 billion in socioeconomic losses attributable to ovarian cancer. Health expenditures to cover treatment in the first 2 years after diagnosis were 7, 41, and 118 times total health spending per capita in high-, upper-middle-, and low- and lower-middle countries, respectively. Patients spent 3,663 years traveling to or receiving treatment. Women lost labor productivity equivalent to 2.5 million workdays due to ill-health from ovarian cancer, and 9,403 women living with ovarian cancer or survivors were estimated to be missing from the workforce. Caregivers spent 17,112 person-years providing practical support to patients-an average of 33 days per woman living with ovarian cancer.

CONCLUSION

This study is the first to quantify the social and economic burden of ovarian cancer in 11 countries and highlights its significant cost and defines actions needed to improve ovarian cancer outcomes.

Utilization of miRNAs as Biomarkers for the Diagnosis, Prognosis, and Metastasis in Gynecological Malignancies

Gynecological cancer is a term referring to malignancies that typically involve ovarian, cervical, uterine, vaginal, and vulvar cancer. Combined, these cancers represent major causes of morbidity and mortality in women with a heavy socioeconomic impact. MiRNAs are small non-coding RNAs that are intensively studied in the field of cancer and changes in them have been linked to a variety of processes involved in cancer that range from tumorigenesis to prognosis and metastatic potential. This review aims to summarize the existing literature that has linked miRNAs with each of the female malignancies as potential biomarkers in diagnosis (circulating miRNAs), in tumor histology and prognosis (as tissue biomarkers), and for local (lymph node) and distant metastatic disease.

Microcosting Analysis of Advanced Ovarian Cancer: Real-World Evidence From the Perspective of a Reference Public Brazilian Hospital

OBJECTIVES

Evaluate the cost of advanced ovarian cancer, using the microcosting technique, based on real-world evidence from the perspective of a reference Brazilian public hospital.

METHODS

Retrospective cohort study of patients newly diagnosed with advanced ovarian cancer in 2017 and followed-up for up to 5 years. A bottom-up microcosting method was applied, using the activity-based cost approach, which evaluates service costs based on activity consumption throughout patients' journey.

RESULTS

The results indicate a median overall survival of 35.3 months and a median age of 57 years (33-80 years old). The average cost per patient was USD 34 991.595 over a period of 35.3 months, with admissions because of the disease progression and end-of-life care being the most relevant.

CONCLUSIONS

The results show that the costs of activities currently involved in the treatment of advanced ovarian cancer represent an important economic impact for the public health system. These data can support future analyses on the impact of incorporating new technologies for the treatment of ovarian cancer and on the financing and sustainability of the Brazilian public healthcare system.

Toward a Framework to Assess the Financial and Economic Burden of Cervical Cancer in Low- and Middle-Income Countries: A Systematic Review

PURPOSE

To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment.

METHODS

We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework.

RESULTS

Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies-mainly through surveys-reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol.

CONCLUSION

Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.

Using a Dynamic Model to Estimate the Cost-Effectiveness of HPV Vaccination in Iran

This study aimed to determine the cost-effectiveness of vaccination against HPV. An age-sex structured dynamic disease transmission model was created to estimate the spread of HPV and the HPV-related incidence of cervical cancer (CC) in Iran. Sixteen age groups of men and women were incorporated to reflect the differences in sexual preferences, vaccination uptake, and disease-related outcomes. Three scenarios were evaluated by using an Incremental Cost-Effectiveness Ratio (ICER) with gained quality-adjusted life years (QALYs). ICER values below one gross domestic product (GDP) per capita are evaluated as highly cost-effective. Vaccination reduces the number of infections and CC-related mortality. Over time, the vaccinated group ages and older age groups experience protection. An initial investment is required and savings in treatment spending reduce the impact over time. Vaccinating girls only was found to be cost-effective, with an ICER close to once the GDP per capita. Vaccinating both sexes was shown to be less cost-effective compared to girls only, and vaccinating boys only was not found to be cost-effective, with an ICER between once and three times, and greater than three times the GDP per capita, respectively. The estimates are conservative since societal cost-saving and the impact of other HPV-related illnesses were not considered and would likely reduce the ICERs.

Colorectal cancer literacy and related factors in northeast of Iran: A cross-sectional study

BACKGROUND

Colorectal cancer (CRC) is a health challenge and the second most common cancer worldwide. Increasing colorectal cancer literacy (CRCL) is one of the most effective factors in CRC prevention.

AIM

The aim of this study was to determine and evaluate CRCL and its related factors in Torbat Heydarieh, northeastern Iran.

METHODS AND RESULTS

This study was a cross-sectional survey conducted in 2021 in Torbat Heydarieh, a city in northeastern Iran, on 200 clients presenting to a comprehensive health service centers. In addition to collecting sociodemographic characteristics, participants were administered the Knowledge and Attitude Questionnaire and the Colorectal Cancer Literacy Questionnaire (CRCLQ). Data were analyzed with SPSS software version 25 using independent samples t-tests, one-way analysis, chi-square, and Pearson correlation coefficients. The statistical significance level was set at p < .05. The results showed that the mean age of the participants was 51.12 ± 8.45 years. The majority of participants (84%) stated that their friends and relatives had no history of CRC. Pearson correlation coefficient results showed a significant correlation between knowledge and attitude toward CRC (r = .15, p = .041). A significant correlation was also found between knowledge and CRCL (r = .4, p ≤ .001).

CONCLUSION

We found low CRCL among clients of comprehensive health service centers. More targeted educational interventions are needed to promote CRCL among Iranian adults.

What rate of Iranian women perform Pap smear test? Results from a meta-analysis

In this study, an attempt was made to estimate the aggregated proportion of Pap smear test uptake among women in Iran from 2012 to 2022 using meta-analysis. The data collection process involved reviewing records registered in databases between January 1, 2012, and September 11, 2022. The final data was analyzed using random effects models, and potential heterogeneity was assessed using the I2 index. To examine publication bias, Egger's test and Funnel Plot were employed. Sensitivity analysis, specifically single study exclusion Meta-analysis, was conducted to assess the influence of each individual study on the aggregated percentage of Pap smear test uptake. A total of 28,754 women were included across the 33 articles analyzed. The pooled percentage of Pap smear test uptake for both one-time and regular screenings was found to be 46.52% (95% CI: 40.91 to 52.14) and 17.80% (95% CI: 12.42 to 23.18), respectively. No significant evidence of publication bias was detected, although the influence of smaller studies was confirmed. Sensitivity analysis indicated that the overall rate of Pap smear test uptake was not highly sensitive to the results of individual studies. The findings emphasize the low rate of regular Pap smear testing among Iranian women and suggest that tailored interventions considering cultural and geographical factors specific to different provinces in Iran could help increase the utilization of this screening service.

Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis

Background

There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment.

Methods

PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT.

Results

Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9.

Conclusion

This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.

Economic burden of cervical cancer and premalignant lesions associated with human papilloma virus: a societal perspective

BACKGROUND

Cervical cancer is one of the most common cancers in women, the cause of which is mostly human papilloma virus (HPV). The aim of this study was to determine the economic burden of cervical cancer and premalignant lesions associated with HPV infection from a societal perspective.

METHODS

The study is a partial economic evaluation (cost of illness), which was conducted cross-sectionally in the referral university clinic in Fars province in 2021. The prevalence-based and bottom-up approaches used to calculate the costs, the indirect costs were calculated by human capital approach.

RESULTS

The mean cost of premalignant lesions associated with HPV infection was USD 2,853 per patient, which 68.57% was direct medical costs. In addition, the mean cost of cervical cancer was USD 39,327 per patient, the largest share of which (57.9%) was related to indirect costs. The mean annual cost of cervical cancer patients in the country was estimated at USD 40,884,609 as well.

CONCLUSION

Cervical cancer and premalignant lesions associated with HPV infection imposed a significant economic burden on the health system and patients. The results of the present study can help health policymakers with efficient and equitable prioritization and allocation of resources.

Utilization of cervical cancer screening services and its associated factors in Iran: a case-control study

BACKGROUND

Considering the high incidence rate of cervical cancer (CC) in Iran, screening is an effective way of reducing the impact of the disease due to early detection. Thus, the recognition of the factors affecting the use of cervical cancer screening (CCS) services is essential.The present study aimed to determine the associated factors of CCS in women living in the suburbs of Bandar Abbas in the south of Iran.

METHODS

The present case-control study was conducted between January and March 2022 in the suburban areas of Bandar abbas. Two hundred participants were assigned to the case group and 400 participants were assigned to the control group. A self-constructed questionnaire was used to collect the data. This questionnaire contained demographic information, reproductive information, knowledge of CC, knowledge of CCS and access to the screening. Univariate and multivariate regression analyses were run to analyze the data. The data were analyzed in STATA 14.2 at a significance level of p < 0.05.

RESULTS

The mean and standard deviation of participants' age in the case group was 30.33 ± 4.892, and in the control group was 31.35 ± 6.149. The mean and standard deviation of knowledge in the case group was 10.21 ± 1.815 and in the control group was 7.24 ± 2.447. The mean and standard deviation of access was 43.72 ± 6.339 in the case and 37.17 ± 4.828 in the control group. The results of multivariate regression analysis showed the following factors increased the odds of CCS: knowledge (OR medium = 18.697, OR high = 13.413), access (OR medium = 4.028, OR high = 8.126), being married (OR = 3.193), being educated (OR diploma = 2.587, OR university degree = 1.432), middle and high SES (OR Middle = 6.078, OR Upper = 6.608), and not smoking (OR = 1.144). Also, women's reproductive status, including history of sexually transmitted diseases (OR = 2.612), use of oral contraceptives (OR = 1.579), sexual hygiene (OR = 8.718).

CONCLUSIONS

In the light of the present findings, it can be concluded that besides increasing suburban women's knowledge, their access to screening facilities should be improved. The present findings showed the need to remove the barriers to CCS in women of low SES to increase the rate of CCS. The present findings contribute to a better understanding of factors involved in CCS.

Cost-Benefit Analysis of Human Papillomavirus Vaccine in Iran

Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicates that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is controversial because its potential benefits may not fit this framework. This study aimed to evaluate the economic effects of the HPV vaccination by cost-benefit analysis (CBA) using bivalent and quadrivalent in Iran in 2020. We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefits: willingness to pay by discrete choice experiment and cost of illness. Costs only included the vaccine cost. The cost of two doses of bivalent and quadrivalent vaccines were US $29 and the US $151, respectively (US $1 = IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ - 432, US $380 per person using the willingness to pay approach, and they were US $7375 and US $6590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was - 15.11 and 2.51 by the willingness to pay approach, and 258.12 and 43.51 by the cost of illness approach. This study confirms the benefits of the national bivalent and quadrivalent vaccination programs and provides reliable evidence for policy-makers programming HPV vaccination.

Women's awareness of ovarian cancer risk factors and symptoms in Western Iran in 2020-2021

Objectives

This study aimed to investigate awareness of women living in the western region of Iran about warning signs and risk factors for ovarian cancer.

Methods

This cross-sectional, descriptive-analytical study was conducted in Sanandaj and Kermanshah, Iran, 2020 and 2021. In this study, 1081 women aged 18–70 years were selected as the sample to fill out the electronic version of the Ovarian Cancer Awareness Measure (OCAM) to identify the significant variables of ovarian cancer warning signs and risk factors. The obtained data were statistically analyzed by descriptive statistics and ordinal logistic regression in SPSS 19.

Results

In this study, 60.9% of the participants had medium awareness of the subject. The results indicated that participants with higher educational attainment (P < 0.05) and those with a history of cancer (P < 0.001) showed higher knowledge of cancer. The lowest level of awareness of symptoms was associated with acute symptoms such as dysphagia (swallowing problems) most days, persistent bloating, a sense of abdominal fullness or heaviness, and frequent urination. Moreover, the lowest awareness of risk factors was related to the history of IVF treatments and the application of talcum powder to the genital area.

Conclusion

The study findings showed that women living in the western region of Iran have moderate awareness of ovarian cancer and insufficient knowledge of cancer warning signs; this suggests that it is necessary to train Iranian women to raise awareness of the signs and risk factors for ovarian cancer.