The Quality of Economic Evaluations of Breast Cancer for Diagnostics, Screening, and Therapeutics in the Middle East: A Targeted Literature Review

OBJECTIVES: Breast cancer has become a growing concern in the Arab world in recent years, presenting a significant burden on patients, healthcare systems and society. The objective of this targeted literature review (TLR) was to assess the quality of published economic evaluations focusing on breast cancer screening, diagnosis, and treatment in the Middle East (ME) region. The aim was to provide researchers and health system decision-makers with insights into the design, implementation, and presentation of economic evaluation studies.

METHODS: A targeted literature search was conducted on Embase^® and MEDLINE^® (via Ovid^®) from 1974 (Embase^®) and 1946 (MEDLINE^®) until June-21-2023. All economic analyses focusing on breast cancer diagnosis, screening, and therapy in the ME region, and published in English language with full text was shortlisted. Screening and extraction process was carried out by one reviewer and checked by another reviewer. The quality of the included studies was performed by using Drummond checklist.

RESULTS: Out of 1574 publications identified, 17 were included in the review. Among these studies, 10 were conducted in Iran followed by two each in Turkey and Israel and one each in Lebanon, Saudi Arabia, and Qatar. Approximately 90% of the included studies employed cost-effectiveness analysis. The majority were focused on screening and therapeutic interventions. Markov models and payer perspective were predominant. The time horizons varied from 8-months to lifetime, and discount rates used in the studies ranged from 1.5% to 5%. Most of the included studies were graded as high quality. However, some common weaknesses were founded.

CONCLUSIONS: The commonly identified methodological weaknesses were ignoring the productivity loss costs and failure to account for uncertainty-based factors in the model. This can have implications for future decision making and hence future research is required to address these issues to estimate overall benefit of interventions in breast cancer.