COST-UTILITY ANALYSIS OF HOSPITAL-BASED INTEGRATED MULTIDISCIPLINARY TEAM PALLIATIVE CARE FOR ADVANCED CANCER IN ETHIOPIA...
Author(s)
ATALAY M. FENTIE1, Edom Seife, MD2, Teferi Gedif Fenta, PhD2, Sachiko Ozawa, PhD3.
1Lecturer and Clinical Pharmacist, Addis Ababa University, School of Pharmacy, Addis Ababa, Ethiopia, 2Addis Ababa University, Addis Ababa, Ethiopia, 3University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
1Lecturer and Clinical Pharmacist, Addis Ababa University, School of Pharmacy, Addis Ababa, Ethiopia, 2Addis Ababa University, Addis Ababa, Ethiopia, 3University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
OBJECTIVES: To estimate the cost-effectiveness and household affordability of hospital-based integrated multidisciplinary team (MDT) palliative care versus usual care for adults with advanced cancer in Ethiopia, where no formal cost-utility analysis (CUA) of integrated palliative care has been previously conducted.
METHODS: A within-trial CUA was nested in a prospective pre-post quasi-experimental matched-pair study at Tikur Anbessa Specialized Hospital (TASH). 192 adults with stage III-IV cancer were enrolled, each contributing a 4-week usual-care (pre) and 4-week MDT (post) period. Costs were captured prospectively from a restricted societal perspective in 2025 US$. Quality-adjusted life-years (QALYs) were computed using the trapezoidal rule and the Ethiopian EQ-5D-5L value set. The incremental cost-utility ratio (ICUR) was compared against 0.5× Ethiopian GDP/capita, with non-parametric bootstrapping, subgroup analyses, and deterministic sensitivity analyses. Household affordability of 20 essential palliative-care items was assessed using WHO/HAI methodology, with items costing >1 day’s wage of the lowest-paid government worker (US$1.84/day) classified as unaffordable.
RESULTS: MDT was dominant: mean cost US$222.07 versus US$252.30 (ΔCost = −US$30.24), with QALYs of 0.0336 versus 0.0238 (ΔQALY = +0.0098). Probability of cost-effectiveness was 99.9% at 0.5×GDP, and MDT dominated in 99.7% of bootstrap replicates and across all subgroups (largest QALY gain in severe baseline pain, +0.0152). Findings were robust to opportunity-cost adjustment for incremental MDT staff time (ΔCost = −US$25.34). However, only 6/20 items (30%) were affordable at TASH and 0/20 in the private sector; palliative radiotherapy (165 days’ wages), 7-day hospitalization (13-15 days at TASH; 115 days privately), and CT scans (22 days at TASH) were the largest affordability burdens.
CONCLUSIONS: Integrated MDT palliative care was cost-saving and more effective than usual care in Ethiopia. Realizing household-level affordability gains alongside system-level cost-effectiveness will require parallel policy investments in essential-medicine procurement, stewardship of low-yield testing, and expansion of home-based palliative-care services.
METHODS: A within-trial CUA was nested in a prospective pre-post quasi-experimental matched-pair study at Tikur Anbessa Specialized Hospital (TASH). 192 adults with stage III-IV cancer were enrolled, each contributing a 4-week usual-care (pre) and 4-week MDT (post) period. Costs were captured prospectively from a restricted societal perspective in 2025 US$. Quality-adjusted life-years (QALYs) were computed using the trapezoidal rule and the Ethiopian EQ-5D-5L value set. The incremental cost-utility ratio (ICUR) was compared against 0.5× Ethiopian GDP/capita, with non-parametric bootstrapping, subgroup analyses, and deterministic sensitivity analyses. Household affordability of 20 essential palliative-care items was assessed using WHO/HAI methodology, with items costing >1 day’s wage of the lowest-paid government worker (US$1.84/day) classified as unaffordable.
RESULTS: MDT was dominant: mean cost US$222.07 versus US$252.30 (ΔCost = −US$30.24), with QALYs of 0.0336 versus 0.0238 (ΔQALY = +0.0098). Probability of cost-effectiveness was 99.9% at 0.5×GDP, and MDT dominated in 99.7% of bootstrap replicates and across all subgroups (largest QALY gain in severe baseline pain, +0.0152). Findings were robust to opportunity-cost adjustment for incremental MDT staff time (ΔCost = −US$25.34). However, only 6/20 items (30%) were affordable at TASH and 0/20 in the private sector; palliative radiotherapy (165 days’ wages), 7-day hospitalization (13-15 days at TASH; 115 days privately), and CT scans (22 days at TASH) were the largest affordability burdens.
CONCLUSIONS: Integrated MDT palliative care was cost-saving and more effective than usual care in Ethiopia. Realizing household-level affordability gains alongside system-level cost-effectiveness will require parallel policy investments in essential-medicine procurement, stewardship of low-yield testing, and expansion of home-based palliative-care services.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE92
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
SDC: Oncology