A COST EFFECTIVENESS ANALYSIS OF NGS-BASED PANEL FOR BREAST CANCER PATIENTS IN EGYPT
Author(s)
Mariam Mohammed Elattar, MBA1, Gehan Ramadan, MSc2, Walid Gadelhak, MSc3, Gihan Hamdy Elsisi, Sr., BSc, MSc, PhD4.
1HEOR Director, HTA Office-Technology Appraisal, Cairo, Egypt, 2Medical Director, Romex Healthcare, Cairo, Egypt, 3Managing Director, Romex Healthcare, Cairo, Egypt, 4The American University in Cairo, cairo, Egypt.
1HEOR Director, HTA Office-Technology Appraisal, Cairo, Egypt, 2Medical Director, Romex Healthcare, Cairo, Egypt, 3Managing Director, Romex Healthcare, Cairo, Egypt, 4The American University in Cairo, cairo, Egypt.
OBJECTIVES: Breast cancer is the most frequently diagnosed female malignancy in Egypt, where 47.5% of patients are diagnosed at late stages. Next-generation sequencing (NGS)-based targeted panels optimize precision oncology by identifying actionable mutations, guiding therapy, and reducing exposure to ineffective treatments. This study evaluated the cost-effectiveness of a BRCA-based targeted panel compared with no testing in Egypt.
METHODS: A hybrid decision tree and partitioned survival model (progression-free, progressed disease, death) evaluated germline BRCA-based NGS testing versus no testing in treatment-naïve, advanced, PD-L1-negative triple-negative breast cancer patients over a lifetime horizon from the Egyptian public payer perspective. Identified BRCA-positive patients received targeted therapy (olaparib), while all others received chemotherapy. Efficacy inputs came from OlympiAD and KEYNOTE-355 trials. Direct medical costs (2026 EGP) comprising genetic testing, medication acquisition, health-state management, adverse events, and end-of-life care came from the Universal Health Insurance Authority, with resource use validated via a local Delphi panel. Utilities were obtained from published literature. Costs and QALYs were discounted at 3.5%. One-way sensitivity analysis evaluated robustness.
RESULTS: Genetic testing accumulated total costs of EGP 277,384 and 1.41 QALYs per patient, versus EGP 206,454 and 1.19 QALYs without testing. The strategy resulted in an incremental cost of EGP 70,930 and a gain of 0.22 QALYs, yielding an Incremental Cost-Effectiveness Ratio (ICER) of EGP 316,059 per QALY (relative gain: 0.16). Compared to an Egyptian willingness-to-pay threshold of twice the GDP per capita (EGP 351,344), the strategy was cost-effective. Sensitivity analysis demonstrated model robustness, with the utility of progression following targeted therapy being the primary driver.
CONCLUSIONS: BRCA-based genetic testing provides substantial clinical and economic value in Egypt. By enabling early identification of actionable mutations, it facilitates timely access to targeted therapy and prevents exposure to ineffective treatments. Integrating this panel into national guidelines supports personalized care and optimizes healthcare resource allocation.
METHODS: A hybrid decision tree and partitioned survival model (progression-free, progressed disease, death) evaluated germline BRCA-based NGS testing versus no testing in treatment-naïve, advanced, PD-L1-negative triple-negative breast cancer patients over a lifetime horizon from the Egyptian public payer perspective. Identified BRCA-positive patients received targeted therapy (olaparib), while all others received chemotherapy. Efficacy inputs came from OlympiAD and KEYNOTE-355 trials. Direct medical costs (2026 EGP) comprising genetic testing, medication acquisition, health-state management, adverse events, and end-of-life care came from the Universal Health Insurance Authority, with resource use validated via a local Delphi panel. Utilities were obtained from published literature. Costs and QALYs were discounted at 3.5%. One-way sensitivity analysis evaluated robustness.
RESULTS: Genetic testing accumulated total costs of EGP 277,384 and 1.41 QALYs per patient, versus EGP 206,454 and 1.19 QALYs without testing. The strategy resulted in an incremental cost of EGP 70,930 and a gain of 0.22 QALYs, yielding an Incremental Cost-Effectiveness Ratio (ICER) of EGP 316,059 per QALY (relative gain: 0.16). Compared to an Egyptian willingness-to-pay threshold of twice the GDP per capita (EGP 351,344), the strategy was cost-effective. Sensitivity analysis demonstrated model robustness, with the utility of progression following targeted therapy being the primary driver.
CONCLUSIONS: BRCA-based genetic testing provides substantial clinical and economic value in Egypt. By enabling early identification of actionable mutations, it facilitates timely access to targeted therapy and prevents exposure to ineffective treatments. Integrating this panel into national guidelines supports personalized care and optimizes healthcare resource allocation.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE693
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Disease
Genetic, Regenerative & Curative Therapies, No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Personalized & Precision Medicine