Estimation of the cost of treatment by chemotherapy for early breast cancer in Morocco

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the first cancer in women both in incidence and mortality. The treatment of breast cancer benefited from the progress of chemotherapy and targeted therapies, but there was a parallel increase in treatment costs. Despite a relatively high incidence of many sites of cancer, so far, there is no national register for this disease in Morocco.</p> <p>The main goal of this paper is to estimate the total cost of chemotherapy in the early stages of breast cancer due to its frequency and the chances of patients being cured. This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of antimitotics and trastuzumab in Morocco.</p> <p>Method</p> <p>We start by evaluating the individual cost according to the therapeutic sub-groups, namely:</p> <p indent="1">1. Patients needing chemotherapy with only anthracycline-based therapy.</p> <p indent="1">2. Patients needing chemotherapy with both anthracycline and taxane but without trastuzumab.</p> <p indent="1">3. Patients needing trastuzumab in addition to chemotherapy.</p> <p>For each sub-group, the protocol of treatment is described, and the individual costs <it>per </it>unit, and for the whole cycle, are evaluated.</p> <p>Then we estimate the number of women suffering from breast cancer on the basis of two data bases available in Morocco.</p> <p>Finally, we calculate the total annual cost of treatment of breast cancer in Morocco.</p> <p>Results</p> <p>The total cost of breast cancer in Morocco is given in Moroccan dirhams (MAD), the US dollar at the current exchange rate (MAD 10 = USD 1.30) and in international dollars or purchasing power parity (MAD 10 = PPP 1.95).</p> <p>The cost of a therapy with trastuzumab is 8.4 times the cost of a sequential chemotherapy combining anthracycline and taxane, and nearly 60 times the cost of chemotherapy based on anthracycline alone.</p> <p>Globally, between USD 13.3 million and USD 28.6 million need to be devoted every year by the Moroccan health authorities to treat women with localized breast cancer in keeping with international recommendations.</p> <p>Discussion</p> <p>According to our estimation methods, the complete cost of adjuvant chemotherapy including trastuzumab will range from 1.3 to 2.4% of the global budget of the Moroccan Health Department (MAD 9.8 billion or USD 1.274 billion). Unfortunately, only one-third of the Moroccan population has healthcare insurance whereas for each patient the treatment with chemotherapy alone costs 1.15 times the annual minimum income (MAD 23,710 or USD 3,082), and treatment requiring both chemotherapy and trastuzumab costs 9.76 times the annual minimum income. For the tumour over expressing HER2Neu, we need to treat 25 women in order to save (cure) one woman: the calculated cost for one life saved is USD 663,000. The question is, is it cost-effective for an emerging country?</p> <p>Conclusion</p> <p>In this paper we aimed at evaluating the total cost of chemotherapy in the early stages of breast cancer in order to provide health decision-makers with a first estimation and a good opportunity for the optimal use of available data for the needs of antimitotics and trastuzumab in Morocco. Different protocols were considered and the individual cost of the whole treatment was given according to therapies using anthracycline alone, sequential chemotherapy combining anthracycline and taxane, and sequential chemotherapy with trastuzumab. According to our estimations, Moroccan health authorities need to devote between USD 13.3 million and USD 28.6 million every year in order to treat women suffering from localized breast cancer in ways consistent with international recommended standards.</p

Bevacizumab based chemotherapy in first line treatment of HER2 negative metastatic breast cancer: results of a Moroccan observational institutional study

<p>Abstract</p> <p>Background</p> <p>In metastatic breast cancer (MBC) patients, randomised controlled trials evaluated Bevacizumab as first-line treatment showed improvements in tumour response rate and progression-free survival (PFS) when added to chemotherapy. In Morocco, we conducted an observational study to investigate clinical features, treatment and prognosis associated with Bevacizumab based chemotherapy in first line treatment of HER2 negative MBC.</p> <p>Findings</p> <p>Nineteen women were included in this study. All these women were diagnosed as having HER2 negative MBC at the National Institute of Oncology in Rabat, Morocco, between January 2009 and December 2010. The median age of patients was 48.1 years. Four patients (21%) had metastatic disease at diagnosis and 15 patients (79%) had received treatment for first metastatic relapse. Bone, liver and lung were the most frequent metastasis sites. Patients were followed up until April 2011. Most patients had objective response; 15.8% of complete response, 47.3% of partial response and 21.1% of stabilisation. Median PFS was estimated at 11.5 months. Sub-groups analysis showed a statistically significant difference (Log-rank test: p = 0.01); PFS for patients receiving Bevacizumab - weekly Paclitaxel was estimated at 18.1 months, and at 9.1 months for patients receiving the combination Bevacizumab - Docetaxel. This benefit in PFS was associated with an acceptable safety profile.</p> <p>Conclusion</p> <p>As demonstrated in this study, Bevacizumab based chemotherapy in first line treatment of HER2 negative MBC in Morocco and particularly in combination with Taxanes extends PFS, as confirmed in a recent meta-analysis of 3 randomised controlled phase III studies.</p

Le coût par QALY rapporté au PIB (CQP): suggestion d’un nouvel indice économique évaluant l’impact réel du coût du bénéfice des molécules onéreuses en oncologie par rapport aux moyens économique d’un pays

La prescription de molécules onéreuses en cancérologie coûte cher à la société et implique un effort très important de la collectivité en faveur d'un malade. La prescription de ces médicaments doit d'une part être assortie à une efficacité notable et avoir un coût raisonnable. Pour pouvoir mesurer ce coût, il faut d'abord mesurer le bénéfice. QALY ‘Quality adjusted life year’ ou année de vie pondérée par la qualité est un indicateur qui évalue simultanément l'espérance de vie avec la notion de qualité de vie et permet de l'associer à un coût. L'impact de ce coût sur la société varie d'un pays à l'autre en fonction des ressources économiques disponibles .A travers cet article nous suggérons l'introduction d'un nouvel indice économique qui permet de mesurer l'impact réel du coût du bénéfice en rapportant le coût d'une action de santé au produit intérieur brut par habitant. Nous avons choisi de nommer cet indice: le coût par QALY rapporté au PIB (CQP).A titre d'exemple le CQP du Bevacizumab dans l'indication du cancer colorectal en première ligne métastatique varie entre 75.51 au Maroc ,70.47 en Egypte ,43.57 en Algérie et 5.5 en France.Pan African Medical Journal 2015; 2

Use of medicinal plants by cancer patients at the National Institute of Oncology, Rabat: a cross-sectional survey

Introduction:&nbsp;the use of medicinal plants has increased significantly in recent years. According to the World Health Organization, 80% of the world's population uses medicinal plants to treat themselves. Our study aims to estimate the prevalence of medicinal plant use by cancer patients, list the different plants and identify their adverse effects cited by users and their reported efficacy. Methods:&nbsp;this study was realised among 100 patients via a questionnaire with 14-items. Socio-economic and clinical characteristics have been analysed. The bivariate and multivariate analyses have been used to demonstrate the association between the socio-demographic characteristics of the participants, the duration of the disease and the use of medicinal plants. Results:&nbsp;45% of participants used medicinal plants. The most commonly reported reason for using medicinal plants was cancer cure (22%). During this study, 32 plants were identified. The Honey was the most commonly used (25%), thyme was also consumed at 15%, fenugreek at 13% and garlic at 7%. According to the multivariate analysis, the residence is predictor of medicinal plant use, urban residents used medicinal plants more than rural patients with an OR: 3,098, IC, 95%: [1,183-8,113] and P = 0,021. Fifty patients reported the moderate efficacy of the use of medicinal plants, and 20% described some side effects such as abdominal pain in 34%. Conclusion:&nbsp;in order to avoid any interaction with oncological drugs and to improve their effectiveness, a great importance must be given to information, education and awareness sessions

Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer, Morocco

le doctors were the only professional group that had satisfactory knowledge of risk factors while the nurses had an unsatisfactory knowledge with a mean score of 43%. A half of participants believed that that herbal therapy can cure breast cancer. 75% practice breast self-examination once a month and only 15% have ever had a mammogram. Age, profession and beliefs were not significantly associated with rate of BSE in this study; however this rate is influenced by knowledge of breast cancer risk factors. CONCLUSION: Results from this study suggest the need for continuing medical education programs aimed at improving knowledge of breast cancer among the nurses

Ovarian cancer revealed by paraneoplastic cerebellar degeneration: a case report

The prevalence of paraneoplastic cerebellar degeneration (PCD) associated with gynecological cancer is rare. Here, we reported the first case of ovarian cancer revealed by PCD in our institute. we describe a 80- year –old  Moroccan female presented with subacute vestibular and cerebellar syndromes, she had an inguinal  lymphadenopathy,with high levels of Anti-YO. Rapid progression and absence of known etiologies point   towards a probable paraneoplastic origin of the syndrome in this patient. The exact incidence of PNS among   those diagnosed with cancer remains uncertain, it is important to report this cases in the literature to help  early diagnosis and appropriate treatment, which are able to stabilize the neurological symptoms.Key words: Paraneoplastic cerebellar degeneration, Paraneoplastic syndromes, ovarian cance

Neoadjuvant chemotherapy in well-differentiated fetal adenocarcinoma: a case report

BACKGROUND: Fetal adenocarcinoma of the lung is a rare subtype of pulmonary adenocarcinoma with a relative estimated incidence of 0.5% or fewer of all lung cancers. Because of its extreme rarity, there have been no controlled clinical trials investigating treatment regimens for fetal adenocarcinoma and, as a result, there are no guidelines for management. CASE PRESENTATION: We report a case of a well-differentiated fetal adenocarcinoma, which is a variant of pulmonary blastoma, that is a low-grade malignancy and associated with a good prognosis. A 29-year-old Moroccan man presented with a well-differentiated fetal adenocarcinoma staged T3N0M0, who received 3 cycles of neoadjuvant chemotherapy followed by surgery, with no recurrence at 2 years follow-up. CONCLUSION: Fetal adenocarcinoma is a rare suptype of adenocarcinoma. Surgical resection is the treatment of choice for resectable disease. The role of chemotherapy in the neoadjuvant setting or adjuvant setting is not well defined

Peritoneal carcinomatosis, an unusual and only site of metastasis from lung adenocarcinoma

Isolated peritoneal metastases of lung adenocarcinoma are very rare, even exceptional, occurring most often in the context of a multi-metastatic disease. This report presents a rare clinical case of isolated peritoneal metastasis from lung adenocarcinoma. We report a 56-year-old male who was monitored for lung adenocarcinoma whose evolution has been marked by an isolated metastatic recurrence in the peritoneum objectified by an abdominal-pelvic computed tomography (CT) and confirmed by a laparoscopy with abiopsy of the peritoneal nodules. The patient had received palliative chemotherapy with gemcitabine, cisplatin and bevacizumab. The evolution was marked by a progressive deterioration of the general condition and death two months after the third treatment cycle. Peritoneal carcinomatosis from lung adenocarcinoma is a very rare event, and is often associated with a poor prognosis.Pan African Medical Journal 2016; 2