Economic burden of five common cancers in Iran: a systematic review of cost-of-illness with a focus on healthcare resource utilization.

BACKGROUND

According to the latest World Health Organization report, approximately half of the new cancer cases in Iran are attributed to five common cancers: gastric, breast, colorectal, lung, and prostate cancer. These cancers impose a heavy economic burden on healthcare systems and society, including direct medical costs (DMC), direct non-medical costs (DNMC), and indirect costs (IDC). This systematic review aimed to investigate the economic burden of these cancers in Iran.

METHODS

This systematic review was conducted according to PRISMA guidelines. The search strategy was developed using MeSH terms, Emtree, and previous literature. To identify relevant studies published up until December 27, 2023, searches were conducted in both international databases (PubMed, Scopus, Web of Science, Embase, Cochrane, and the NHS Economic Evaluation Database) and national databases (SID, Magiran, and IranMedex). After removing duplicates and screening studies using Endnote software, eligible studies were selected for inclusion in the review. The costs were converted to USD 2021 using the CCEMG-EPPI-Centre cost converter.

RESULTS

A total of 22 studies were included in this review. Breast and colorectal cancer each had 4 studies, while prostate, gastric, and lung cancer each had 3 studies. The remaining 5 studies covered a combination of multiple cancers. Converting the costs from different studies to USD 2021 showed that the average annual DMC per patient with breast cancer varied from $13,954 to $34,772. These costs ranged from $14,671 to $28,656 for colorectal cancer, $7,970 to $16,821 for prostate cancer, $12,206 to $17,681 for gastric cancer, and $9,369 to $40,682 for lung cancer. Part of these variations may be related to differences in healthcare resource utilization, while another part may be due to differences in cost calculation methodology, study perspective, and study location. Additional cost conversion findings showed that in 85% of the studies, the average annual DNMC per patient for all cancers were estimated to be less than $4,000. Furthermore, the average annual IDC per patient for breast and lung cancer were estimated to be as high as $100,000 due to high mortality, compared to less than $30,000 for other cancers.

CONCLUSIONS

Given the high prevalence of these five cancers in Iran, their economic burden is significant. Policymakers should focus not only on reducing the disease burden but also on minimizing the economic burden of cancer. Strategies such as improving early detection, optimizing treatment pathways, and implementing cost-effective interventions could help reduce both healthcare costs and the overall financial strain on patients and the healthcare system.