Cost-effectiveness of sorafenib versus best supportive care in advanced hepatocellular carcinoma in Egypt

Background: In light of constrained budgets and the need to fund efficient treatment options, this study set out to assess the cost-effectiveness of sorafenib as a first-line treatment of hepatocellular carcinoma (HCC) compared to best supportive care (BSC) from the military hospital perspective in Egypt.

Methods: A decision analytic Markov model simulated disease progression with clinical parameters and utility values derived from published data. Data on direct medical costs were collected from the local healthcare system or payer. Costs and effects were discounted at 3.5% annually and reported in USD using purchasing power parity adjustments. Deterministic and probabilistic sensitivity analyses were conducted.

Results: Mortality occurred less frequently in the sorafenib group (sorafenib group: 99.96%, BSC group: 99.99%). The total quality-adjusted life years (QALYs) of the sorafenib cohort were estimated to be 46.24 compared with 42.27 for the BSC cohort, which resulted in an incremental gain of 3.96 QALYs. The total costs for the sorafenib and BSC cohorts were USD 4,229,940 and USD 3,092,886, respectively (incremental cost = $1,137,054), resulting in an incremental cost-effectiveness ratio (ICER) of USD 286,776 per QALY gained for the sorafenib cohort. One-way sensitivity analyses that addressed the uncertainty of the BSC estimates indicated that the progression-free survival for BSC and utility value of progression had the greatest effects on the results.

Conclusion: This study concluded that sorafenib does offer increased survival and quality-of-life at an increased cost but at an ICER that exceeds the nationally accepted cost-effectiveness threshold. The findings support healthcare decision-making of the efficient allocation of healthcare system resources to improve the health of the Egyptian population. Whether sorafenib is cost-effective in specific sub-groups with additional risk factors needs to be addressed in future studies.     

The Egyptian Government's Role in Re-Establishing the Hotel Industry in Cairo (1953–1957)

This article analyzes the role of the Egyptian Government in reviving and improving the Egyptian hotel industry in the revolutionary period. It provides a case study of a country with large political problems, but at the same time pursuing a dream—a dream that was expensive and demanding. Tourism was understood to be an important tool in promoting political stability and providing some legitimacy to a political system opposed by the major powers in the world. This study will examine the Egyptian Government's role in re-establishing the hotel industry as an important economic sector in Egypt during the period from 1953 to 1957, which was considered a critical political period. The year 1953 marked the beginning of the official plans to increase the hotel facilities in Cairo with the establishment of the Tourism Department; and 1957 marked the end of Suez Crisis of 1956. The study utilized unpublished U.S. Department of State documents that show that the hotel industry was used as tool to put pressure on the Egyptian President Gamal Abdel Nasser (1952–1970) to accept U.S. foreign policy in the Middle East and was one of the main issues negotiated between the two countries after the Suez Crisis.     

The one-billion-plus marginalization: Toward a scholarly understanding of Islamic consumers

Information regarding the Islamic perspective on marketing is still lacking in mainstream literature. The present work aims to assemble the theoretical foundations of Islamic marketing thought in relation to the modern marketing paradigm. The paper highlights the opportunity costs involved with marginalizing the one billion plus Muslim consumer segment and presents a conceptualization of Islamic religiosity and its marketing implications building upon the Islamic theology infrastructure in terms of its inherent broad objectives (maqasid ash-shari'ah) while putting forth multi-stakeholder research propositions for future testing. The conceptualization presented serves to establish an enlightened dialogue and foster further cross-cultural understanding of the Muslim consumer segment to benefit academics, practitioners, and policy makers.     

Cost-effectiveness of six months versus 1-year adjuvant trastuzumab in HER2 positive early breast cancer in Egypt

Abstract

Introduction: Breast cancer is the most prevalent cancer among women in Egypt. Trastuzumab is administered with chemotherapy for patients with HER2-positive advanced breast cancer (HER2?+?ve ABC) in the metastatic and adjuvant settings resulting in improved treatment outcomes, and long-term follow-up. Some studies have evaluated whether equivalent outcomes can be achieved with reduced treatment duration. This study evaluates the cost-effectiveness of 6-month versus 1-year trastuzumab treatments from payer perspective over a 10 year time horizon.

Methods: A half-cycle corrected Markov model was developed with five mutually exclusive health states; patient with HER2?+ve ABC, disease-free survival (DFS), local or regional relapse, metastatic relapse, and death. A cycle length of 6 months was applied, direct medical costs including cost of treatments, day-care, surgery, health states and follow-up visits were collected, and indirect costs such as lost productivity were not estimated. The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted.

Results: Among the HER2?+ve ABC patient population in Egypt, the total QALYs of the 6-month trastuzumab were estimated to be 2.99 compared with 2.93 for the 1-year trastuzumab which resulted in a difference of 0.06 QALYs. The total costs were EGP 271,647 ($106,947) and EGP 381,248 ($150,097), respectively. These costs yielded an ICER of –109,600 EGP/QALY (–43,149 $/QALY) for the 6-month trastuzumab. The 6-month trastuzumab is a dominant strategy when compared to 1-year trastuzumab, resulting in improved effectiveness at a reduced cost. All analyses results confirmed the dominance of 6-month trastuzumab and our model robustness.

Conclusions: This study concluded that 6-month trastuzumab is a cost-effective option when compared to 1-year trastuzumab in patients with HER2?+ve ABC in Egypt. Our findings provide health care decision makers with additional insights to best allocate available resources concurrently with the improvement of the Egyptian patient’s outcomes.     

Hospital Servicescape Design for Inpatient Wellbeing

Wellbeing of end-users is a growing concern in services research. The growth of transformative service research and evidence-based design highlights the need to focus on hospital patients to improve their state of wellbeing. This study combines both fields to propose a conceptual model for the hospital perceived servicescape. The effect of the servicescape on inpatient wellbeing is tested using a quantitative survey conducted with 372 inpatients in Egypt. Results indicate that hospital servicescapes should include the aspects of art and visuals; plants and greenery; safety and hygiene; patient single rooms and atmosphere; and signage and way-finding.