Advancing women's health in Egypt: an economic evaluation of the presidential initiative for nationwide breast cancer early detection and treatment.

backgroundBreast cancer (BC) is the leading cause of cancer-related mortality among women worldwide and poses a major public health and economic challenge in Egypt, where late-stage diagnosis remains high. Egypt launched the Presidential Initiative for Women's Health, a nationwide, publicly funded program providing free early detection, diagnostic, and treatment services. This study presents a model-based economic evaluation of the initiative.

methodsA hybrid decision tree and Markov model compared the Presidential Initiative pathway with opportunistic case detection, from a societal perspective over a lifetime horizon. Outcomes were quality-adjusted life years (QALYs), life years, net societal cost, and return on investment (ROI); health outcomes were not monetized. Model structure was assessed using face, internal, and cross-validation following the ISPOR-SMDM taxonomy with structured review by 16 clinical and program co-authors. Uncertainty was examined using Monte Carlo probabilistic sensitivity analysis (PSA) with 5000 iterations. Inputs were national program data for July 2019 to September 2024.

resultsApproximately 23.8 million unique women generated 53,453,745 recorded screening and service encounters. Among confirmed cases, the observed stage I to II proportion was 61.3% in the initiative data versus 41.6% in the comparator. The model estimated 32,576 incremental QALYs and 63,448 additional discounted life years, with total societal costs of EGP 11.68 billion (USD 258 million) versus EGP 18.07 billion (USD 398 million), a net societal saving of EGP 6.39 billion (USD 141 million) and an ROI of 54.7%. In the PSA, at the Egyptian threshold of EGP 164,588 per QALY, the initiative was cost-effective in all 5,000 simulations (100%), and dominant in 4,988 (99.76%), with a base-case net monetary benefit of EGP 11.75 billion (USD 259 million).

conclusionsUnder the observed program stage distribution, the Presidential Initiative was projected to provide greater modeled health outcomes at lower societal cost than opportunistic case detection, dominant in the base-case and cost-effective at the Egyptian threshold in every simulation. These are model-based estimates conditional on transferred survival and utility inputs. The findings support continued program evaluation and investment alongside collection of Egyptian long-term outcome data.