Modeling the financial needs of non-metastatic breast cancer care in Armenia: Implications for resource-limited health systems.

29 Background: Non-metastatic breast cancer (BC) accounts for the majority of BC cases in Armenia and poses a growing economic challenge to the national health system. The country lacks a comprehensive public medical insurance system, and access to cancer treatment relies heavily on limited state support and out-of-pocket payments. The Armenian government provides partial financial assistance through a fixed annual subsidy per patient. This support can cover many standard chemotherapeutic agents, but access to novel and targeted therapies remains uneven. In this resource-constrained context, cost modeling is critical to inform national policy, optimize funding allocation, and support the development of a sustainable, equitable cancer care infrastructure. Methods: A cost estimation model was developed to quantify the annual direct medical expenses associated with the diagnosis and treatment of stage I–III BC in Armenia. The analysis was based on national cancer incidence data, institutional records from the Yeolyan Hematology and Oncology Center, and NCCN guidelines. The calculation included routine diagnostics, systemic anti-cancer therapies, and scheduled follow-up within the first year of treatment. Costs for each component of care were determined per patient and extrapolated to a reference population of 1,000 patients, representing the approximate annual number of newly diagnosed non-metastatic BC cases in Armenia. Costs included diagnostic procedures, systemic therapies, and selected supportive medications. The following were excluded: ICU care, antibiotics, antifungals, antihypertensives, medical supplies, BRCA1/2 testing, and certain medications used in the adjuvant setting. Results: Based on our calculations using national incidence data and standardized treatment protocols, the estimated annual cost of diagnosing and treating 1,000 patients with stage I–III BC in Armenia was AMD 2.75 billion (~USD 7.12 million). In 2024, the Armenian government allocated approximately AMD 169.9 billion to healthcare, which represents 1.6% of the national GDP and 5.3% of total public spending. Conclusions: Non-metastatic BC care imposes a substantial financial burden on Armenia’s health system, with treatment costs for early-stage BC accounting for approximately 1.6% of the national healthcare budget. These findings underscore the significant financial pressure a single, common cancer can place on the system—especially in a setting where a comprehensive insurance framework is not yet developed. This pattern is consistent with systemic barriers in low- and middle-income countries, where health system limitations delay access to essential cancer services. Cost modeling such as this is critical to guide policy, advocate for expanded coverage, and support the development of sustainable national insurance strategies in resource-limited settings.