Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries

Abstract

BackgroundOne of the biggest obstacles to developing policies in cancer care in Southeast Asia is lack of reliable data on disease burden and economic consequences. In 2012, we instigated a study of new cancer patients in the Association of Southeast Asian Nations (ASEAN) region – the Asean CosTs In ONcology (ACTION) study – to assess the economic impact of cancer.MethodsThe ACTION study is a prospective longitudinal study of 9,513 consecutively recruited adult patients with an initial diagnosis of cancer. Twelve months after diagnosis, we recorded death and household financial catastrophe (out-of-pocket medical costs exceeding 30 % of annual household income). We assessed the effect on these two outcomes of a range of socio-demographic, clinical, and economic predictors using a multinomial regression model.ResultsThe mean age of participants was 52 years; 64 % were women. A year after diagnosis, 29 % had died, 48 % experienced financial catastrophe, and just 23 % were alive with no financial catastrophe. The risk of dying from cancer and facing catastrophic payments was associated with clinical variables, such as a more advanced disease stage at diagnosis, and socioeconomic status pre-diagnosis. Participants in the low income category within each country had significantly higher odds of financial catastrophe (odds ratio, 5.86; 95 % confidence interval, 4.76–7.23) and death (5.52; 4.34–7.02) than participants with high income. Those without insurance were also more likely to experience financial catastrophe (1.27; 1.05–1.52) and die (1.51; 1.21–1.88) than participants with insurance.ConclusionsA cancer diagnosis in Southeast Asia is potentially disastrous, with over 75 % of patients experiencing death or financial catastrophe within one year. This study adds compelling evidence to the argument for policies that improve access to care and provide adequate financial protection from the costs of illness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0433-1) contains supplementary material, which is available to authorized users.

How great is current curative expenditure and catastrophic health expenditure among patients with cancer in China? A research based on “System of Health Account 2011”

“…As we can see from the results, increased length of stay, no insurance, low level of education, more people in family, high OOP%, household with at least one person over 65 years of age and low‐income level, these factors had major impact on CHE. When CHE was defined as OOP medical costs exceeding 30% of annual household income by some researchers, it was found that education background, income level, type of health institutions, and health insurance were influencing factors of CHE in the study on influencing factors of CHE among households with cancer in 10 countries in southeast Asia, of which the results are similar to ours 8. Also, the study found that cancer stage was one of the factors—the further the stage extended, the more likely CHE would occur.…”

“…A study conducted in South Korea by Choi et al7 showed that 39.8% of the 211 cancer patients suffered from CHE. While in South Asia, 48% of the 9513 patients with cancer experienced CHE 8. It also showed that the incidence of CHE varied among different countries.…”

Household Financial Burden and Poverty Impacts of Cancer Treatment in Vietnam

“…The ACTION study reported that, a year after diagnosis, only 23% of cancer patients from eight countries in ASEAN were alive with no financial catastrophe [15]. A study in Haiti found that two-thirds of women with breast cancer were to face financial catastrophe because of the treatment costs [19].…”

“…However, only older age, lower income, and receiving multiple treatment methods were shown to be statistically significant correlates of the impoverishment problem. At regional level, the ACTION study found that having a below-average income, having no health insurance, not having paid work, and having attended not higher than primary education were all associated with higher odds of experiencing catastrophic expenditure [15] and this reinforces the current knowledge of relationship between socioeconomically disadvantaged conditions and higher risks of financial hardship [23]. There should be financial support programs to cover the treatment costs of cancer and to help socioeconomically disadvantaged cancer patients to cope with the challenging situation.…”

“…This study was conducted as part of a regional study on the economic and health impact of cancer in eight countries in the ASEAN (Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand, and Vietnam), the ASEAN CosTs in ONcology (ACTION) study [15]. This is a longitudinal cohort study conducted on a sample of 10,000 cancer patients.…”