Incidence of Household Catastrophic and Impoverishing Health Expenditures among Patients with Breast Cancer in Iran

Abstract

Background: Breast cancer disease is the most common cancer among Iranian women. Management of this disease requires expensive services and care, imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran.Methods: In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. To defining the CHE, we applied three non-food expenditure thresholds of 40%, 20%, and 10%. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their monthly consumption expenditures, where SES classifications were standardized by Adult Equivalent values of consumption expenditures. For statistical comparisons of the incidence of CHE and impoverishing spending, we applied the independent t-test and one-way ANOVA respectively for two and more than two separate subgroups. Besides identifying the factors affecting these indicators, we performed the two different multivariate logistic regression models.Results: This study finds that each patient had an average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed to CHE of 13.77% of their households. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them have been forced to sell their assets, borrow, or take a bank loan.Conclusions: Vulnerable people should be supported by expanding insurance coverage, governmental supporting programs, and increasing access to quality and effective public sector services.

Out of Pockets Spending Among Breast Cancer Women Receiving Out-Patient Treatment in a Tertiary Teaching Hospital in Kuala Lumpur Malaysia

“…In term of sociodemographic factor, higher socioeconomic group spend significantly higher out of pocket. Higher household income showed higher OOP which is similar to other study 9 . Several studies found lower income group associated with lower OOP and a factor contributing to financial toxicity 10 and higher OOP burden 11 while the proportion of households facing catastrophic OOP health payments were more prevalent in poor income states and aggravate the prevalence and intensity of poverty by the need to pay for health care services 12 .…”