Out-of-pocket expenses incurred by patients obtaining free breast cancer care in Haiti: A pilot study

O’Neill, Kathleen; Mandigo, Morgan; Pyda, Jordan; Nazaire, Yolande; Greenberg, Sarah L M; Gillies, Robyn M.; Damuse, Ruth

doi:10.1016/j.surg.2015.04.040

Cited by 29 publications

(24 citation statements)

References 20 publications

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“…In Vietnam 37.4% of the households with cancer sufferers were impoverished by the treatment costs (29). Despite having free medical care for breast cancer, a study in Haiti found that two-thirds of women suffered financial catastrophe because of the OOP expenditure for non-medical cost and medical cost for out of facility care (30), and 52% of the participant suffered debt and 20% sold possessions (31).…”

Section: Discussionmentioning

confidence: 99%

Estimating the Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital

Khatiwoda

Dhungana

Sapkota

et al. 2019

Front. Public Health

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Background: The increasing prevalence of cancer and lack of strong health financing system in low income countries like Nepal is exerting an enormous financial burden on cancer patients. However, there is scant information relating to the amount of expenditure on health services for cancer treatments in Nepal. Therefore, this study aimed to estimate the direct cost associated with the treatment of cancer on the patients attending a tertiary cancer treatment center in Nepal. Methods: A quantitative cross-sectional study was carried out on 294 cancer patients who were receiving treatment from Bhaktapur Cancer Hospital between 17th November 2016 and 13th February 2017. Direct medical cost and non-medical costs borne by the patients were calculated based on the cost of illness methodology. Medical cost included the cost of consultation, diagnosis and treatment while non-medical cost comprised the cost occurred out of the health facility such as the cost of food, travel, and accommodation. Result: Of those 294, 169 (57.5%) were female and 125 (42.5%) were male. The median (IQR) age was 54 (19) years. Cancer of the lung was present in 19.39%, breast cancer in 15.65% and cervical cancer in 14.29%. Mean (SD) and Median (IQR) direct cost of cancer was NRs 387.5 (196.8) and 346.1 (260.5) thousand. Medical cost contributed to 80.91% of the total direct cost. Almost everyone relied on out-of-pocket (OOP) payment for cancer treatment, where 253 (86.1%) participants reported that they were experiencing financial hardship, 230 (78.2%) took a loan, and 140 (47.6%) sold their property to manage the OOP. Both medical and non-medical costs varied significantly with age, socioeconomic status, types of cancer and the treatment. Conclusion: Medical cost contributed the most to the direct cost. OOP was dominant payment mechanism to utilize health services. Average direct cost of cancer was higher than the average income of patients, sufficient to cause financial catastrophe. This implies the need of improved health financing strategy to protect people from the financial hazards of health service utilization for cancer in Nepal.

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Section: Discussionmentioning

confidence: 99%

Estimating the Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital

Khatiwoda

Dhungana

Sapkota

et al. 2019

Front. Public Health

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“…In a small study from Haiti, despite free treatments, 40% of patient income was eroded by out-of-pocket indirect medical costs. 19 The average per capita health expenditure for African countries is approximately 82 dollars, and it is estimated that 50% to 70% of the health care cost is from private funds. 20 Cancer competes with other diseases, including malaria, HIV, and tuberculosis, in the health budget allocations for African countries.…”

Section: Discussionmentioning

confidence: 99%

Pilot Survey of Breast Cancer Management in Sub-Saharan Africa

Vanderpuye¹,

Olopade²,

Huo³

2017

JGO

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PurposeTo understand the current state of breast cancer management in sub-Saharan Africa.MethodsWe conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013.ResultsTwenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team. Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities. Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, taxanes, vinorelbine, and gemcitabine were available in few facilities. Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%). It took an average of 1 to 3 weeks to report histopathology. Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the country in seven facilities (37%), and outside the country in four facilities (21%). Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol. Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%). In three facilities (16%), receptor status did not influence the prescription of hormone treatment.ConclusionThis pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier. Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.

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“…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]. Similarly, cancer treatment is considered as the most costly healthcare service in India.…”

Section: Discussionmentioning

confidence: 99%

Household Financial Burden and Poverty Impacts of Cancer Treatment in Vietnam

Hoang

Pham

Quynh

et al. 2017

BioMed Research International

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Purpose This paper aims to analyze the household financial burden and poverty impacts of cancer treatment in Vietnam. Methods Under the “ASEAN CosTs in ONcology” study design, three major specialized cancer hospitals were employed to assemble the Vietnamese data. Factors of socioeconomic, direct, and indirect costs of healthcare were collected prospectively through both individual interviews and hospital financial records. Results The rates of catastrophic expenditure based on the cut-off points of 20%, 30%, 40%, and 50% of household's income were 82.6%, 73.7%, 64.7%, and 56.9%, respectively. 37.4% of the households with patient were impoverished by the treatment costs for cancer. The statistically significant correlates of the impoverishment problem were higher among older patients (40–60 years: 1.77, 95% CI 1.14–2.73; above 60 years: 1.75, 95% CI 1.03–2.98); poorer patients (less than 100% national income: 29, 95% CI 18.6–45.24; less than 200% national income: 2.89, 95% CI 1.69–4.93); patients who underwent surgery alone (receiving nonsurgery treatment: 2.46, 95% CI 1.32–4.59; receiving multiple treatments: 2.4, 95% CI 1.38–4.17). Conclusions Lots of households were pushed into poverty due to their expenditure on cancer care; more actions are urgently needed to improve financial protection to the vulnerable groups.

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Out-of-pocket expenses incurred by patients obtaining free breast cancer care in Haiti: A pilot study

Cited by 29 publications

References 20 publications

Estimating the Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital

Estimating the Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital

Pilot Survey of Breast Cancer Management in Sub-Saharan Africa

Household Financial Burden and Poverty Impacts of Cancer Treatment in Vietnam

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