Out-of-pocket expenses incurred by patients obtaining free breast cancer care in Haiti

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

doi:10.1016/s0140-6736(15)60843-1

Cited by 18 publications

(27 citation statements)

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“…In addition to medical costs, OOP payments are caused by nonmedical costs such as transportation and lost wages. A study in Haiti showed that despite receiving free breast cancer care, the majority of patients faced catastrophic medical expenses [20]. High OOP payments can lead to financial difficulties and impaired quality of life.…”

Section: Discussionmentioning

confidence: 99%

The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal cancer patients

et al. 2019

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Objectives: Financial difficulties experienced by cancer patients may affect their health-related quality of life (HRQoL). This study assessed the direct economic burden that out-of-pocket (OOP) payments cause and explored how they and financial difficulties are associated with HRQoL. Methods: This is a cross-sectional registry and survey study of 1978 cancer patients having either prostate (630), breast (840) or colorectal cancer (508) treated in Finland. The patients were divided into five groups according to the stage of their disease: primary treatment, rehabilitation, remission, metastatic disease and palliative care. The cost data and OOP payments were retrieved from primary and secondary healthcare registries, the Social Insurance Institution of Finland, and a patient questionnaire. HRQoL was measured by 15D, EQ-5D-3L and by EORTC-QLQ-C30. Financial difficulties were evaluated based on patients' self-assessment in the EORTC-QLQ-C30 four-level question about financial difficulties. A path analysis was used to explore the relationship between clinical and demographic factors, HRQoL, OOP payments and financial difficulties. Results: The highest OOP payments were caused by outpatient medication. Total costs and OOP payments were highest in the palliative care group in which the OOP payments consisted mostly of outpatient medication and public sector specialist care. Private sector health care was an important item of OOP payments in the early stages of cancer. Financial difficulties increased together with OOP payments. HRQoL deteriorated the more a person had financial difficulties. In the path analysis, financial difficulties had a major negative direct and total effect on the HRQoL. Factors that attenuated financial difficulties were age, cohabiting and higher education and factors that increased them were OOP payments, total costs of healthcare use, and unemployment. Conclusions: High OOP payments are related to financial difficulties, which have a negative effect on HRQoL. Outpatient medication was a major driver of OOP payments. Among palliative patients, the economic burden was highest and associated with impaired HRQoL.

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Section: Discussionmentioning

confidence: 99%

The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal cancer patients

et al. 2019

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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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“…An annual out-of-pocket expenditure of €614 therefore represents a reasonable burden for these households. Conversely, in Haiti, for example, the median non-medical outof-pocket expenditure of BC patients was US$233 (from diagnosis to follow-up) for a median daily salary of US$2 [25]. In contrast, health care costs in some countries are not covered by national health insurance and patients need to take out private insurance.…”

Section: Discussionmentioning

confidence: 99%

Direct medical and non-medical costs of a one-year care pathway for early breast cancer: results of a French multicenter prospective study

Héquet

Huchon

Soilly

et al. 2019

Preprint

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Introduction: The organization of health care for breast (BC) constitutes a public health challenge to ensure quality of care, while also controlling expenditure. Few studies have assessed the global care pathway of early BC patients, including a description of direct medical costs and their determinants.Methods: OPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-ofhospital costs, supportive care costs) and direct non-medical costs (transportation and sick leave costs) were calculated by using a cost-of-illness analysis based on a bottom-up approach.Resources consumed were recorded in situ for each patient, using a prospective direct observation method. Results: Data from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were €12,250. Factors independently associated with higher direct medical costs were: diagnosis on the basis of clinical signs, invasive cancer, lymph node involvement and conventional hospitalization for surgery. Median sick leave costs were €8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs (€3,687/patient/year without chemotherapy versus €10,706 with chemotherapy). Forty percent (n=242) of patients declared additional personal expenditure of €614/patient/year. No drivers of these costs were identified.Conclusion: Initial stage of disease and the treatments administered were the main drivers of direct medical costs. Direct non-medical costs essentially consisted of sick leave costs, accounting for one-half of direct medical costs for working patients. Out-of-pocket expenditure had a limited impact on the household.

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Out-of-pocket expenses incurred by patients obtaining free breast cancer care in Haiti

Cited by 18 publications

References 0 publications

The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal cancer patients

The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal cancer patients

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

Direct medical and non-medical costs of a one-year care pathway for early breast cancer: results of a French multicenter prospective study

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