Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis

Álvarez-Hernández, Everardo; Peláez‐Ballestas, Ingris; Boonen, Annelies; Vázquez‐Mellado, Janitzia; Hernández-Garduño, Adolfo; Rivera, Fernando Carlos; Terán‐Estrada, Leobardo; Ventura‐Ríos, Lucio; Ramos-Remus, César; Skinner-Taylor, Cassandra Michele; Goycochea-Robles, María Victoria; Bernard-Medina, Ana Guilaisne; Burgos‐Vargas, Rubén

doi:10.1016/j.reuma.2012.05.002

Cited by 47 publications

(18 citation statements)

References 20 publications

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“…The primary outcome at 12 months was financial catastrophe (FC) following treatment for cancer, defined as OOP costs at 12 months equal to or exceeding 30 % of annual household income [ 19 , 20 ]. OOP costs represented hospital and non-hospital health care costs which were directly incurred by patients at point of delivery and not reimbursed by insurance.…”

Section: Methodsmentioning

confidence: 99%

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

Kimman¹,

Jan²,

Yip³

et al. 2015

BMC Med

134

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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.

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Section: Methodsmentioning

confidence: 99%

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

Kimman¹,

Jan²,

Yip³

et al. 2015

BMC Med

134

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“…[7][8][9] Participants were asked to deduct any reimbursement from health insurance from their health expenditures associated with an admission to hospital. A reason this threshold was used as opposed to the 40% of nonfood expenditure/income threshold is because it does not require the collection of data on household food/ nonfood expenditure.…”

Section: Methodsmentioning

confidence: 99%

“…[4][5][6] This financial burden is commonly defined in terms of incidence of financial catastrophe, where out-of-pocket expenditure for health care exceeds a defined threshold proportion of annual income, usually 30% of annual household income [7][8][9] or 40% of nonfood expenditure or income. 10 Although these are well-recognized measures, a limitation is that income does not reflect nonmonetary earnings and the availability of financial support from family members outside the immediate household.…”

mentioning

confidence: 99%

Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: Results from the ACTION Study

2015

Surgery

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“…For studies where indirect costs dominated, the approach to estimating indirect costs had an important impact. It was observed that work disability measured by disability pension was taken into account in these studies [16][17][18]30,31 , except for two studies from Mexico and Hong Kong 32,33 , where indirect costs were driven by unemployment due to RA. On the other hand, for those studies where direct costs dominated, work disability was generally not included as an indirect cost component 28,[34][35][36][37][38] .…”

Section: Direct and Indirect Costs Of Ramentioning

confidence: 99%

Economic burden of rheumatoid arthritis: a systematic review of literature in biologic era

et al. 2020

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BackgroundThe past decades have seen rapid advances in the treatment of rheumatoid arthritis (RA). In particular, the introduction of biologic and targeted synthetic disease-modifying antirheumatic drugs have improved clinical outcomes and reconfigured traditional RA cost compositions.ObjectivesTo map the existing evidence concerning cost of illness of RA, as the treatment pathway evolves in the biologic era, and examine how costs have been measured and estimated, in order to assemble and appropriately interpret available data.MethodsSystematic review of studies that estimated the costs of patients with RA. Multiple electronic databases were searched to identify studies published between 2000 and 2019. The reported total costs and cost components were evaluated according to the study and population characteristics. The Cochran-Armitage test was used to determine statistically significant trends in increasing or decreasing proportions over time.ResultsOverall, 72 studies were included. Drug costs compromised the main component (up to 87%) of direct costs with an increasing trajectory over time, although not statistically significant. The proportion of costs for hospitalisation showed a statistically significant decrease chronologically (p=0.044). Indirect costs, primarily associated with absenteeism and work disability accounted for 39% to 86% of total costs. The reported indirect costs are highly sensitive to the approach to estimation.ConclusionsA decreasing trend in inpatient costs chronologically suggested a cost shift in other components of direct costs. Indirect costs still contributed a considerable proportion of total costs, with work disability being the main cost component. Economic analyses that do not incorporate or appropriately measure indirect costs will underestimate the full economic impact of RA.

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Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis

Cited by 47 publications

References 20 publications

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

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

Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: Results from the ACTION Study

Economic burden of rheumatoid arthritis: a systematic review of literature in biologic era

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