Catastrophic Healthcare Expenditure and Coping Strategies among Patients Attending Cancer Treatment Services in Addis Ababa, Ethiopia

Abstract

Background: With the rapid increase in magnitude and mortality of cancer, which is costly disease to manage, several patients particularly in developing countries are facing a huge financial burden. Objective: The purpose of the study was to examine the level of catastrophic health expenditure (CHE), identify associated factors and coping strategies among patients attending cancer treatment services in Addis Ababa, Ethiopia. Methods: A hospital based cross-sectional survey of patients with cancer was conducted in public and private hospitals between January and March 2018. Data was collected using a structured questionnaire. All direct medical and nonmedical expenditures were measured and reported as expenditure (US$) per patient (1US$ equivalent to 23.41 Ethiopian Birr). The CHE was estimated using a threshold of 10% of annual household income. Results: A total of 352 (response rate of 87.1%) participants were interviewed. Majority (73.3%) of the respondents were females; most (94%) from public hospitals and their mean (±SD) age was 48±13.2years. Breast (37%) and Cervical (16.5%) cancers accounted the largest proportion. Vast majority (74.4%) of patients experienced CHE with mean overall expenditure of $2366 per patient (median: $1708). Medical expenditure shared the highest overall expenditure (83.6%) with mean medical and nonmedical costs of $1978 (median: $1394) and $388 (median: $222), respectively. Patients who took greater than six cycles of chemotherapy (AOR: 3.64; 95%CI: 1.11-11.92), and age (AOR: 1.03; 95%CI: 1.01-1.06) were significantly associated with CHE. Household saving (85.5%) followed by financial support (43.0%) were the main coping strategies. Conclusion: A substantial number of patients with cancer are exposed to CHE with considerable medical expenditure. Hence, mobilizing the health insurance scheme is urgently needed to ensure financial risk protection and realize universal health coverage for patients with cancer.

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

“…Also, about a quarter of them are forced to borrow and about 16% of them are forced to take a bank loan. (Table 5) This nding broadly supports the work of other studies in this area in Iran [19,31], Ethiopia [21,32], India [33], and Australia [34].…”

“…It means that in the bestcase scenario, 13.7% of the Iranian households involved with the disease suffered from CHE and had forced to sacri ces the consumption of other goods and services necessary for their well-being. This is much lower than estimates made by other comparable studies in Iran (60.9%) [19], China (30.98%) [20], Ethiopia (72.3%) [21], Vietnam (71.8%) [22], Haiti (67%) [23], and South Korea (39.8%) [24]. Although households with higher SES levels are less likely to incur CHE, a signi cant portion of all SES subgroups are exposed to these limiting costs.…”

Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis

“…And if so, which cancer treatment is it? •Almost half of survivors experienced material financial hardship •10% of cancer survivors reported experiencing behavioural financial hardship Kasahun et al [ 40 ] 2020 To examine the incidence of catastrophic health expenditure and identify associated factors and coping strategies among patients attending cancer treatment services in Addis Ababa, Ethiopia Cross-sectional/questionnaire Ethiopia 352 Breast = 130, cervical = 58, colorectal = 46, NPC = 13 and others = 105 NR M = 94 and F = 258 48 ± 13.2 Structured questionnaire based on WHO Study of Global Ageing and Adult Health Household income and expenditure were measured based on respondents’ self-reported daily or monthly income and expenditure •74.4% of patients experienced CHE with mean overall expenditure of $2366 per patient •Inpatient services accounted for 2-thirds of the total expenditure with a mean cost of $1584 Zhao et al [ 41 ] 2019 To measure the comprehensive needs of cancer patients and explore the possible factors associated with their needs Cross-sectional/questionnaires China 200 General NR M = 96 and F = 104 54.87 ± 12.45 Used the comprehensive needs assessment tool (CNAT) in cancer for patients to measure financial burden •84.5% of the patients had medical insurance •Patients who were younger, female, with low family monthly income, at their own expense, more than 3 years after diagnosis, and with highly educated caregivers had higher score of CNAT (49.13 ± 10.13) •Lowest score of CNAT was the need for physical symptoms (35.12 ± 16.68) Tekin and Saygili [ 29 ] 2019 To determine the annual direct medical costs of all breast cancer patients in Turkey with top-down cost approach Retrospective cohort/electronic records Turkey 26,664 Breast NR M = 2432 and F = 24,232 NR Hospital billing system …”

“…Three studies provided the prevalence estimates of objective financial toxicity [ 40 , 44 , 45 ] enabling a meta-analysis. The pooled prevalence of objective financial toxicity was 56.96% (95% CI, 30.51, 106.32) (see Fig.…”

“…Direct medical costs were categorised into seven cost items: consultation; diagnosis; treatment, including surgery, radiotherapy, chemotherapy, hormone therapy, combined modalities and palliative/supportive care; inpatient care; outpatient care; and follow-up care. In total, 11 studies presented data on mean direct medical costs [ 25 , 27 – 29 , 31 , 36 , 37 , 40 , 42 , 49 , 52 ]. Overall mean direct medical costs were $2740.18, which ranged from $1953.62 to $3526.74 per cancer patient.…”