Costs of breast cancer treatment incurred by women in Vietnam

Abstract

Background There is a paucity of research on the cost of breast cancer (BC) treatment from the patient’s perspective in Vietnam. Methods Individual-level data about out-of-pocket (OOP) expenditures on use of services were collected from women treated for BC (n = 202) using an online survey and a face-to-face interview at two tertiary hospitals in 2019. Total expenditures on diagnosis and initial BC treatment were presented in terms of the mean, standard deviation, and range for each type of service use. A generalised linear model (GLM) was used to assess the relationship between total cost and socio-demographic characteristics. Results 19.3% of respondents had stage 0/I BC, 68.8% had stage II, 9.4% had stage III, none had stage IV. The most expensive OOP elements were targeted therapy with mean cost equal to 649.5 million VND ($28,025) and chemotherapy at 36.5 million VND ($1575). Mean total OOP cost related to diagnosis and initial BC treatment (excluding targeted therapy cost) was 61.8 million VND ($2667). The mean OOP costs among patients with stage II and III BC were, respectively, 66 and 148% higher than stage 0/I. Conclusions BC patients in Vietnam incur significant OOP costs. The cost of BC treatment was driven by the use of therapies and presentation stage at diagnosis. It is likely that OOP costs of BC patients would be reduced by earlier detection through raised awareness and screening programmes and by providing a higher insurance reimbursement rate for targeted therapy.

Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review

“…The high cost of breast cancer diagnosis and treatment is observed in most countries worldwide, including developed and developing countries [ 66 ]. In some parts of Asia, the average out-of-pocket payment (OOP) for breast cancer diagnosis and treatment is 61.8 million VND ($2667) in Vietnam [ 67 ], while in China, the curative care expenditure for breast cancer was also similar [ 68 ]. The studies indicated that the advancement of the stage of cancer at diagnosis is associated with an increased cost.…”

Cost-effectiveness of clinical breast examination screening programme among HER2-positive breast cancer patients: a modelling study

“…Inputs for costs (from patient perspective) and utilities were derived from a sub-sample of only HER2-positive patients/survivors in a study on HRQoL of Vietnamese BC patients/survivors and cost of treatment. Details of these studies methodology and results on HRQol and cost of treatment among general BC patients/survivors (full sample) are available elsewhere [ 5 , 17 ]. Cost inputs for health services and drugs from public and the payer perspective were obtained from public health service price list regulated by Ministry of Health [ 18 ] and National Cancer Hospital (data were supplied in personal communication), respectively.…”

“…WHO urges LMICs to look at alternative low-cost screening modalities like clinical breast examination (CBE) and analyse its cost-effectiveness before implementation [ 4 ]. In Vietnam, currently, there is no BC screening programme, although BC has the highest prevalence (among female cancers), the highest number of cancer-related deaths, an increasing incidence, and a high rate of late-stage cases at diagnosis (64.2% at stage III or IV) [ 5 ]. Thus, there is a need for a cost-effectiveness analysis (CEA) of a CBE screening programme versus no-screening.…”

“…The downstaging effect of CBE would be expected to increase survival and increase/reduce costs depending on BC subtype. The costs of treatment for general BC patients in Vietnam were 66% and 148% higher if they were diagnosed at stage II and III, respectively, compared with stage 0/I [ 5 ]. In contrast, the costs of treatment for HER2-positive patients would be expected to increase as patients diagnosed at earlier stage of BC (stage I–III) tend to opt for targeted therapy, while patients diagnosed with metastatic BC (stage IV) chose chemotherapy only to save cost.…”

“…In contrast, the costs of treatment for HER2-positive patients would be expected to increase as patients diagnosed at earlier stage of BC (stage I–III) tend to opt for targeted therapy, while patients diagnosed with metastatic BC (stage IV) chose chemotherapy only to save cost. This choice pattern is a consequence of the remarkably higher cost of targeted therapy in Vietnam which was 10 times more expensive than the total cost of all other treatments combined due to its high cost in nature and low coverage from health insurance (48% for Trastuzumab and 0% for Pertuzumab) [ 5 ]. However, if CBE screening is shown to be cost-effective among HER2-positive patients for whom a rise in treatment cost related to earlier detection is likely to be greatest, it is highly likely that it will be even more cost-effective for all BC patients.…”