Financial toxicity due to breast cancer treatment in low- and middle-income countries: evidence from Vietnam

Abstract

Background This study examined the financial toxicity faced by breast cancer (BC) patients in Vietnam and the factors associated with the risk and degree of that toxicity. Methods A total of 309 BC patients/survivors completed an online survey (n=209) or a face-to-face interview (n=100) at two tertiary hospitals. Descriptive statistics and χ2 tests were used to identify and analyse the forms and degree of financial toxicity faced by BC patients/survivors. A Cragg hurdle model assessed variation in risk and the degree of financial toxicity due to treatment. Results 41% of respondents faced financial toxicity due to BC treatment costs. The mean amount of money that exceeded BC patients/survivors’ ability to pay was 153 million Vietnamese Dong (VND) ($6602) and ranged from 2.42 million VND to 1358 million VND ($104–58,413). A diagnosis at stage II or III of BC was associated with 16.0 and 18.0 million VND (~$690–777) more in the degree of financial toxicity compared with patients who were diagnosed at stage 0/I, respectively. Being retired or married or having full (100%) health insurance was associated with a decrease in the degree of financial toxicity. Conclusions A significant proportion of Vietnamese BC patients/survivors face serious financial toxicity due to BC treatment costs. There is a need to consider the introduction of measures that would attenuate this hardship and promote uptake of screening for the reduction in financial toxicity as well as the health gains it may achieve through earlier detection of cancer.

Financial toxicity assessment and associated factors analysis of patients with cancer in China

“…The patients in this study registered a median COST score of 18, more than 80% of patients with cancer reported at least moderate FT (COST score <26 [ 11 ]), and nearly one-third of them suffered from severe FT (COST score <14 [ 11 ]), lower than the 25.5 and 22.5 reported by other Chinese scholars [ 19 , 25 ]. Although previous studies focused on patients in a single center and with a single disease type, they also demonstrated very serious FT experienced by patients with cancer in China, and the incidence of FT was found to be higher than that of other developing countries [ 10 , 26 , 27 ]. Other related studies have found that characteristics such as rural residents [ 28 ], female [ 29 ], younger age [ 7 , 19 ], unemployment [ 4 , 11 ], marriage [ 27 , 30 ], lower educational level [ 11 , 31 ], and lower income [ 4 , 10 , 19 , 30 ] were associated with higher FT, but our results revealed that FT was independent of gender [ 31 ], marital status [ 26 ], and education [ 17 ].…”

“…Although previous studies focused on patients in a single center and with a single disease type, they also demonstrated very serious FT experienced by patients with cancer in China, and the incidence of FT was found to be higher than that of other developing countries [ 10 , 26 , 27 ]. Other related studies have found that characteristics such as rural residents [ 28 ], female [ 29 ], younger age [ 7 , 19 ], unemployment [ 4 , 11 ], marriage [ 27 , 30 ], lower educational level [ 11 , 31 ], and lower income [ 4 , 10 , 19 , 30 ] were associated with higher FT, but our results revealed that FT was independent of gender [ 31 ], marital status [ 26 ], and education [ 17 ]. Sociodemographic differences in FT were reflected in household residence type [ 27 ], medical insurance policies [ 4 , 7 , 32 ], and OOP medication expenditures which are consistent with existing studies, confirming that demographic risk factors are extensive.…”

Costs of breast cancer treatment incurred by women in Vietnam

“…Breast cancer (BC) is the most common cancer among Vietnamese women with increasing incidence over time and the highest number of cancer-related deaths [ 6 , 7 ]. CHE occurred more often among households with breast cancer patients compared with households of patients with other cancer types (72% vs 57%, respectively) [ 5 ].…”

“…It was established in 1992 and became mandated for everybody since 2014 [ 15 , 16 ]. However, due to inadequate monitoring and inspection as well as enforcement, the population coverage stood at 81.7% in 2016 [ 7 , 14 ]. When patients use healthcare services included in the benefit package of SHI, the insurer will cover 80% (most common), 95%, or 100% of the total service cost (i.e., reimbursement rate) while the remaining 20, 5, and 0%, respectively, are met by co-payments incurred by patients [ 16 ].…”

Discussing Cost and Value in Patient Decision Aids and Shared Decision Making: A Call to Action

“…Financial toxicity is an international problem, 12 – 16 but it is more pronounced in the United States given the lack of universal insurance coverage and high out-of-pocket costs even among those with insurance. 17 , 18 More than 30 million people in the United States lack insurance to cover any of the costs of care.…”