Impact of universal health coverage on childhood cancer outcomes in Indonesia

Indraswari, Braghmandita Widya; Kelling, E.; Vassileva, Sofi M; Sitaresmi, Mei Neni; Danardono, Danardono; Mulatsih, Sri; Supriyadi, Eddy; Widjajanto, Pudjo Hagung; Sutaryo, Sutaryo; Kaspers, Gertjan J. L.; Mostert, Saskia

doi:10.1002/pbc.29186

Cited by 9 publications

(12 citation statements)

References 28 publications

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“…For example, an observational study in Indonesia looked at a set of key health indicators, including maternal mortality ratio, infant mortality rate, and life expectancy, and found that UHC interventions achieved preliminary success in improving health equity and service access [ 7 ]. Another study from Indonesia used survival analysis to examine child cancer outcomes under UHC and reported significant improvements—especially among disadvantaged socioeconomic groups—in cancer survival and treatment failure [ 8 ]. However, the presence of multiple context-dependent confounders limited the generalizability of these findings to other similar healthcare settings.…”

Section: Introductionmentioning

confidence: 99%

Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries

2022

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Background Several studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC’s peacetime impact, limiting our understanding of UHC’s potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries’ progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage. Methods and findings Using a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a “high UHC index” group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries’ income group per the World Bank classification, countries’ geographical region as defined by WHO, and countries’ preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study’s primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes. Conclusions We observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.

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Section: Introductionmentioning

confidence: 99%

Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries

2022

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“…Some of ALL2013 patients and all ALL2016 patients also benefited from the National Obligatory Health Insurance starting in 2014, especially patients from low SES. Based on our recent study, after starting of the new health insurance treatment abandonment in the low SES population decreased from 36% to 19% ( p < .001) 24 . In our setting, the uncertainties about disease prognosis, treatment‐related risks, financial burden, disease‐related communication, and the use of traditional medication emphasize the need for psychosocial care and assistance for families with a child with leukemia 25…”

Section: Discussionmentioning

confidence: 81%

“…Based on our recent study, after starting of the new health insurance treatment abandonment in the low SES population decreased from 36% to 19% (p < .001). 24 In our setting, the uncertainties about disease prognosis, treatment-related risks, finan-cial burden, disease-related communication, and the use of traditional medication emphasize the need for psychosocial care and assistance for families with a child with leukemia. 25 Similar with other studies in LMICs, 3,4,9,[26][27][28][29] infection was the major cause of death apart from relapse, both in ALL2013 and ALL2016.…”

Section: Discussionmentioning

confidence: 99%

Childhood acute lymphoblastic leukemia: Four years evaluation of protocols 2013 and 2016 in a single center in Indonesia, a lower‐middle‐income country

Sutaryo

Hagung

Mulatsih

et al. 2022

Pediatric Blood & Cancer

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Background The prognosis of childhood acute lymphoblastic leukemia (ALL) in Indonesia, a lower‐middle‐income country (LMIC), is lower than in high income countries (HICs). The Indonesian ALL2013 protocol resulted in too many toxic deaths (21%) and abandonments (11%). Therefore, we drafted an adapted protocol, ALL2016. Main changes: no anthracyclines in standard risk (SR), prednisone replaced dexamethasone at induction in high risk (HR), and anthracyclines and cyclophosphamide were rescheduled in HR. Procedure Patients (aged: 1–18 years) were stratified into SR and HR. HR was defined as age over 10 years, leucocyte count over 50 × 109/L, central nervous system (CNS) involvement, mediastinal mass, T‐cell phenotype, testicular involvement, or poor prednisone response. Results ALL2013 included 174 patients (106 SR and 68 HR) and ALL2016 188 (91 SR and 97 HR). Although the number of HR patients was significantly higher in ALL2016 (51.6% vs. 39.1%; p = .017), the outcome of ALL2016 improved over ALL2013 (4‐year‐probable overall survival (pOS) 60.1% vs. 50.0%; p = .042 and 4‐year‐probable event‐free survival (pEFS) 49.5% vs. 36.8%; p = .018). ALL2016 showed a nonsignificant advantage for SR patients (4‐year‐pEFS 56.0% vs. 47.2%; p = .220 and 4‐year‐pOS 70.3% vs. 61.3%; p = .166), but less toxic deaths (7% vs. 20%; p = .011). In HR group, the outcomes were significantly better in ALL2016 (4‐year‐pEFS 43.3% vs. 20.6%; p = .004; 4‐year‐pOS 50.5% vs. 32.4%; p = .014) especially due to less relapses (31% vs. 62%; p = .001). Isolated CNS relapses went down from 18 to 8% in HR (p = .010) and 11 to 5% in SR (p = .474). Both SR and HR showed lower numbers of abandonment in ALL2016 (6% vs. 14%; p = .039). Conclusions Overall ALL2016 results improved over ALL2013. Modest changes in protocol resulted in less initial toxicity and abandonments.

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“…The hospital serves population of 5.8 million in southern‐Java. Annually 180 children are diagnosed and treated for malignancies by 5 pediatric‐oncologists and 28 nurses 1 …”

Section: Methodsmentioning

confidence: 99%

Unmet palliative care needs of a child with cancer in Indonesia

et al. 2022

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� Childhood cancer survival varies greatly between high-income (80%) versus Low and middle-income countries (LMIC) (<20%). To bridge this gap, provision of aggressive curative treatment has been prioritized in latter countries. Palliative care (PC), by contrast, has received little or no attention � When children who can no longer be cured from cancer continue aggressive treatment, they may suffer unnecessarily from pain, discomfort and low quality-of-life during prolonged periods � In many LMIC, families are often not given the opportunity to participate in decision-making whether they want to extend the life of their children or focus on relieving pain and discomfort � This case report illustrates difficulties that Indonesian families may face when their child is diagnosed with cancer, receives intensive chemotherapy despite poor prognosis and severe side-effects, and is not informed about choices of treatment children have during final illness � This study highlights the importance to start PC immediately at diagnosis. Both physical and psychosocial wellbeing of patients need to be closely monitored through regular symptom burden assessments. Training on open communication in PC is required in universities and hospitals to enable shared decision-making and improve quality-of-life of children and their families

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Impact of universal health coverage on childhood cancer outcomes in Indonesia

Cited by 9 publications

References 28 publications

Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries

Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries

Childhood acute lymphoblastic leukemia: Four years evaluation of protocols 2013 and 2016 in a single center in Indonesia, a lower‐middle‐income country

Unmet palliative care needs of a child with cancer in Indonesia

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