Is There a Difference in The “Out-Of-Pocket” Costs of Cancer Treatment When Comparing Patients From The Brazilian National Health System With Patients Enrolled in Clinical Research Protocols?

Abstract

Introduction: Economic burden of cancer treatment does not fall only on the Brazilian National Health System (“SUS”) but also on patients. Nonreimbursed indirect costs include noncovered oral medications, food, transportation, and others. Our study compares out-of-pocket costs of cancer treatment between patients from the SUS and patients enrolled in research protocols. Methods Observational, cross-sectional and analytical study conducted in 2021. Patients undergoing chemotherapy were divided into 2 groups: patients from a tertiary hospital affiliated with the SUS and patients enrolled in research protocols at a research center. The primary outcome was the evaluation of out-of-pocket costs using a socioeconomic questionnaire to identify the cost and time spent by patients during treatment. This study was approved by the Research Ethics Committee. Results 195 patients were included, of whom 165 (84.6%) were treated by the SUS and 30 (15.4%) by research protocols. Of the total, 61% were female, and the mean age of the patients was 57 years. The median total out-of-pocket costs of SUS patients was Brazilian reais (R$) 453.80 (US$ 78.92), and that of patients who were enrolled in research protocols was R$ 448.00 (US$ 77.91) (P = 0.317). A comparison of the groups by multivariate analysis showed that only the time spent by patients on chemotherapy and radiotherapy was significantly different, being higher in the SUS group (OR 2.58, 95% CI 1.03–6.50). Conclusion Total out-of-pocket spending by SUS patients is similar in magnitude to that by patients in research protocols, although the reasons for the spending are different.