The Out-of-Pocket Cost Burden of Cancer Care—A Systematic Literature Review

Abstract

Background: Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. Methods: A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. Results: Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15–400 in Canada, USD 4–609 in Western Europe, and USD 58–438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40–71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. Conclusions: We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.

Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems

“…Objective financial burden in publicly funded healthcare systems in terms of (in-)direct costs have largely been quantified, depending on the cancer entity and degree of healthcare coverage [ 12 , 16 , 17 , 18 ]. For instance, Longo et al [ 12 ] identified out-of-pocket (OOP) costs and income losses as main contributors to financial toxicity based on the authors understanding of financial toxicity as a consequence of objective financial burden.…”

Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System—A Mixed-Methods Study

“…However, they often experience dilemmas regarding whether to recommend innovative treatments to patients with financial difficulties and without private health insurance. Such dilemmas in patient-physician discussions about cost were also mentioned in past studies [18][19][20]. Additionally, over a third of the participants indicated that they feel embarrassed and uncomfortable discussing the cost of care with patients-another trend indicated in recent studies [21,22].…”

Living experiences of patients with advanced cancer with low socioeconomic status: protocol for a systematic review of qualitative evidence

“…18 19 Further, active clinical treatment is often associated with higher out-of-pocket costs in these patients than their high SES counterparts. [20][21][22] A systematic review by Iragorri et al 21 showed that patients with cancer residing in low-income areas spent 42% of their annual income on cancer-related out-of-pocket expenses. This was approximately 2.6 times higher than the out-ofpocket expense-to-annual income ratio for patients with cancer in high-income areas.…”