Background
This study assessed the extent to which individuals with surgically operable cancer
in Southeast Asia experience financially catastrophic out-of-pocket costs, discontinuation
of treatment, or death.
Methods
The ACTION study is a prospective, 8-country, cohort study of adult patients recruited
consecutively with an initial diagnosis of cancer from public and private hospitals.
Participants were interviewed at baseline and 3 months. In this paper, we identified
4,584 participants in whom surgery was indicated in initial treatment plans and assessed
the following competing outcomes: death, financial catastrophe (out-of-pocket costs
of >30% of annual household income), treatment discontinuation, and hospitalization
without financial catastrophe incurred. We then analyzed a range of predictors using
a multinomial regression model.
Results
Of the participants, 72% were female and 44% had health insurance at baseline. At
3 months, 31% of participants incurred financial catastrophe, 8% had died, 23% had
discontinued treatment, and 38% were hospitalized but avoided financial catastrophe.
Health insurance status was found to be associated with lower odds of treatment discontinuation
(odds ratio [OR], 0.60; 95% CI, 0.47–0.77) relative to hospitalization without financial
catastrophe. Women had greater odds of financial catastrophe than men (OR, 1.35; 95%
CI, 1.05–1.74), whereas lower socioeconomic status (range of indicators) was generally
found to be associated with higher odds of death, treatment discontinuation, and financial
catastrophe.
Conclusion
Priority should be given to measures such as programs to extend social health insurance
to offset the out-of-pocket costs associated with surgery for cancer faced in particular
by women, the uninsured, and individuals of low socioeconomic status in Southeast
Asia.
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References
- The burden of cancer in member countries of the Association of Southeast Asian Nations (ASEAN).Asian Pac J Cancer Prev. 2012; 13: 411-420
Lancet. Lancet Asia Research Forum [updated 2007; cited 2014 Jul 27]. Available from: www.thelancetconferences.com/cancer/forum-highlights.html.
- Access to cancer treatment in low- and middle-income countries. An essential part of global cancer control.CanTreat International, Warrington, Cheshire, UK2010
- Economic impacts of health shocks on households in low and middle income countries: a review of the literature.Global Health. 2014; 10: 21
- The economic impact of non-communicable diseases on households in India.Global Health. 2012; 8: 9
- The economic implications of noncommunicable disease for India.World Bank, Washington, DC2010
- Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis.Reumatol Clin. 2012; 8: 168-173
- Role of health insurance in averting economic hardship in families after acute stroke in China.Stroke. 2009; 40: 2149-2156
- Out-of-pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals.Salud Publica Mex. 2003; 45: 285-292
- Household catastrophic health expenditure: a multicountry analysis.Lancet. 2003; 362: 111-117
- The socio-economic impact of cervical cancer on patients and their families in Argentina, and its influence on radiotherapy compliance. Results from a cross-sectional study.Gynecol Oncol. 2007; 105: 335-340
- The problem of treatment abandonment in children from developing countries with cancer.Pediatr Blood Cancer. 2007; 49: 941-946
- Cost of treatment for breast cancer in central Vietnam.Glob Health Action. 2013; 6: 18872
- Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya.Pediatr Blood Cancer. 2014; 61: 913-918
- Health-financing reforms in southeast Asia: challenges in achieving universal coverage.Lancet. 2011; 377: 863-873
- Taking stock of Myanmar's progress toward the health-related Millennium Development Goals: current roadblocks, paths ahead.Int J Equity Health. 2013; 12: 78
- Socioeconomic impact of cancer in member countries of the Association of Southeast Asian Nations (ASEAN): the ACTION study protocol.Asian Pac J Cancer Prev. 2012; 13: 421-425
- Global surgery: defining an emerging global health field.Lancet. 2014; 384: 2245-2247
- How are household economic circumstances affected after a stroke? The Psychosocial Outcomes In StrokE (POISE) Study.Stroke. 2012; 43: 3110-3113
- An alternative framework for analyzing financial protection in health.PLoS Med. 2012; 9: e1001294
- EuroQol–a new facility for the measurement of health-related quality of life.Health Policy. 1990; 16: 199-208
- Estimating population-based values for EQ-5D health states in Thailand.Value Health. 2011; 14: 1142-1145
- Polytomous logistic regression analysis could be applied more often in diagnostic research.J Clin Epidemiol. 2008; 61: 125-134
- Multiple imputation of discrete and continuous data by fully conditional specification.Stat Methods Med Res. 2007; 16: 219-242
- Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data.Lancet. 2006; 368: 1357-1364
- Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010.Lancet Oncol. 2011; 12: 387-398
- Meeting the emerging challenge of breast and cervical cancer in low- and middle-income countries.Int J Gynaecol Obstet. 2012; 119: S85-S88
- Social determinants of health: the solid facts.World Health Organization, Geneva2003
- Income non-reporting: implications for health inequalities research.J Epidemiol Community Health. 2000; 54: 207-214
Reference
- High default rate in thyroid cancer management in Ibadan, Nigeria: a need for health insurance.Afr J Med Med Sci. 2012; 41: 105-109
Article info
Publication history
Published online: April 28, 2015
Accepted:
February 28,
2015
Footnotes
Funding: Unrestricted educational grant from Roche Asia Pacific. S.J. is the recipient of an Australian National Health and Medical Research Council (NHMRC) Senior Research Fellowship and M.W. is the recipient of an NHMRC Principal Research Fellowship.
Reprint requests: Stephen Jan, PhD, The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. Email: [email protected]
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© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
