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Aminuddin F, Raman S, Bahari MS, Zaimi NA, Mohd Nor Sham Kunusagaran MSJ, Zainuddin NA, Mostapha M, Ping TY, Mohd Hassan NZA. Cancer impact on lower-income patients in Malaysian public healthcare: An exploration of out-of-pocket expenses, productivity loss, and financial coping strategies. PLoS One 2024; 19:e0311815. [PMID: 39383152 PMCID: PMC11463769 DOI: 10.1371/journal.pone.0311815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 09/24/2024] [Indexed: 10/11/2024] Open
Abstract
Cancer patients often grapple with substantial out-of-pocket (OOP) expenses and productivity loss, with the ramifications being particularly crucial for lower-income households. This study aims to estimate OOP costs incurred by cancer patients, assess their productivity loss, and analyse the financial coping mechanisms employed by individuals within the lower-income bracket. The study employed face-to-face interviews among cancer patients aged 40 years and above, currently undergoing treatment, and belonging to the lower-income group. Participants were recruited from six public cancer referral hospitals. OOP expenses, encompassing medical and non-medical costs, along with productivity loss, were measured. A generalized linear model was applied to identify potential OOP determinants. Additionally, the coping mechanisms employed by individuals to finance their cancer OOP expenses were also determined. Among the 430 participants recruited, predominantly female (63.5%), and aged 60 or older (53.9%). The annual mean total cancer costs per patient were US$ 2,398.28 (±2,168.74), including 15% for medical costs US$ 350.95 (±560.24), 34% for non-medical costs US$820.24 (±818.24), and 51% for productivity loss costs US$1,227.09 (±1,809.09). Transportation, nutritional supplements, outpatient treatment, and medical supplies were notable cost contributors to total OOP expenditures. Ethnicity (β = 1.44; 95%CI = 1.15-1.79), household income (β = 1.40; 95%CI = 1.10-1.78), annual outpatient visits (β = 1.00; 95%CI = 1.00-1.01), age (β = 0.74; 95%CI = 0.56-0.98), and employment status (β = 0.54; 95%CI = 0.72-1.34) were identified as significant predictors of OOP costs among cancer patients. Notably, 91% of participants relied on household salaries and savings, while 15% resorted to interest-free borrowing, 11% sold possessions, and 0.5% borrowed with interest to finance their expenses. This study offers crucial insights into the economic impact of cancer on individuals and their families, providing policymakers with valuable information to tackle challenges faced in their journey. Despite substantial public healthcare subsidies, the study revealed that cancer costs can remain a potential barrier to accessing essential treatment. Therefore, there is a need for reinforced system-level infrastructure to facilitate targeted financial navigation services.
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Affiliation(s)
- Farhana Aminuddin
- Institute for Health Systems Research, Centre of Health Economics Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Sivaraj Raman
- Institute for Health Systems Research, Centre of Health Economics Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Mohd Shahri Bahari
- Institute for Health Systems Research, Centre of Health Economics Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Nur Amalina Zaimi
- Institute for Health Systems Research, Centre of Health Economics Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | | | - Nur Azmiah Zainuddin
- Institute for Health Systems Research, National Institutes of Health, Centre of Health Policy Research, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Marhaini Mostapha
- Institute for Health Systems Research, Centre of Health Economics Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Tan Yui Ping
- Institute for Health Systems Research, Centre of Health Economics Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Nor Zam Azihan Mohd Hassan
- Institute for Health Systems Research, Centre of Health Economics Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
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Greiner W, Patel K, Crossman-Barnes CJ, Rye-Andersen TV, Hvid C, Vandebrouck T. High-Expenditure Disease in the EU-28: Does Drug Spend Correspond to Clinical and Economic Burden in Oncology, Autoimmune Disease and Diabetes? PHARMACOECONOMICS - OPEN 2021; 5:385-396. [PMID: 33411314 PMCID: PMC8333173 DOI: 10.1007/s41669-020-00253-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Drug costs are increasing in Europe, and there is a heightened need to reduce pressure on healthcare systems. In 2017, oncology, autoimmune disease, and diabetes featured as the three highest therapy areas for drug spend in the EU-28. However, the absolute 1-year drug spend growth for diabetes did not feature within the ten fastest growing therapy areas. OBJECTIVE This study explores the association between drug spend and disease burden in oncology, autoimmune disease, and diabetes in the EU-28. METHODS Oncology, autoimmune disease and diabetes therapeutic areas were investigated using four methodologies. Historical and forecasted drug spend was analysed using the IQVIA MIDAS® drug sales database. Clinical and economic burden was estimated from targeted literature reviews. Trend analyses compared changes in drug spend with clinical burden using the Global Burden of Disease tool as the epidemiological reference. Cost per quality-adjusted life-years (QALYs) from UK health technology assessments were compared to interpret the health economic value. RESULTS Oncology had the highest historical drug spend and growth compared with autoimmune disease and diabetes. Total drug spend and growth in oncology is forecasted to exceed diabetes by twofold. Increasing oncology drug spend historically did not correspond with reductions in mortality and morbidity. Diabetes had the lowest drug spend and greatest QALY/€1000 spent benefit. CONCLUSION This study indicates that drug spend may not correlate to clinical burden across diseases. Future research could stimulate debate on whether more equitable drug funding may improve disease management.
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Affiliation(s)
- Wolfgang Greiner
- Department for Health Economics, Bielefeld University, Bielefeld, Germany.
| | | | | | | | - Christian Hvid
- Novo Nordisk Region Europe Pharmaceuticals A/S, Copenhagen, Denmark
| | - Tom Vandebrouck
- Novo Nordisk Region Europe Pharmaceuticals A/S, Brussels, Belgium
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Ippoliti R, Falavigna G, Grosso F, Maconi A, Randi L, Numico G. The Economic Impact of Clinical Research in an Italian Public Hospital: The Malignant Pleural Mesothelioma Case Study. Int J Health Policy Manag 2018; 7:728-737. [PMID: 30078293 PMCID: PMC6077275 DOI: 10.15171/ijhpm.2018.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background: The current economic constraints cause hospital management to use the available public resources as rationally as possible. At the same time, there is the necessity to improve current scientific knowledge. This is even more relevant in the case of patients with malignant pleural mesothelioma (MPM), given the severity of the disease, its dismal prognosis, and the cost of chemotherapy drugs. This work aims to evaluate the standard cost of patients with MPM, supporting physicians in their decision-making process in relation to budget constraints, as well as policy-makers with respect research policy.
Methods: The authors conducted a retrospective cost analysis on all the patients with MPM who were first admitted to a reference hospital specialized in MPM care between 2014 and 2015, collecting data on their diagnostic pathways and active treatments, as well as on the related official fees for each procedure. Then, using a multiple regression model, we estimated the overall expected cost of a patient with MPM treated in our hospital, to be born by the Regional Healthcare System based on the chosen clinical pathway.
Results: According to results, the economic impact of caring for a patient with MPM is mostly related to the selected active treatments, with drug and hospitalization costs as main drivers. Our analysis suggests that the expected reimbursed fee to care for a patient with MPM is equal to € 18 214.99, with chemotherapy and monitoring costs equal to € 12 861.43 and hospitalization cost equal to € 5353.55. This cost decreases to € 320.18 in the case of enrollment in an experimental trial of first-line treatment. In the other cases (second-line or third-line trials), the expected cost borne by the healthcare system for treating patients grows exponentially (€ 40,124.18 and € 59 839.94, respectively).
Conclusion: Experimental trials might be a solution to decrease the economic burden for the public healthcare system only in the case of first-line treatments, where the cost of chemotherapy is relevant. Nevertheless, policy-makers have to accept the sharing of this economic burden between society and the pharmaceutical industry to broaden the current scientific knowledge.
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Affiliation(s)
- Roberto Ippoliti
- Scientific Promotion, General Hospital of Alessandria, Alessandria, Italy.,Department of Management, University of Turin, Turin, Italy
| | - Greta Falavigna
- Research Institute on Sustainable Economic Growth, National Research Council of Italy, Moncalieri, Italy
| | - Federica Grosso
- Oncology Unit, General Hospital of Alessandria, Alessandria, Italy
| | - Antonio Maconi
- Scientific Promotion, General Hospital of Alessandria, Alessandria, Italy
| | - Lorenza Randi
- Scientific Promotion, General Hospital of Alessandria, Alessandria, Italy
| | - Gianmauro Numico
- Oncology Unit, General Hospital of Alessandria, Alessandria, Italy
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Kásler M, Ottó S, Sólyom O. [National Cancer Registry. Significance of a reliable database in the implementation of the required structural changes of cancer care in Hungary]. Orv Hetil 2014; 155:1415-20. [PMID: 25176515 DOI: 10.1556/oh.2014.29994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors summarize the basic objectives and scope of the Hungarian Cancer Registry. They review more than 100-year history of the national cancer database and its effects on current cancer data collection activities, which is outstanding in Europe. The compilation deals with the development of information technology, covers points of principle and practical issues such as parallel display and evaluation of mortality and morbidity statistics and their national and international importance concerning public health. The authors underline that reliable data collection and services of the National Cancer Registry are important for the society because they are public health issues with a critical importance for a better understanding of risk factors, prevention and patient care. Restructuring and European harmonization of the Hungarian cancer system are inevitable using a reliable information exchange and service, taking into account national specificities and international requirements.
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Affiliation(s)
- Miklós Kásler
- Országos Onkológiai Intézet Budapest Ráth György u. 7-9. 1122
| | - Szabolcs Ottó
- Országos Onkológiai Intézet Budapest Ráth György u. 7-9. 1122
| | - Olimpia Sólyom
- Országos Onkológiai Intézet Budapest Ráth György u. 7-9. 1122
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Peixoto V, Faria AL, Gonçalves M, Macedo J, Rego S, Macías E, Magano A, Loureiro M, Araújo A. Evolution of costs of cancer drugs in a Portuguese hospital. World J Clin Oncol 2014; 5:164-169. [PMID: 24829864 PMCID: PMC4014789 DOI: 10.5306/wjco.v5.i2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/18/2014] [Accepted: 03/04/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the costs of cancer drugs administered in a Portuguese Hospital compared with the Karolinska Institute study.
METHODS: To evaluate spending on cancer drugs, we retrospectively analyzed data on the overall costs of cancer drugs, obtained at the Department of Medical Oncology of the Centro Hospitalar de Entre Douro e Vouga, between 2004 and 2010. In this comparative study we selected only drugs belonging to the following groups: chemotherapy, targeted therapy, immunotherapy and endocrine therapy. The selected drugs were further grouped according to their market placement year: ≤ 1998, 1999 to 2002, 2003 to 2005, and 2006 to 2010. Drugs used as supportive therapy and bisphosphonates were excluded.
RESULTS: The overall costs of cancer drugs increased gradually between 2004 and 2008 (from €1911947 to €3666284), with an increase in the number of patients treated during this period. The expenditure decreased in 2009 (€3438155) and increased again in 2010 (€3673116), but the costs increment was not the same as in previous years. Chemotherapy and targeted therapy were responsible for most of the expenditure. Drugs placed on the national market before 1999 accounted for more than 50% of the expenditure up to 2007. From 2008, these drugs represented less than 50% of the total expenditure. Cancer drugs placed between 1999 and 2002 accounted for 25%-35% of the costs in all the years studied, while drugs placed between 2003 and 2005 accounted for less than 30%. Drugs placed between 2006 and 2010 were responsible for less than 10% of the expenditure.
CONCLUSION: In this study, older drugs were responsible for most of the expenditure up to 2007, which is in agreement with the Karolinska study.
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Shin JY, Kim SY, Lee KS, Lee SI, Ko Y, Choi YS, Seo HG, Lee JH, Park JH. Costs during the first five years following cancer diagnosis in Korea. Asian Pac J Cancer Prev 2013; 13:3767-72. [PMID: 23098469 DOI: 10.7314/apjcp.2012.13.8.3767] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES We estimated the total medical costs incurred during the 5 years following a cancer diagnosis and annual medical use status for the six most prevalent cancers in Korea. METHODS From January 1 to December 31, 2006, new patients registered with the six most prevalent cancers (stomach, liver, lung, breast, colon, and thyroid) were randomly selected from the Korea Central Cancer Registry, with 30% of patients being drawn from each cancer group. For the selected patients, cost data were generated using National Health Insurance claims data from the time of cancer diagnosis in 2006 to December 31, 2010. The total number of patients selected was 28,509. Five-year total medical costs by tumor site and Surveillance, Epidemiology, and End Results (SEER) stage at the time of diagnosis, and annual total medical costs from diagnosis, were estimated. All costs were calculated as per-patient net costs. RESULTS Mean 5-year net costs per patient varied widely, from $5,647 for thyroid cancer to $20,217 for lung cancer. Advanced stage at diagnosis was associated with a 1.8-2.5-fold higher total cost, and the total medical cost was highest during the first year following diagnosis and decreased by the third or fourth year. CONCLUSIONS The costs of cancer care were substantial and varied by tumor site, annual phase, and stage at diagnosis. This indicates the need for increased prevention, earlier diagnosis, and new therapies that may assist in reducing medical costs.
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Affiliation(s)
- Ji-Yeon Shin
- National Cancer Control Research Institute, Goyang, Republic of Korea
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Soria JC, Blay JY, Spano JP, Pivot X, Coscas Y, Khayat D. Added value of molecular targeted agents in oncology. Ann Oncol 2011; 22:1703-16. [PMID: 21300696 DOI: 10.1093/annonc/mdq675] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The treatment of certain cancers has been revolutionised in recent years by the introduction of novel drugs designed to target specific molecular factors implicated in tumour growth. Notable examples include trastuzumab, a humanized monoclonal antibody (mAb) against human epidermal growth factor receptor (HER)-2 in women with HER2-positive breast cancer; rituximab, an anti-CD20 mAb in patients with non-Hodgkin's lymphoma; imatinib, a tyrosine kinase inhibitor in KIT-positive gastrointestinal stromal tumours and sunitinib, another tyrosine kinase inhibitor, in metastatic renal cell carcinoma. For regulatory reasons, new molecular targeted agents are first evaluated in advanced and metastatic disease, wherein they prolong survival. However, their most profound impact has been observed in the adjuvant setting, where they may contribute to curative therapy rather than mere palliation. Expansion in the use of molecular targeted therapies will have important cost implications for health care systems. Although expensive, on a monthly basis, molecular targeted therapies may not be more costly than treatments for other major chronic diseases, especially considering the contribution of cancer to the global disease burden, the associated socioeconomic costs and the long-term benefits of therapy. Nevertheless, the use of these agents must be optimised, in part using molecular biomarkers associated with drug response.
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Affiliation(s)
- J C Soria
- Institut Gustave Roussy, Villejuif, France.
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Kim YG, Park JH, Park JH. Cancer patients' need for financial assistance and its related factors. HEALTH POLICY AND MANAGEMENT 2010. [DOI: 10.4332/kjhpa.2010.20.4.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
It is well known that cancer incidence and mortality figures are very poor in Hungary. By providing the latest figures the authors analyze the epidemiological background and the risk factors responsible for this situation. Furthermore, based on international recommendations and national specificities, the authors define areas of action to solve this significant health issue. The main conclusion of their analysis is that it is inevitable to improve oncology care by adjusting it to European standards. The decade-old National Cancer Control Program (NCCP) is improved by incorporating legislative actions, educational issues, research and development priorities. The program now provides the definition of regional centers, recommend improvements of the function of oncology teams and rehabilitation. Based on successful European models, this program must be coordinated by the National Cancer Institute.
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