https://orcid.org/0000-0002-6489-335X
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Abstract
Background
Out-of-pocket (OOP) health expenditures for cancer care expose households to unanticipated economic consequences. When the available health services are mainly dependent on OOP expenditure, the household faces catastrophic health expenditure (CHE). This study aimed to estimate the incidence and intensity of CHE in hospitalized cancer patients and identify coping strategies and associated factors.
Method and Material
Hospital-based cross-sectional study design was conducted on 305 cancer inpatients in Addis Ababa between November 2021 and February 2022. All patients with cancer who were hospitalized during the data collection period were included in the study. The incidence of CHE was estimated at the 40% threshold of households’ non-food expenditure and the intensity of CHE was captured based on the amount by which household expenditure exceeded the threshold and mean positive overshoot, the mean level by which CHE exceeds the threshold used. Multivariate logistic regression was used to assess the relationship between CHE levels and the independent variables.
Results
The incidence of CHE at the 40% threshold of households’ non-food expenditure was 77.7%, while the O and MPO were 36.2% and 46.6%, respectively. CHE for cancer care was significantly associated with patient residence, increased number of chemotherapy cycles, increased duration of hospital admission, lack of insurance enrolment, and lower-income quintiles. Saving and selling assets were identified as the primary coping mechanisms.
Conclusion
The incidence and intensity of CHE among inpatients with cancer were high and which could lead to impoverishment of households. Improved quality and coverage of health insurance and decentralizing cancer care to regions standards similar to Addis Ababa will save households from incurring CHE.
Abbreviations
AOR, adjusted odds ratio; CBHI, community-based health insurance; CHE, catastrophic health expenditure; MoH, Ministry of Health; OOP, out-of-pocket expenditure; WHO, World Health Organization; TASH, Tikur Anbesa Specialized Hospital; IQR, interquartile range; SD, standard deviation.
Operational Definitions
Equb; is an Ethiopian cultural association of people to mobilize finance and distribute on a rotating basis for each member. Edir; is a social Ethiopian institution aimed at mutual aid and grants cooperative insurance to specific communities.
Data Sharing Statement
The data are available from the correspondent author upon reasonable request.
Ethical Considerations
Ethical approval was obtained from the School of Public Health's Institutional Research Ethics Review Board (IRB), Addis Ababa University (Ref. No. SPH/025/14). Written informed consent was obtained from all participants. Study participants were assured by data collectors that their data would be kept confidential and that they would not face any harm or disadvantage for taking part in the study. For minor participants, guardians (relatives) signed on behalf of the patient, and this study was conducted in accordance with the Declaration of Helsinki.
Acknowledgments
The authors would like to acknowledge the Department of Health Systems and Health Policy, School of Public Health, Addis Ababa University.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors have declared that they have no conflicts of interest in this work.