The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review.
cancer
catastrophic expenditure
economic burden
financial hardship
out-of-pocket costs
Journal
Current oncology (Toronto, Ont.)
ISSN: 1718-7729
Titre abrégé: Curr Oncol
Pays: Switzerland
ID NLM: 9502503
Informations de publication
Date de publication:
15 03 2021
15 03 2021
Historique:
received:
15
10
2020
revised:
05
03
2021
accepted:
11
03
2021
entrez:
3
4
2021
pubmed:
4
4
2021
medline:
25
9
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33804288
pii: curroncol28020117
doi: 10.3390/curroncol28020117
pmc: PMC8025828
doi:
Types de publication
Journal Article
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1216-1248Références
Am J Prev Med. 2015 Dec;49(6 Suppl 5):S489-97
pubmed: 26590644
Psychooncology. 2019 Jun;28(6):1349-1353
pubmed: 30946504
BMC Health Serv Res. 2014 Sep 24;14:434
pubmed: 25252614
J Oncol Pract. 2015 Jul;11(4):273-7
pubmed: 26105668
Prostate. 2010 Aug;70(11):1255-64
pubmed: 20658653
JAMA Oncol. 2015 Jun;1(3):273-4
pubmed: 26181165
Aust N Z J Public Health. 2018 Feb;42(1):86-91
pubmed: 29168287
J Adv Pract Oncol. 2013 Sep;4(5):354-60
pubmed: 25032014
J Cancer Surviv. 2016 Oct;10(5):850-64
pubmed: 26920872
Chin J Cancer. 2017 Apr 28;36(1):41
pubmed: 28454595
Oncologist. 2001;6(5):441-5
pubmed: 11675522
Cancer. 2014 Nov 1;120(21):3378-84
pubmed: 24962682
Psychooncology. 2016 Jan;25(1):77-83
pubmed: 26087260
Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2006-14
pubmed: 21980008
Med Care. 2016 Feb;54(2):107-9
pubmed: 26761725
Am J Obstet Gynecol. 2019 Aug;221(2):136.e1-136.e9
pubmed: 30965052
Head Neck. 2017 Dec;39(12):2470-2480
pubmed: 28963804
Clin Lung Cancer. 2019 Jul;20(4):231-236
pubmed: 30797721
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Acta Oncol. 2019 Jul;58(7):1062-1068
pubmed: 30943813
Surgery. 2015 Jun;157(6):971-82
pubmed: 25934082
J Natl Cancer Inst. 2016 Oct 20;109(2):
pubmed: 27754926
J Oncol Pharm Pract. 2013 Dec;19(4):328-37
pubmed: 23353712
J Oncol Pract. 2018 Sep;14(9):e533-e546
pubmed: 30138052
Am J Manag Care. 2017 Sep;23(9):553-559
pubmed: 29087157
Eur J Cancer Care (Engl). 2017 Jan;26(1):
pubmed: 26423576
J Cancer Surviv. 2014 Mar;8(1):9-20
pubmed: 23975612
Am J Clin Oncol. 2018 Jul;41(7):708-715
pubmed: 27893470
Cancer Med. 2017 Mar;6(3):572-581
pubmed: 28229562
Cancer Med. 2016 May;5(5):863-70
pubmed: 26853096
Int J Clin Oncol. 2010 Jun;15(3):256-62
pubmed: 20198398
Psychooncology. 2007 Dec;16(12):1130-9
pubmed: 17345557
Asia Pac J Clin Oncol. 2018 Jun;14(3):167-178
pubmed: 28670694
Lancet. 2015 Apr 27;385 Suppl 2:S48
pubmed: 26313097
J Natl Cancer Inst. 2013 Feb 20;105(4):280-92
pubmed: 23349250
J Manag Care Spec Pharm. 2014 Jul;20(7):669-75
pubmed: 24967520
PLoS One. 2018 Jan 11;13(1):e0191132
pubmed: 29324861
J Oncol Pract. 2017 Feb;13(2):e152-e162
pubmed: 28095170
Cancer. 2010 Jul 15;116(14):3477-84
pubmed: 20564103
Eur J Cancer. 2017 Mar;74:26-37
pubmed: 28335885
Lancet Oncol. 2012 Aug;13(8):790-801
pubmed: 22658655
Am J Manag Care. 2018 Apr 1;24(4):e128-e133
pubmed: 29668216
Australas J Dermatol. 2019 Nov;60(4):294-300
pubmed: 31012087
Melanoma Res. 2017 Dec;27(6):607-618
pubmed: 28800027
BMC Med Res Methodol. 2005 Apr 20;5:13
pubmed: 15840177
J Clin Oncol. 2015 Jul 1;33(19):2190-6
pubmed: 25987701
Cancer. 2016 Nov 15;122(22):3447-3455
pubmed: 27723214
J Surg Oncol. 2017 Nov;116(6):683-689
pubmed: 28608393
J Clin Oncol. 2016 Feb 1;34(4):375-80
pubmed: 26644524
JAMA Oncol. 2017 Jun 01;3(6):757-765
pubmed: 27893028
Am J Manag Care. 2014;20(12):988-92
pubmed: 25526387
JAMA. 2014 Dec 17;312(23):2542-50
pubmed: 25494006
Curr Oncol. 2013 Jun;20(3):158-65
pubmed: 23737684
Value Health. 2004 Mar-Apr;7(2):186-94
pubmed: 15164808
Am J Manag Care. 2009 Nov;15(11):801-6
pubmed: 19895184
J Oncol Pract. 2017 Apr;13(4):e310-e318
pubmed: 28195811
JAMA Otolaryngol Head Neck Surg. 2019 Mar 01;145(3):239-249
pubmed: 30789634
J Clin Oncol. 2017 Oct 10;35(29):3306-3314
pubmed: 28541791
J Oncol Pract. 2016 Jul;12(7):e755-64
pubmed: 27328795
J Clin Oncol. 2004 Sep 1;22(17):3524-30
pubmed: 15337801
Palliat Med. 2015 Dec;29(10):908-17
pubmed: 26040484
J Clin Oncol. 2014 Feb 1;32(4):306-11
pubmed: 24366936
BMC Cancer. 2012 Apr 24;12:152
pubmed: 22530992
Cancer. 2013 Mar 15;119(6):1257-65
pubmed: 23225522
J Clin Oncol. 2011 Jul 10;29(20):2821-6
pubmed: 21632508
J Pediatr Hematol Oncol. 2003 Nov;25(11):854-63
pubmed: 14608194
Am J Manag Care. 2016 Mar;22(4 Suppl):s78-86
pubmed: 27270157
Clin Lymphoma Myeloma Leuk. 2018 Mar;18(3):210-218
pubmed: 29429817
J Oncol Pract. 2010 Mar;6(2):69-73
pubmed: 20592778
Aust J Prim Health. 2018 Jan;24(6):530-536
pubmed: 30463662
Support Care Cancer. 2016 Jan;24(1):103-108
pubmed: 25940031
Cancer. 1979 Jan;43(1):403-8
pubmed: 761174
J Glob Oncol. 2018 Sep;4:1-9
pubmed: 30241272
Obstet Gynecol. 2017 Dec;130(6):1269-1275
pubmed: 29112648
J Pain Symptom Manage. 2018 Apr;55(4):1113-1121.e3
pubmed: 29241809
CMAJ Open. 2018 Jan 4;6(1):E1-E10
pubmed: 29301745
ESMO Open. 2018 Feb 2;3(2):e000285
pubmed: 29464109
Health Soc Care Community. 2015 Nov;23(6):605-18
pubmed: 25443659
Support Care Cancer. 2013 Sep;21(9):2583-92
pubmed: 23649879
J Clin Oncol. 2014 Apr 20;32(12):1269-76
pubmed: 24663041
Lancet Oncol. 2011 Sep;12(10):933-80
pubmed: 21958503
Fam Med. 2005 May;37(5):360-3
pubmed: 15883903
J Cancer Surviv. 2010 Sep;4(3):202-9
pubmed: 20401542
BMC Cancer. 2019 Mar 8;19(1):214
pubmed: 30849964
Oncologist. 2010;15(8):883-93
pubmed: 20667966
Patient. 2017 Jun;10(3):295-309
pubmed: 27798816
Curr Oncol. 2011 Jan;18(1):e1-8
pubmed: 21331267
Support Care Cancer. 2019 Jun;27(6):2221-2228
pubmed: 30315427
Psychooncology. 2012 Oct;21(10):1113-23
pubmed: 21774033
Int J Equity Health. 2017 Oct 10;16(1):180
pubmed: 29017542
Health Econ Rev. 2018 Oct 31;8(1):28
pubmed: 30382489
J Oncol Pract. 2012 May;8(3 Suppl):9s-15s
pubmed: 22942827
Lung Cancer. 2018 Oct;124:298-309
pubmed: 29961557
Breast Cancer Res Treat. 2011 Jun;127(2):521-9
pubmed: 20976542
Psychooncology. 2017 Jun;26(6):849-855
pubmed: 27479170
Support Care Cancer. 2006 Nov;14(11):1077-85
pubmed: 16896878
Curr Oncol. 2013 Dec;20(6):e522-31
pubmed: 24311952
PLoS One. 2013 Aug 12;8(8):e71853
pubmed: 23951258
Cancer. 1984 Jun 1;53(11):2388-92
pubmed: 6424925
J Clin Oncol. 2017 Aug 1;35(22):2482-2489
pubmed: 28471711
PLoS One. 2018 Jun 25;13(6):e0199598
pubmed: 29940025
Cancer. 2018 Sep 15;124(18):3668-3676
pubmed: 30033631
Support Care Cancer. 2019 May;27(5):1697-1708
pubmed: 30121786
Support Care Cancer. 2018 Oct;26(10):3543-3552
pubmed: 29704109
Cancer Med. 2014 Dec;3(6):1539-43
pubmed: 25060622
Support Care Cancer. 2016 May;24(5):2225-2233
pubmed: 26573280
Cancer. 2019 Feb 1;125(3):374-381
pubmed: 30566762
JAMA Oncol. 2018 Jun 14;4(6):e173598
pubmed: 29121177
Am Soc Clin Oncol Educ Book. 2018 May 23;38:540-545
pubmed: 30231354
Neurooncol Pract. 2014 Jun;1(2):71-76
pubmed: 26034619
J Oncol Pract. 2017 Dec;13(12):e992-e1001
pubmed: 29035618
J Natl Cancer Inst. 2015 Dec 11;108(5):
pubmed: 26657336
Ir J Med Sci. 2017 Feb;186(1):81-87
pubmed: 27498210
Cancer Nurs. 2013 Mar-Apr;36(2):E8-E19
pubmed: 22565106
Med J Aust. 2012 Jan 16;196(1):29-31
pubmed: 22256924
Am J Manag Care. 2012 Nov;18(11 Suppl):S272-8
pubmed: 23327459
Cancer. 1993 Mar 1;71(5):1867-74
pubmed: 8448751
J Med Econ. 2017 Aug;20(8):850-862
pubmed: 28532187
Indian J Med Paediatr Oncol. 2017 Jan-Mar;38(1):4-9
pubmed: 28469329
Cancer Nurs. 2013 Jul-Aug;36(4):301-8
pubmed: 23047800
Support Care Cancer. 2017 Sep;25(9):2733-2741
pubmed: 28341973
Breast Cancer Res Treat. 2018 Sep;171(2):449-459
pubmed: 29855813
Pharmacoeconomics. 2000 Apr;17(4):361-70
pubmed: 10947491
Support Care Cancer. 2016 Oct;24(10):4423-32
pubmed: 27225528
Lancet Oncol. 2013 Nov;14(12):1165-74
pubmed: 24131614
JAMA. 1985 Apr 26;253(16):2393-7
pubmed: 3981767
Int J Equity Health. 2019 Feb 12;18(1):32
pubmed: 30755217