Background and Objective
Psychosocial costs, or quality of life costs, account for psychological distress, pain, suffering and other negative experiences associated with cancer. They contribute to ...the overall economic burden of cancer that patients experience. But this category of costs remains poorly understood. This hinders opportunities to make the best cancer control policy decisions. This study explored the psychosocial cost burden associated with cancer, how studies measure psychosocial costs and the impact of this burden.
Methods
A systematic literature review of academic and grey literature published from 2008 to 2018 was conducted by searching electronic databases, guided by the Institute of Medicine’s conceptualization of psychosocial burden. Results were analyzed using a narrative synthesis and a weighted proportion of populations affected was calculated. Study quality was assessed using the Ottawa‐Newcastle instrument.
Results
A total of 25 studies were included. There was variation in how psychosocial costs were conceptualized and an inconsistent approach to measurement. Most studies measured social dimensions and focused on the financial consequences of paying for care. Fewer studies assessed costs associated with the other domains of this burden, including psychological, physical, and spiritual dimensions. Fourty‐four percent of cancer populations studied were impacted by psychosocial costs and this varied by disease site (38%‐71%). Two studies monetized the psychosocial cost burden, estimating a lifetime cost per case ranging from CAD$427753 to CAD$528769. Studies were of varying quality; 60% of cross‐sectional studies had a high risk of bias.
Conclusions
Consistency in approach to measurement would help to elevate this issue for researchers and decision makers. At two‐thirds of the total economic burden of cancer, economic evaluations should account for psychosocial costs to better inform decision‐making. More support is needed to address the psychosocial cost burden faced by patients and their families.
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty ...alleviation efforts. For patients with NCDs, being uninsured is associated with 2–7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals.
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.
A decade ago the term cancer divide was used to describe the unacceptable difference in survival rates for preventable and treatable cancers across and within countries.4,5 Now, affordable, ...implementable solutions exist, yet survival gaps persist, exemplified by childhood cancer: in wealthy countries, 90% of children have the likelihood of cure, while in the poorest countries only 10% can hope to survive.4,6,7 This global health failure is perverse. Late diagnosis and impoverishment will leave families unable to afford health care, and weakened or devastated health systems will have less capacity to manage complex diseases such as cancer.20 Our task is to identify pathways that improve access to technology and innovations that support better and more equitable cancer control, spanning prevention to palliation, while strengthening health systems to be more prepared for other health challenges, including future pandemics. Additionally, artificial intelligence could improve health-care quality and efficiency in all resource settings, alleviating workforce and equipment shortages, and facilitating clinical decision support tools and remote technical and quality assurance.6,21 The Commissioners (appendix) comprise disciplinary, thematic, experiential, and scientific expertise into intellectual bridges that aim to transcend the false dichotomies that characterise the worlds of cancer and health systems.22 Commissioners include cancer clinicians and scientists, health-system stewards, global health leaders, primary care providers, economists, and patient advocates in a gender-balanced group that spans world regions.
In this review we aimed to determine the economic impact of epilepsy and factors associated with costs to individuals and health systems.
A narrative systematic review of incidence and case series ...studies with prospective consecutive patient recruitment and economic outcomes published before July 2014 were retrieved from Medline, Embase and PsycInfo.
Of 322 studies reviewed, 22 studies met the inclusion criteria and 14 were from high income country settings. The total costs associated with epilepsy varied significantly in relation to the duration and severity of the condition, response to treatment, and health care setting. Where assessed, 'out of pocket' costs and productivity losses were found to create substantial burden on households which may be offset by health insurance. However, populations covered ostensibly for the upfront costs of care can still bear a significant economic burden.
Epilepsy poses a substantial economic burden for health systems and individuals and their families. There is uncertainty over the degree to which private health insurance or social health insurance coverage provides adequate protection from the costs of epilepsy. Future research is required to examine the role of different models of care and insurance programs in protecting against economic hardship for this condition, particularly in low and middle income settings.
Despite receiving highly subsidized treatment, dialysis patients receiving care in these two sites in northern India still faced high medical out-of-pocket costs: 87.1% of patients in public ...hospitals were spending over 100% of their monthly income on dialysis compared to 78.9% of patients in private care.4 This expenditure excluded non-medical costs, which can also be substantial.5 As part of its agenda to achieve universal health coverage (UHC) by 2022, the Indian government has committed to establishing at least one eight-station dialysis unit in each of its 688 districts, and is offering free haemodialysis to people living below the poverty threshold.6 The government's ability to meet this commitment will depend not only on increasing its fiscal capacity, but also on the implementation of frugal innovations (such as low-cost dialysis machines7 and greater use of non-physician health workers), enhanced early screening interventions8 and better access to home-based peritoneal dialysis. Better access to peritoneal dialysis would potentially mitigate the substantial non-medical costs associated with travel and lost productivity to attend haemodialysis units.5'6 While financing reforms to implement UHC are critical to enhancing financial protection of patients with chronic kidney disease, these reforms are not enough. Dialysis and transplantation are highly unaffordable in most low- and middle-income countries, particularly for vulnerable groups.6 Comprehensive health benefit packages must prioritize early screening and treatment of risk factors such as diabetes and hypertension, access to essential medicines and the implementation of public health interventions to prevent disease progression.8 Targeted support programmes are also needed as part of a comprehensive strategy to strengthen financial protection for chronic kidney disease patients.
Abstract
Priority setting represents an even bigger challenge during public health emergencies than routine times. This is because such emergencies compete with routine programmes for the available ...health resources, strain health systems and shift health-care attention and resources towards containing the spread of the epidemic and treating those that fall seriously ill. This paper is part of a larger global study, the aim of which is to evaluate the degree to which national COVID-19 preparedness and response plans incorporated priority setting concepts. It provides important insights into what and how priority decisions were made in the context of a pandemic. Specifically, with a focus on a sample of 18 African countries’ pandemic plans, the paper aims to: (1) explore the degree to which the documented priority setting processes adhere to established quality indicators of effective priority setting and (2) examine if there is a relationship between the number of quality indicators present in the pandemic plans and the country’s economic context, health system and prior experiences with disease outbreaks. All the reviewed plans contained some aspects of expected priority setting processes but none of the national plans addressed all quality parameters. Most of the parameters were mentioned by less than 10 of the 18 country plans reviewed, and several plans identified one or two aspects of fair priority setting processes. Very few plans identified equity as a criterion for priority setting. Since the parameters are relevant to the quality of priority setting that is implemented during public health emergencies and most of the countries have pre-existing pandemic plans; it would be advisable that, for the future (if not already happening), countries consider priority setting as a critical part of their routine health emergency and disease outbreak plans. Such an approach would ensure that priority setting is integral to pandemic planning, response and recovery.
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