Global Variation in Out-of-Pocket Payments for Cancer Surgery

Area of Science:

• Global Health
• Surgical Oncology
• Health Economics

Background:

• Cancer surgery is a critical intervention for a leading global health challenge.
• High costs associated with cancer treatment pose significant financial burdens worldwide.
• Understanding out-of-pocket payments (OOPP) is essential for assessing financial toxicity in cancer care.

Purpose of the Study:

• To analyze and compare out-of-pocket payments for cancer surgery across different country income groups.
• To identify factors associated with OOPP for cancer surgery in low- and middle-income countries.

Main Methods:

• Secondary analysis of an international prospective cohort study.
• Included 24,498 patients from 108 countries undergoing cancer surgery in October 2020.
• Compared OOPP rates across high-income (HICs), upper-middle-income (UMICs), lower-middle-income (LMICs), and low-income countries (LICs).
• Used logistic regression to identify predictors of OOPP in LMICs.

Main Results:

• Overall, 6.4% of patients incurred OOPP for cancer surgery.
• OOPP rates significantly increased with lower country income: 0.5% (HICs) to 48.1% (LICs).
• Male sex and elective surgery were independently associated with higher OOPP in LMICs.

Conclusions:

• Patients in LMICs face a substantial risk of catastrophic expenditure due to OOPP for cancer surgery.
• Governments should implement health insurance plans covering elective cancer surgery, involving various stakeholders.
• Further research is needed to understand gender-related disparities in out-of-pocket spending and healthcare access.