2019年埃塞俄比亚西北部阿姆哈拉西部地区综合专科医院成年癌症患者的经济负担及成本变异性预测因素
Economic Burden and Predictors of Cost Variability Among Adult Cancer Patients at Comprehensive Specialized Hospitals in West Amhara, Northwest Ethiopia, 2019.
作者信息
Hagos Asebe, Yitayal Mezgebu, Kebede Adane, Debie Ayal
机构信息
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
Cancer Manag Res. 2020 Nov 18;12:11793-11802. doi: 10.2147/CMAR.S282746. eCollection 2020.
BACKGROUND
Cancer is the second leading cause of death in the world and accounts for 5.8% of deaths in Ethiopia. High out-of-pocket payment for the cost of illness of cancer could be linked to the low adherence to cancer treatment. This study aimed to assess the economic burden and predictors of cost variability among adult cancer patients at comprehensive specialized hospitals in West Amhara, Northwest Ethiopia.
METHODS
An institutional-based cross-sectional study was conducted from January to February 2019 at the University of Gondar and Felege Hiwot hospitals. The cost of illness of cancer was estimated using a bottom-up micro-costing approach. Direct costs of illness of cancer were measured by calculating out-of-pocket expenditure. The indirect costs were estimated using human capital model approach. Multiple linear regression was used to identify the predictors for the log-transformed data. Unstandardized β-coefficient with 95% CI and -value < 0.05 were used to declare factors associated with cost of illness of cancer.
RESULTS
The mean cost of cancer illness among adult patients was US$ 1103.7 ±33.2, and median cost was US$ 951.0 with IQR of 822.1. Factors such as urban residents (β = 0.147; 95% CI: 0.047, 0.246), distance (β = 0.0007; 95% CI: 0.0002, 0.001), married (β = 0.125; 95% CI: 0.037, 0.212), higher education (β = 0.318; 95% CI: 0.202, 0.435), buying drugs at private facilities (β = 0.134; 95% CI: 0.026, 0.243), richest households (β = 0.320; 95% CI: 0.143, 0.496) and frequent cycles of chemotherapy (β = 0.093; 95% CI: 0.061, 0.125) were positively associated with cost, while being female patients (β = -0.144; 95% CI: - 0.210, - 0.018) were negatively associated.
CONCLUSION
The cost of illness of cancer was high. The government, therefore, should expand health insurance and invest an additional budget to safeguard patients from financial catastrophic shock.
背景
癌症是全球第二大死因，在埃塞俄比亚占死亡人数的5.8%。癌症疾病高昂的自付费用可能与癌症治疗依从性低有关。本研究旨在评估埃塞俄比亚西北部阿姆哈拉州西部综合专科医院成年癌症患者的经济负担及费用变异性的预测因素。
方法
2019年1月至2月在贡德尔大学和费莱格·希沃特医院开展了一项基于机构的横断面研究。采用自下而上的微观成本核算方法估算癌症疾病费用。通过计算自付支出衡量癌症疾病的直接费用。采用人力资本模型方法估算间接费用。使用多元线性回归确定对数转换数据的预测因素。采用未标准化β系数及95%置信区间和P值<0.05来确定与癌症疾病费用相关的因素。
结果
成年患者的癌症疾病平均费用为1103.7美元±33.2美元，中位数费用为951.0美元，四分位间距为822.1美元。城市居民（β = 0.147；95%置信区间：0.047，0.246）、距离（β = 0.0007；95%置信区间：0.0002，0.001）、已婚（β = 0.125；95%置信区间：0.037，0.212）、高等教育（β = 0.318；95%置信区间：0.202，0.435）、在私立机构购买药品（β = 0.134；95%置信区间：0.026，0.243）、最富裕家庭（β = 0.320；95%置信区间：0.143，0.496）以及频繁的化疗周期（β = 0.093；95%置信区间：0.061，0.125）等因素与费用呈正相关，而女性患者（β = -0.144；95%置信区间：-0.210，-0.018）与费用呈负相关。
结论
癌症疾病费用高昂。因此，政府应扩大医疗保险并增加预算投入，以保护患者免受经济灾难性冲击。
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