Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of Economics, Global Development Institute, University of Manchester, Manchester, UK.
Lancet Glob Health. 2021 Dec;9(12):e1750-e1757. doi: 10.1016/S2214-109X(21)00408-3. Epub 2021 Oct 29.
Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse.
In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed.
We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was -36% (95% CI -94 to 594; p=0·707).
Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified.
Wellcome Trust; National Institute for Health Research; and EMMS International.
包容性全民健康覆盖需要在没有经济障碍的情况下获得高质量的医疗保健。在晚期癌症诊断后接受姑息治疗可能会减少家庭贫困，但来自低收入和中等收入国家的证据很少。
在这项前瞻性研究中，主要目的是调查在诊断出晚期癌症后，接受和不接受姑息治疗的情况下，癌症相关医疗保健的家庭总费用。2019 年 1 月 16 日至 7 月 31 日，在马拉维伊丽莎白女王中央医院，将包含患者及其无薪家庭护理人员的家庭招募到队列研究中。在 6 个月内记录癌症相关医疗保健使用（包括姑息治疗）和健康相关生活质量的成本。回归分析探讨了接受姑息治疗与家庭总收入中医疗保健支出占比之间的关系。计算了灾难性支出（定义为总收入的 20%或以上）、资产出售和贷款（负储蓄）及其与姑息治疗的关系。
我们招募了 150 个家庭。在 6 个月时，150 个家庭中的 89 个（59%）提供了数据，包括 89 名患者（中位年龄 50 岁，79%为女性）和 64 名护理人员（中位年龄 40 岁，73%为女性）。在 150 个家庭中，有 55 个（37%）的患者死亡，6 个（4%）失访。89 个家庭中有 19 个（21%）接受了姑息治疗。接受姑息治疗的 19 个家庭中有 9 个（47%）出现灾难性支出，而未接受姑息治疗的 70 个家庭中有 48 个（69%）出现灾难性支出（相对风险 0.69，95%CI 0.42 至 1.14，p=0.109）。姑息治疗与显著减少负储蓄相关（中位数分别为 11 美元，IQR 0 至 30 与 34 美元，14 至 75；p=0.005）。接受姑息治疗的家庭癌症相关医疗保健总费用平均差异为-36%（95%CI-94 至 594；p=0.707）。
在低收入国家，诊断出晚期癌症后，弱势家庭可能会面临灾难性的健康相关支出。姑息治疗可能会减少这些家庭的负储蓄。姑息治疗的经济效益值得进一步考虑。
惠康信托基金会；英国国家卫生研究院；和 EMMS 国际。
