Simoes Joana F F, Picciochi Maria, Ademuyiwa Adesoji, Adisa Adewale, Anyomih Theophilus, Bhangu Aneel, Calvache Jose A, Ghosh Dhruva, Jolly Kate, Kachapila Mwayi, Lawani Ismail, Nepogodiev Dmitri, Ntirenganya Faustin, Oppong Raymond, Tabiri Stephen, Ramos-De la Medina Antonio
NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK.
Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria.
World J Surg. 2025 Aug;49(8):2207-2216. doi: 10.1002/wjs.12637. Epub 2025 Jun 29.
Cancer is one of the most expensive global health challenges and surgery is needed in most cases. This study aimed to describe out-of-pocket payments for cancer surgery across country income groups.
This was a preplanned secondary analysis from an international prospective cohort study of consecutive patients undergoing cancer surgery in October 2020. Out-of-pocket payments (OOPP) to cover most of the cost of cancer surgery were compared across country income groups. Other funding sources were also described as follows: public funds, insurance, or others. A logistic regression model was used to identify variables independently associated with OOPP in low- and middle-income countries.
There were 24,498 patients included from 1332 hospitals from 108 countries. Overall, 6.4% (1571/24,498) had OOPP to cover most of the cost of their cancer surgery. OOPP rates varied across country income groups: 0.5% (89/16,680) in HICs, 5.7% (272/4784) in UMICs, 38.6% (1008/2614) in LMICs, and 48.1% (202/429) in LICs. Besides the country income, male sex (OR 1.16, 95% CI 1.02-1.32, and p = 0.024) and elective surgery (OR 1.31, 1.04-1.67, and p = 0.022) were associated with OOPP for cancer surgery.
Patients accessing cancer surgery in LMICs are at an increased risk of catastrophic expenditure. Governments should prevent this by developing health insurance plans that cover elective cancer surgery, possibly involving diverse stakeholders. The interpretation of gender-related risks demands deeper understanding of the ability to pay out-of-pocket and access care.
癌症是全球最昂贵的健康挑战之一，大多数情况下都需要进行手术。本研究旨在描述不同国家收入群体癌症手术的自付费用情况。
这是一项对2020年10月连续接受癌症手术的患者进行的国际前瞻性队列研究的预先计划的二次分析。比较了不同国家收入群体用于支付癌症手术大部分费用的自付费用（OOPP）。其他资金来源也如下所述：公共资金、保险或其他。使用逻辑回归模型来确定低收入和中等收入国家中与OOPP独立相关的变量。
来自108个国家1332家医院的24498名患者被纳入研究。总体而言，6.4%（1571/24498）的患者有OOPP来支付其癌症手术的大部分费用。OOPP率因国家收入群体而异：高收入国家为0.5%（89/16680），上中等收入国家为5.7%（272/4784），低收入国家为38.6%（1008/2614），低收入国家为48.1%（202/429）。除了国家收入外，男性（OR 1.16，95% CI 1.02 - 1.32，p = 0.024）和择期手术（OR 1.31，1.04 - 1.67，p = 0.022）与癌症手术的OOPP相关。
在低收入和中等收入国家接受癌症手术的患者面临灾难性支出的风险增加。政府应通过制定涵盖择期癌症手术的健康保险计划来预防这种情况，这可能需要不同利益相关者的参与。对与性别相关风险的解读需要更深入地了解自付能力和获得医疗服务的情况。
