Patient side cost and its predictors for cervical cancer in Ethiopia: a cross sectional hospital based study

BMC Cancer

Alemayehu Hailu¹  Damen Haile Mariam¹ 

[1] School of Public Health, Addis Ababa University, P.O.Box 9086, Addis Ababa, Ethiopia

关键词: Human papilloma virus;    Ethiopia;    Cervical cancer;    Cost of illness;   

Others  :  1079921
DOI  :  10.1186/1471-2407-13-69

 received in 2012-10-04, accepted in 2013-02-05,  发布年份 2013

【 摘 要 】

Background

Cervical cancer is a leading cause of death from cancer among women in low-resource settings, affecting women at a time of life when they are critical to social and economic stability. In addition, the economic burden is important for policy formulation. The aim of this study is to estimate patient side cost and to determine predictors of its variation for the treatment of cervical cancer.

Methods

Analytic cross sectional study involving 227 cervical cancer cases at Tikur Anbessa Hospital, Ethiopia was conducted. Cost estimation was based on patients' perspective and using the prevalence-based model as a time frame. Productivity losses were estimated from lost working days.

Results

The mean outpatient cost per patient for cervical cancer was $407.2 (Median = $206.9). Direct outpatient cost (Mean = $334.2) takes the largest share compared with the indirect counterpart ($150). The outpatient cost for half of the respondent falls in a range between $93.7 and $478. The mean inpatient cost for hospitalized patients was $404.4. The average direct inpatient cost was $329 (74% medical costs and 26% non medical costs). The mean value for total inpatient cost for half of the respondents was in the range of $133.5 and $493.9. For every additional day of inpatient hospital stay, there is a daily incremental inpatient cost of $4.2.

Conclusion

As has been found in other studies, our findings revealed that cervical cancer creates an immense financial burden on patients. Primary prevention measures, vaccination against HPV and screening, should be initiated and expanded to reduce morbidity from cervical cancer and subsequent costs in both human lives and money resources. Control of co-morbidity and complication should be emphasized during management of cervical cancer patients. Capacitating regional hospitals and provision of low cost or fee exemption schemes should be arranged and strengthened.

【 授权许可】

   
2013 Hailu and Mariam; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO: Comprehensive Cervical Cancer Control: A guide to essential practice. Switzerland: WHO Press; 2006.
• [2]Anorlu RI: What is the significance of the HPV epidemic? Can J Urol 2008, 15(1):3860-3865.
• [3]GLOBOCAN: Cervical Cancer Incidence and Mortality Worldwide in 2008. CANCER FACT SHEET; 2008.
• [4]Castellsagué X, Sanjosé S, Aguado T, Louie KS, Bruni L, Muñoz J, et al.: HPV and Cervical Cancer in the World. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre) 2007.
• [5]WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre): Human Papillomavirus and Related Cancers in Ethiopia Summary Report. 2010.
• [6]Aseffa A, Zein AZ: Neoplasms in Gondar. Ethiop Med J 1986, 24:133-136.
• [7]Loutfi A, Pickering IL: The distribution of cancer specimens from two pathology centers in Ethiopia. Ethiop Med J 1982, 30:13-17.
• [8]Ashine S, Lemma B: Malignant tumours at Yirga Alem hospital. Ethiop Med J 1999, 37:163-172.
• [9]Pelzer A, Duncan ME, Tibaux G, Mehari L: A study of cervical cancer in Ethiopian women. Cytopathology 1992, 3(3):139-148.
• [10]Insinga RP, Dasbach EJ, Elbasha EH: Assesing the annual economic burden of preventing and treating anogenital human papillomavirus-related disease in the US: analytic framework and review of the literature. Pharmacoeconomics 2005, 23(11):1107-1122.
• [11]Lipsy RJ: Assessing the short-term and long-term burden of illness in cervical cancer. Am J Manag Care 2008, 14(6 Suppl 1):S177-S184.
• [12]Gil A, San-Martin M, Gil R, Hernandez V, Ribes J, Gonzalez A: Burden of hospital admissions for cervical cancer in Spain during 1999–2002. Hum Vaccin 2007, 3(6):276-280.
• [13]Ben Gobrane H, Aounallah-Skhiri H, Oueslati F, Frikha H, Achour N, Hsairi M: Estimated cost of managing invasive cervical cancer in Tunisia. Sante Publique 2009, 21(6):561-569.
• [14]Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL: Methods for the Economic valuation of Health Care Programs. 3rd edition. Oxford: Oxford University Press; 2005.
• [15]World Bank databesehttp://data.worldbank.org/indicator/PA.NUS.PPPC.RF webcite (accessed: January 27, 2013
• [16]Benedet JL, Bender H, Jones H, Ngan HY, Pecorelli S: FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000, 70(2):209-262.
• [17]Tsu VD, Levin CE: Making the case for cervical cancer prevention: what about equity? Reprod Health Matters 2008, 16(32):104-112.
• [18]Wolstenholme JL, Whynes DK: Stage-specific treatment costs for cervical cancer in the United Kingdom. Eur J Cancer 1998, 34(12):1889-1893.
• [19]Bhurgri Y, Nazir K, Shaheen Y, Usman A, Faridi N, Bhurgri H, et al.: Patho-epidemiology of Cancer Cervix in Karachi South. Asian Pac J Cancer Prev 2007, 8(3):357-362.
• [20]Silvina A, Elena M, Nicolas Z, Berta R, Sankaranyananana R, Maxwell P: The socio-economic impact of cervical cancer on patients and their families in Argentina, and its influence on radiotherpay compliance. Results from a cross-sectional study. Gynacologyc Oncology 2007, 105:335-340.
• [21]Denny L: Prevention of cervical cancer. Reprod Health Matters 2008, 16(32):18-31.
• [22]Ratinahirana S, Razanamparany PV, Razafintsalama B, Randriamampandry A, Ravaoarison J, Rabarijaona L, et al.: 79 cases of invasive cancer of the cervix uteri in the Department of Oncology in Antananarivo. Can diagnostic delays be improved? Sante 1995, 5(3):195-198.
• [23]Denny L, Kuhn L, De Souza M, Pollack AE, Dupree W, Wright TC: Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial. JAMA 2005, 294(17):2173-2181.
• [24]Arveux P, Benard S, Bouee S, Lafuma A, Martin L, Cravello L, et al.: Invasive cervical cancer treatment costs in France. Bull Cancer 2007, 94(2):219-224.
• [25]Issah F, Maree JE, Mwinituo PP: Expressions of cervical cancer-related signs and symptoms. Eur J Oncol Nurs 2011, 15(1):67-72.
• [26]Ashing-Giwa KT, Gonzalez P, Lim JW, Chung C, Paz B, Somlo G, et al.: Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors. Cancer 2010, 116(13):3195-3204.
• [27]Charles L, Bennett A, Elizabeth A: Evaluating the Total Costs of Chemotherapy-Induced Febrile Neutropenia: Results from a Pilot Study with Community Oncology Cancer Patients. Oncologist 2007, 12:478-483.
• [28]Clegg LX, Reichman ME, Miller BA, Hankey BF, Singh GK, Lin YD, et al.: Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study. Cancer Causes Control 2009, 20(4):417-435.
• [29]Oliva J, Lobo F, Lopez-Bastida J, Zozaya N, Romay R: Indirect costs of cervical and breast cancers in Spain. Eur J Health Econ 2005, 6(4):309-313.