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Out-of-pocket costs sustained in the last 12 months by cancer patients: an Italian survey-based study on individual expenses between 2017 and 2018

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Abstract

Purpose

Out of Pocket costs (OOP) sustained by cancer patients also in public NHS contribute to disease-related financial toxicity. Aim of the study was to investigate the amount and the types of OOP sustained by Italian cancer patients for care services.

Methods

A sample survey was conducted by FAVO in December 2017-June 2018, in 39 adhering hospitals and 1289 patients diagnosed from 1985 to 2018, by standardized questionnaire inquiring on: yearly expenditure by cancer service, age, year of diagnosis, disease phase, cancer site, sex, marital status, education, residence. Univariate and multivariable regression analyses were performed between OOP and each variable. Multilevel mixed-effects negative binomial regression was used to assess the combined effects of patients characteristics on the differences in acquiring health services.

Results

The yearly average OOP was 1841.81€, with the highest values for transports (359.34€) and for diagnostic examinations (259.82€). Significantly higher OOP were found in North and Centre than South and Islands (167.51 vs. 138.39). In the fully adjusted multivariable analysis, the variables significantly associated with higher than reference expenditure were: medium/high education (OR 1.22 [1.05–1.42], upper gastrointestinal tract cancer (OR 1.37 [1.06–1.77]), disease phase of treatments for cancer progression or pain therapy (OR 1.59 [1.30–1.93]).

Conclusion

Italian cancer patients in 2018 sustained OOP quite similar to those measured in 2012 to supplement NHS services. The main component of the OOP costs were diagnostic examination and transportation. The NHS should pay attention to potentiate its ability to answer unmet needs of patients with advanced cancer who are the most fragile ones.

Implications for cancer survivors

Reinforcing the services where the main OOP expenses are located can help in promoting public health actions and reduce socio-economic needs that could compromise the receipt of optimal care along the whole disease course, from diagnosis to rehabilitation.

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Data availability

Data are available on appropriate and adequately motivated request.

Code availability

Analyses syntax code is available on appropriate and adequately motivated request.

References

  1. Zafar, S.Y., Peppercorn, J.M., Schrag, D., Taylor, D.H., Goetzinger, A.M., Zhong, X., Abernethy, A.P.: The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18, 381–390 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  2. O’Connor, J.M., Kircher, S.M., de Souza, J.A.: Financial toxicity in cancer care. J Community Support Oncol 14, 101–106 (2016)

    Article  PubMed  Google Scholar 

  3. Ezeife, D.A., Morganstein, B.J., Lau, S., et al.: Financial burden among patients with lung cancer in a publically funded health care system. Clin Lung Cancer 20(4), 231–236 (2019)

    Article  PubMed  Google Scholar 

  4. Honda, K., Gyawali, B., Ando, M., et al.: prospective survey of financial toxicity measured by the comprehensive score for financial toxicity in Japanese patients with cancer. J Glob Oncol. 5, 1–8 (2019)

    PubMed  Google Scholar 

  5. Longo, C.J., Fitch, M.I., Banfield, L., et al.: Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review. Support Care Cancer 28, 4645–4665 (2020)

    Article  PubMed  Google Scholar 

  6. Lueckmann, S.L., Schumann, N., Hoffmann, L., et al.: It was a big monetary cut-A qualitative study on financial toxicity analysing patients experiences with cancer costs in Germany. Health Soc Care Commun 28, 771–780 (2020)

    Article  Google Scholar 

  7. Perrone, F., Jommi, C., Di Maio, M., et al.: The association of financial difficulties with clinical outcomes in cancer patients: secondary analysis of 16 academic prospective clinical trials conducted in Italy. Ann Oncol 27, 2224–2229 (2016)

    Article  CAS  PubMed  Google Scholar 

  8. Poudyal, B.S., Giri, S., Tuladhar, S., et al.: A survey in Nepalese patients with acute leukaemia: a starting point for defining financial toxicity of cancer care in low-income and middle-income countries. Lancet Haematol 7, e638–e639 (2020)

    Article  PubMed  Google Scholar 

  9. Baili, P., Di Salvo, F., de Lorenzo, F., Maietta, F., Pinto, C., Rizzotto, V., Vicentini, M., Rossi, P.G., Tumino, R., Rollo, P.C., Tagliabue, G., Contiero, P., Candela, P., Scuderi, T., Iannelli, E., Cascinu, S., Aurora, F., Agresti, R., Turco, A., Sant, M., Meneghini, E., Micheli, A.: Out-of-pocket costs for cancer survivors between 5 and 10 years from diagnosis: an Italian population-based study. Support Care Cancer 24(5), 2225–2233 (2016)

    Article  PubMed  Google Scholar 

  10. Aaronson, N.K., Ahmedzai, S., Bergman, B., et al.: The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85, 365–376 (1993)

    Article  CAS  PubMed  Google Scholar 

  11. Riva, S., Bryce, J., De Lorenzo, F., et al.: Development and validation of a patient-reported outcome tool to assess cancer-related financial toxicity in Italy: a protocol. BMJ Open 9, e031485 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  12. Riva, S., Efficace, F., Di Maio, M., et al.: A qualitative analysis and development of a conceptual model assessing financial toxicity in cancer patients accessing the universal healthcare system. Support Care Cancer 29(6), 3219–3233 (2021)

    Article  PubMed  Google Scholar 

  13. Riva, S., Arenare, L., Di Maio, M., Efficace, F., Montesarchio, V., Frontini, L., Giannarelli, D., Bryce, J., Del Campo, L., De Lorenzo, F., Iannelli, E., Traclò, F., Gitto, L., Jommi, C., Vaccaro, C.M., Barberio, D., Cinieri, S., Porta, C., Del Mastro, L., Zagonel, V., Cogoni, A.A., Bordonaro, R., Gimigliano, A., Piccirillo, M.C., Guizzaro, L., Gallo, C., Perrone, F.: Cross-sectional study to develop and describe psychometric characteristics of a patient-reported instrument (PROFFIT) for measuring financial toxicity of cancer within a public healthcare system. BMJ Open 11(10), e049128 (2021)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Saris, W.E., Gallhofer, I.N. (eds.): Design, evaluation, and analysis of questionnaires for survey research, 2nd edn. John Wiley & Sons, Inc., Hoboken, New Jersey (US) (2014)

    Google Scholar 

  15. Carrera, P.M., Kantarjian, H.M., Blinder, V.S.: The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin 68(2), 153–165 (2018)

    Article  PubMed  PubMed Central  Google Scholar 

  16. Vercelli, M., Lillini, R., Quaglia, A., Capocaccia, R., SEIH (Socio-Economic Indicators and Health) Working Group & AIRTUM contributors: Italian regional health system structure and expected cancer survival. Tumori 100(4), 386–398 (2014)

    Article  PubMed  Google Scholar 

  17. Nemes, S., Jonasson, J.M., Genell, A., Steineck, G.: Bias in odds ratios by logistic regression modelling and sample size. BMC Med Res Methodol 9, 56 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  18. King, G., Zeng, L.: Logistic regression in rare events data. Polit Anal 9, 137–163 (2001)

    Article  Google Scholar 

  19. Numico, G., Pinto, C., Gori, S., Ucci, G., Di Maio, M., Cancian, M., De Lorenzo, F., Silvestris, N.: Clinical and organizational issues in the management of surviving breast and colorectal cancer patients: attitudes and feelings of medical oncologists. PLoS ONE 9(7), e101170 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sirintrapun, S.J., Lopez, A.M.: Telemedicine in cancer care. Am Soc Clin Oncol Educ Book 23(38), 540–545 (2018)

    Article  Google Scholar 

  21. Sun, C.-Y., Shi, J.-F., Wen-Qi, Fu., Zhang, X., Liu, G.-X., Chen, W.-Q., He, J.: Catastrophic health expenditure and its determinants among households with breast cancer patients in China: a multicenter, cross-sectional survey. Front Public Health 9, 704700 (2021)

    Article  PubMed  PubMed Central  Google Scholar 

  22. Marti, J., Hall, P.S., Hamilton, P., Hulme, C.T., Jones, H., Velikova, G., Ashley, L., Wright, P.: The economic burden of cancer in the UK: a study of survivors treated with curative intent. Psychooncology. 25(1), 77–83 (2016)

    Article  PubMed  Google Scholar 

  23. Koskinen, J.P., Färkkilä, N., Sintonen, H., Saarto, T., Taari, K., Roine, R.P.: The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal cancer patients. Acta Oncol. 58(7), 1062–1068 (2019)

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research was partially funded by the Italian Ministry of Health “Ricerca Corrente” funds.

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Authors and Affiliations

  1. Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy

    Roberto Lillini, Paolo Baili & Milena Sant

  2. Italian Federation of Cancer Patients Organization, FAVO, Via Barberini 11, 00187, Rome, Italy

    Francesco De Lorenzo, Elisabetta Iannelli & Laura M. Del Campo

  3. Italian Association of Cancer Patients, Relatives and Friends, Aimac, Via Barberini, 11, 00187, Rome, Italy

    Dina Pero & Gianfranca Traclò

  4. Datamining Srl, Viale Jonio, 332, 00141, Rome, Italy

    Alessandro Sproviero

  5. Clinical Trials Unit, National Cancer Institute of Naples, IRCCS Fondazione Pascale, Via Mariano Semmola, 80131, Naples, Italy

    Francesco Perrone

Authors
  1. Roberto Lillini
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  2. Francesco De Lorenzo
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  3. Paolo Baili
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  4. Elisabetta Iannelli
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  5. Laura M. Del Campo
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  6. Dina Pero
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  7. Gianfranca Traclò
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  8. Alessandro Sproviero
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  9. Milena Sant
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  10. Francesco Perrone
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Contributions

RL and FDL were co-first authors; FP and MS were co-last authors. RL was the corresponding author. Specific contribution. RL: Data analysis, interpretation and text redaction in “Introduction, “Materials and Methods”, “Results”. FDL: Conception/design and revision of the article, approval of the final version. FP: Results interpretation and revision of the article. MS: Interpretation of the results, text redaction in “Introduction”, “Discussion”, “Conclusion” and “Abstract”, revision and approval of the final version.

Corresponding author

Correspondence to Roberto Lillini.

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Conflict of interest

The authors declare no competing interests.

Ethics approval

All the Ethics Committee, pertaining to the care Centres where the survey was administered, approved the research and its application.

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Informed consent was obtained from all participants included in the study and interviewed by the questionnaire.

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Lillini, R., De Lorenzo, F., Baili, P. et al. Out-of-pocket costs sustained in the last 12 months by cancer patients: an Italian survey-based study on individual expenses between 2017 and 2018. Eur J Health Econ 24, 1309–1319 (2023). https://doi.org/10.1007/s10198-022-01544-9

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