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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

Author

Listed:
  • Roberto Lillini

    (Fondazione IRCCS Istituto Nazionale dei Tumori)

  • Francesco De Lorenzo

    (Italian Federation of Cancer Patients Organization, FAVO)

  • Paolo Baili

    (Fondazione IRCCS Istituto Nazionale dei Tumori)

  • Elisabetta Iannelli

    (Italian Federation of Cancer Patients Organization, FAVO)

  • Laura M. Del Campo

    (Italian Federation of Cancer Patients Organization, FAVO)

  • Dina Pero

    (Italian Association of Cancer Patients, Relatives and Friends, Aimac)

  • Gianfranca Traclò

    (Italian Association of Cancer Patients, Relatives and Friends, Aimac)

  • Alessandro Sproviero

    (Datamining Srl)

  • Milena Sant

    (Fondazione IRCCS Istituto Nazionale dei Tumori)

  • Francesco Perrone

    (National Cancer Institute of Naples, IRCCS Fondazione Pascale)

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.

Suggested Citation

  • Roberto Lillini & Francesco De Lorenzo & Paolo Baili & Elisabetta Iannelli & Laura M. Del Campo & Dina Pero & Gianfranca Traclò & Alessandro Sproviero & Milena Sant & Francesco Perrone, 2023. "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," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(8), pages 1309-1319, November.
    • Handle: RePEc:spr:eujhec:v:24:y:2023:i:8:d:10.1007_s10198-022-01544-9
    DOI: 10.1007/s10198-022-01544-9
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    1. King, Gary & Zeng, Langche, 2001. "Logistic Regression in Rare Events Data," Political Analysis, Cambridge University Press, vol. 9(2), pages 137-163, January.
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