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

Roberto Lillini (), Francesco De Lorenzo, Paolo Baili, Elisabetta Iannelli, Laura M. Del Campo, Dina Pero, Gianfranca Traclò, Alessandro Sproviero, Milena Sant and Francesco Perrone
Additional contact information
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

The European Journal of Health Economics, 2023, vol. 24, issue 8, No 6, 1309-1319

Abstract: 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.

Keywords: Out-of-pocket health expenditures; Cancer patients; Cancer care; Financial toxicity; National health system (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10198-022-01544-9

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