Catastrophic Healthcare Expenditure and Coping Strategies among Patients Attending Cancer Treatment Services in Addis Ababa, Ethiopia: A Hospital-Based Cross-Sectional Study

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Addis Ababa Universty


Background: With the rapid increase in magnitude and mortality of cancer, which is costly disease to manage, several patients particularly in developing countries are facing a huge financial burden. However, there is limited evidence about the level of catastrophic health expenditure (CHE) in Ethiopia. Objectives: To examine the level of CHE, identify associated factors and coping strategies among patients attending cancer treatment services in Addis Ababa, Ethiopia. Method: A hospital based cross-sectional survey of patients with cancer was conducted in one public and three private hospitals between January and March 2018. Patients who received at least one of oncology treatment alternatives were enrolled and data was collected using SAGE (study on Study of Global AGEing and Adult Health) adopted pre-tested interviewer-administered questionnaire. All direct medical and nonmedical expenditures were measured and values are reported as expenditure (US$) per patient (1US$ equivalent to 23.41 Ethiopian Birr). CHE was estimated using a threshold of 10% of annual household income. Description of variables was made using mean, median and frequency. Multivariable logistic regression was used to explore factors associated with CHE. Patients’ household strategies used to cope for the financial constraints of cancer care were also explored. Data was analyzed using STATA version 13. Results: A total of 352 (response rate of 87.1%) participants were interviewed. Majority (73.3%) of the respondents were females; most (94%) from public hospitals and their mean age was 48 years (SD=13.2). Breast (37%) and cervical (16.5%) cancers accounted the largest proportion. Vast majority (74.4%) of patients experienced CHE with mean overall expenditure of $2366 per patient (median: $1708). Medical expenditure accounted the highest percentage (83.6%) with mean medical and nonmedical costs of $1978 (median: $1394) and $388 (median: $222), respectively. Average (median) outpatient and inpatient expenditure were: $782 ($557) and $1584 ($1067) respectively. Patients who took greater than six cycles of chemotherapy (AOR: 3.64; 95% CI: 1.11-11.92), and age (AOR: 1.03; 95% CI: 1.01-1.06) were factors significantly associated with CHE. Household savings (85.5%) followed by financial support (43.0%) were the main coping strategies used to cover the health payment. VII Conclusion: A substantial number of patients with cancer are exposed to CHE with considerable medical expenditure and household saving was the main means of coping strategy. Hence, mobilizing the health insurance scheme is urgently needed to ensure financial risk protection and realize universal health coverage particularly for patients with Cancer.



Cancer, catastrophic healthcare expenditure, coping strategy, out-of-pocket expenditure, medical expenditure, non-medical expenditure, cost, Ethiopia