Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study

Summary: Background: Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. Methods: In this...

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Autores principales:	Maya Jane Bates, FRCGP, Miriam R P Gordon, MSc, Stephen B Gordon, MD, Ewan M Tomeny, MSc, Adamson S Muula, PhD, Helena Davies, MD, Claire Morris, MSc, Gerald Manthalu, PhD, Eve Namisango, PhD, Leo Masamba, MSc, Marc Y R Henrion, PhD, Peter MacPherson, PhD, S Bertel Squire, MD, Louis W Niessen, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/3b28959b8a29486e892afb4ebc82fae4
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spelling	oai:doaj.org-article:3b28959b8a29486e892afb4ebc82fae42021-11-18T04:48:36ZPalliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study2214-109X10.1016/S2214-109X(21)00408-3https://doaj.org/article/3b28959b8a29486e892afb4ebc82fae42021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214109X21004083https://doaj.org/toc/2214-109XSummary: Background: Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. Methods: In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed. Findings: We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was −36% (95% CI −94 to 594; p=0·707). Interpretation: Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified. Funding: Wellcome Trust; National Institute for Health Research; and EMMS International.Maya Jane Bates, FRCGPMiriam R P Gordon, MScStephen B Gordon, MDEwan M Tomeny, MScAdamson S Muula, PhDHelena Davies, MDClaire Morris, MScGerald Manthalu, PhDEve Namisango, PhDLeo Masamba, MScMarc Y R Henrion, PhDPeter MacPherson, PhDS Bertel Squire, MDLouis W Niessen, PhDElsevierarticlePublic aspects of medicineRA1-1270ENThe Lancet Global Health, Vol 9, Iss 12, Pp e1750-e1757 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Public aspects of medicine RA1-1270
spellingShingle	Public aspects of medicine RA1-1270 Maya Jane Bates, FRCGP Miriam R P Gordon, MSc Stephen B Gordon, MD Ewan M Tomeny, MSc Adamson S Muula, PhD Helena Davies, MD Claire Morris, MSc Gerald Manthalu, PhD Eve Namisango, PhD Leo Masamba, MSc Marc Y R Henrion, PhD Peter MacPherson, PhD S Bertel Squire, MD Louis W Niessen, PhD Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study
description	Summary: Background: Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. Methods: In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed. Findings: We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was −36% (95% CI −94 to 594; p=0·707). Interpretation: Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified. Funding: Wellcome Trust; National Institute for Health Research; and EMMS International.
format	article
author	Maya Jane Bates, FRCGP Miriam R P Gordon, MSc Stephen B Gordon, MD Ewan M Tomeny, MSc Adamson S Muula, PhD Helena Davies, MD Claire Morris, MSc Gerald Manthalu, PhD Eve Namisango, PhD Leo Masamba, MSc Marc Y R Henrion, PhD Peter MacPherson, PhD S Bertel Squire, MD Louis W Niessen, PhD
author_facet	Maya Jane Bates, FRCGP Miriam R P Gordon, MSc Stephen B Gordon, MD Ewan M Tomeny, MSc Adamson S Muula, PhD Helena Davies, MD Claire Morris, MSc Gerald Manthalu, PhD Eve Namisango, PhD Leo Masamba, MSc Marc Y R Henrion, PhD Peter MacPherson, PhD S Bertel Squire, MD Louis W Niessen, PhD
author_sort	Maya Jane Bates, FRCGP
title	Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study
title_short	Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study
title_full	Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study
title_fullStr	Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study
title_full_unstemmed	Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study
title_sort	palliative care and catastrophic costs in malawi after a diagnosis of advanced cancer: a prospective cohort study
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/3b28959b8a29486e892afb4ebc82fae4
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Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study

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