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Bates, Maya Jane, Gordon, Miriam R P, Gordon, Stephen 
ORCID: https://orcid.org/0000-0001-6576-1116, Tomeny, Ewan ORCID: https://orcid.org/0000-0003-4547-2389, Muula, Adamson S, Davies, Helena, Morris, Claire, Manthalu, Gerald, Namisango, Eve, Masamba, Leo, Henrion, Marc Y R, MacPherson, Peter, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and Niessen, Louis ORCID: https://orcid.org/0000-0002-8639-5191
(2021)
'Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study'. Lancet Global Health, Vol 9, Issue 12, E1750-E175.
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Abstract
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.
| Item Type: | Article |
|---|---|
| Subjects: | W General Medicine. Health Professions > W 74 Medical economics. Health care costs QZ Pathology > Neoplasms. Cysts > QZ 200 Neoplasms. Cysts (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WB Practice of Medicine > Therapeutics > WB 300 General works |
| Faculty: Department: | Biological Sciences > Vector Biology Department Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > International Public Health Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW) |
| Digital Object Identifer (DOI): | https://doi.org/10.1016/S2214-109X(21)00408-3 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 03 Nov 2021 17:35 |
| Last Modified: | 10 Dec 2021 11:25 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/19333 |
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