565O_PR Predictors of financial catastrophe following cancer in a high-middle-income Asian country

Abstract

Background: Cancer is an important driver of catastrophic expenditures. We examined the risk and predictors of financial catastrophe (FC) following cancer in Malaysia, an upper middle-income country with universal health coverage. Methods: Through the 2012-2014 ASEAN Costs in Oncology Study, 1662 Malaysian cancer patients were followed-up for 1 year following initial diagnosis. FC was defined as out-of-pocket health costs ≥ 30% of annual household income. Logistic regression analysis was used to identify the independent predictors of FC. Results: Median age was 52 years; 60% were women. 51% of patients were from general hospitals, 43% from academic and 6% from private centers. 27% had some type of health insurance. Excluding 430 patients with hematologic malignancies, 60% of patients had stage III or stage IV cancer at initial diagnosis. Only 58% of eligible patients with non-metastatic cancers received surgery. Chemotherapy administration in patients with solid tumors was 79%. At 1-year, 8% of patients with solid tumors, and 24% of patients with hematological malignancies had died. Of those who were alive, 51% experienced FC. Factors independently associated with FC were low-income status (odds ratio [OR]: 23.21, 95%CI: 15.01-35.89, vs. high-income), attending private or academic hospitals (OR: 6.41, 95%CI: 2.88-14.24, and OR: 4.76, 95%CI: 3.32-6.81, respectively vs. general hospitals), lack of health insurance (OR: 1.61, 95%CI: 1.14-2.28, vs. having health insurance), and lack of surgery (OR: 1.41, 95%CI: 1.02-1.94, vs. receipt of surgery). Lower risk of FC was observed in patients with hematologic malignancies (OR: 0.15, 95%CI: 0.07-0.33, vs. solid tumors), and those without chemotherapy (OR: 0.54, 95%CI: 0.36-0.80, vs. chemotherapy). Analyses confined to patients with nonmetastatic breast and colorectal cancers did not change inferences. Conclusions: A high proportion of Malaysians suffer FC due to cancer. Key policy changes need to focus on improvements in early cancer detection, and delivery of main modalities of cure and control. The government must also re-evaluate the existing health-financing mechanism to increase financial risk protection, especially for the poor, and ensure practice of Value Based Medicine.