The Burden of Health‐Related Out‐of‐Pocket Cancer Costs in Canada: A Case‐Control Study Using Linked Data

Abstract

Background: The burden of out‐of‐pocket costs among cancer patients/survivors in Canada is not well understood. The objective of this study was to examine the health‐related out‐of-pocket cost burden experienced by households with a cancer patient/survivor compared to those without, examine the components of health‐related costs and determine who experiences a greater burden. Data and methods: This study used a data linkage between the Survey of Household Spending and the Canadian Cancer Registry to identify households with a cancer patient/survivor (cases) and those without (controls). The out‐of‐pocket burden (out‐of‐pocket costs measured relative to household income) and mean costs were described and regression analyses examined the characteristics associated with the household out‐of‐pocket burden and annual out‐of‐pocket costs. Results: The health‐related out‐of‐pocket cost burden and annual costs measured in households with a cancer patient/survivor were 3.08% (95% CI: 2.55–3.62%) and CAD 1600 (95% CI: 1456–1759), respectively, compared to a burden of 2.84% (95% CI: 2.31–3.38) and annual costs of CAD 1511 (95% CI: 1377–1659) measured in control households, respectively. Households with a colorectal cancer patient/survivor had a significantly higher out‐of‐pocket burden compared to controls (mean difference: 1.0%, 95% CI: 0.18, 0.46). Among both cases and controls, the lowest income quintile households experienced the highest health‐related out‐of‐pocket cost burden. Interpretation: Within a universal health care system, it is still relevant to monitor health‐related out‐of‐pocket spending that is not covered by existing insurance mechanisms; however, this is not routinely assessed in Canada. We demonstrate the feasibility of measuring such costs in households with a cancer patient/survivor using routinely collected data. While the burden and annual health‐related out‐of-pocket costs of households with a cancer patient/survivor were not significantly higher than control households in this study, the routine measurement of out‐of‐pocket costs in Canada could be systemized, providing a novel, system‐level, equity‐informed performance indicator, which is relevant for monitoring inequities in the burden of out‐of‐pocket costs.