Private and catastrophic health expenditure of patients with early and locally advanced breast cancer in Greece

Abstract

Objectives: Catastrophic health expenditure (CHE) occurs when over 20% of the total family income is spent on healthcare services as out-of-pocket payments. Aim of the present study is to investigate the extent of CHE of households with women with breast cancer in Greece and their private expenditure due to the cost of the disease. Methods: A cross-sectional study was conducted among 390 breast cancer patients, diagnosed between January 2011 and August 2014, based on a structured questionnaire. Patients were approached through the respective patient organizations. Results: The average private expenditure for surgery was estimated at 2,160€ , for chemotherapy at 789.4€ , for treatment with biologic agents at 264.6€ , for radiation therapy at 706.8€ and the annual cost of follow up at 571.9€ . The total mean private expenditure from diagnosis to end of treatment was estimated at 4,706€ , which incurred in an average period of 10.5 months. It was found that 47.3% of households that had a breast cancer patient spent more than 20% of their total family income on treatments, 28.2% spent more than 50%, 12.2% spent more than 100%, 8.5% spent more than 150%, while 5.9% spent more than 200%. 73.3% of the patients stated that this cost was mostly covered by their family income, 35.8% from family's savings, 19% from parents' contributions while 10% had to borrow money or to liquidate private assets. Conclusions: The study suggests that a significant share of households with breast cancer patients undergo CHE in order to cover the cost of the disease or to receive the care they desire. The organization of the national health system in a way that protects households from CHE and provides patients with access to needed services is essential. The reduction of out-of-pocket spending through the development of social insurance would protect households from CHE.