K. M. O’Neill1, M. Mandigo5, R. Damuse6,7, Y. Nazaire6,7, J. Pyda4, R. Gillies7, J. G. Meara2,3,7 1University Of Pennsylvania,Perelman School Of Medicine,Philadelphia, PA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3Children’s Hospital Boston,Plastic Surgery,Boston, MA, USA 4Beth Israel Deaconess Medical Center,Surgery,Boston, MA, USA 5University Of Miami,School Of Medicine,Miami, FL, USA 6Hopital Universitaire Mirebalais,Mirebalais, CENTRE, Haiti 7Partners In Health,Boston, MA, USA
Introduction: In low- and middle-income countries (LMIC), it has been reported that 90% of patients with breast cancer have stage III or IV upon presentation.[i] Although many factors contribute to this phenomenon, the financial burden of seeking care incurred through indirect costs such as user fees, food, travel and lost wages is an important consideration that is often overlooked.
Methods: In this study, we delineated the costs that Haitian patients pay out-of-pocket to seek comprehensive oncology care at Hôpital Universitaire de Mirebalais (HUM), where oncologic care is offered free of charge. In total, 61 patients were directly interviewed about associated costs during different points along the treatment cycle: (1) Diagnostic visits; (2) Chemotherapy visits (pre- and post-surgery) and (3) Surgical visit.
Results: On average, patient indirect expenses were: $619.04 for diagnostic costs, $635.68 for chemotherapy and $94.33 for the surgical visit. When costs at outside facilities were included, we found that patients paid $1,698.84 out-of-pocket on average during the course of their treatment. When comparing these expenses to the income of the patients, we found that patients were spending 193% (95% CI: 99%-287%) of their income on average for out of pocket expenses, with 68% of patients spending >40% of their potential income on medical expenses. When we included lost wages into the indirect costs, the average indirect costs came to $6,465 (95% CI: $1,833 – $11,096). The indirect costs to the patient were on average 3.36 times higher than the direct costs to the hospital (calculated in a separate study as $1,922 per patient).
Conclusion: Health expenditures are financially catastrophic for families throughout the world. In Haiti, 74% of people live on less than $2 per day and 65% live in extreme poverty (less than $1 per day).[ii] Given the findings in this study, it is likely that the financial burden of seeking care for breast cancer—even when that care is offered “free of charge”—may be insurmountable for the majority of patients.
[i] Fregene A & Newman LA. Breast cancer in sub-Saharan Africa: How does it relate to breast cancer in African American women? Cancer 2005Íž103(8):154050.
[iI] "Objectifs du Millenaire pour le developpement etat, tendances et perspectives. Ministere de L’Economie et des Finances. Institut Haitien De Statistique et D’informatique. December 2009 http://www.ihsi.ht/pdf/odm/OMD_Novembre_2010.pdf Accessed June 20, 2014
