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Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis

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Abstract

Background

Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE.

Methods

This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified.

Results

Among the 19 studies included, an average of 43.3% (95% CI 36.7–50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex.

Conclusion

The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients.

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Acknowledgements

The authors would like to thank the Research Center for Evidence-Based Health Management at Maragheh University of Medical Sciences for support.

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Correspondence to Edris Hasanpoor.

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Research support was provided by Tabriz Health Services Management Research Center at Tabriz University of Medical Sciences.

Authors' contributions

EH and LD did the literature review. EH and BE found the full text of some articles that were difficult to find. EH, LD and GJAJ designed the study. LD and HHB abstracted study information and additional data and assessed study quality. GJAJ, LD and HHB wrote the paper.

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The original Online version of this article was revised : The co-author's affiliation has been incorrectly published.

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Doshmangir, L., Hasanpoor, E., Abou Jaoude, G.J. et al. Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis. Appl Health Econ Health Policy 19, 839–855 (2021). https://doi.org/10.1007/s40258-021-00672-2

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