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Catastrophic Health Expenditure Among Gastrointestinal Cancer Patients Undergoing Surgery in Uganda: A Prospective Study

Health & Medicine

Key takeaway

Ugandan patients with gastrointestinal cancers face devastating financial burdens from surgery costs, highlighting the urgent need for improved healthcare access and affordability in underserved regions.

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Quick Explainer

This study explored the severe financial toll that gastrointestinal cancer surgery places on Ugandan patients, many of whom lack access to national health insurance. By analyzing out-of-pocket costs and household expenditure, the researchers found that over 60% of patients experienced catastrophic health expenditure - costs that exceeded 10% of their annual income. This disproportionately impacted poorer households, women, and those undergoing curative surgery, who often resorted to selling assets or disrupting school fee payments to cover the expenses. The findings underscore the urgent need for Uganda to implement a national health insurance scheme to protect vulnerable cancer patients from this devastating financial burden.

Deep Dive

Technical Deep Dive: Catastrophic Health Expenditure Among Gastrointestinal Cancer Patients in Uganda

Overview

This study investigated the financial burden faced by gastrointestinal (GI) cancer patients undergoing surgery in public hospitals in Uganda, a country without a national health insurance scheme. The researchers assessed the prevalence and determinants of catastrophic health expenditure (CHE) among this patient population.

Problem & Context

  • Globally, the burden of GI cancers is projected to rise sharply by 2050, with incidence and mortality in Africa nearly double global estimates.
  • Surgery remains the cornerstone of GI cancer treatment, but imposes substantial financial burdens, especially in Uganda where there is no national health insurance.
  • Patients are highly vulnerable to catastrophic health expenditure (CHE), defined as out-of-pocket health costs exceeding 10% of annual household expenditure.

Methodology

  • A prospective study conducted over 10 months in the GI surgery wards of a tertiary hospital in Uganda.
  • Adults with GI cancer scheduled for surgery were consecutively recruited.
  • Sociodemographic, clinical, and household expenditure data were collected at baseline and discharge.
  • Out-of-pocket (OOP) costs, annual household expenditure, non-food expenditure, and capacity to pay were derived.
  • CHE was assessed using Wagstaff/van Doorslaer and Xu thresholds, and determinants of CHE were analyzed.

Data & Experimental Setup

  • 164 participants were recruited, 54.3% male and 75.0% over 50 years old.
  • The median OOP expenditure for GI cancer surgery was $663, nearly twice the median annual household income.

Results

  • At the 10% threshold, the prevalence of CHE was 64%.
  • Sources of financing for OOP costs varied by socioeconomic status (SES):
    • Highest SES households relied primarily on savings.
    • Lowest SES households depended on asset sales and loans.
  • School fees payment was disrupted, particularly among middle- and low-SES households.
  • Factors independently associated with higher CHE included:
    • Female sex
    • Formal employment
    • Curative intent of surgery
    • Low household SES

Interpretation

  • Over half of patients experienced severe financial toxicity, often selling assets and compromising long-term security.
  • The burden was greatest among poorer households, women, and those undergoing curative surgery.
  • These findings highlight the urgent need for national health insurance in Uganda to protect cancer surgery patients from catastrophic expenditures.

Limitations & Uncertainties

  • Recall bias may have influenced the self-reported household expenditure data.
  • The study was limited to a single tertiary hospital, so the results may not be fully representative of the national situation.

What Comes Next

The authors recommend the implementation of a national health insurance scheme in Uganda to provide financial protection for cancer surgery patients. Further research is needed to understand the broader financial impact of cancer care across different healthcare settings in the country.

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