BACKGROUND

The survival advantage of HER2-positive breast cancer from targeted treatment is commonly undermined by catastrophic health expenditure (CHE), particularly in resource-limited areas. Recognizing that financial catastrophe leads to non-adherence to treatment and dissaving practices, we examined the out-of-pocket (OOP) expenses of patients with HER2-positive breast cancer.

OBJECTIVE

The study aimed to estimate the median total per-cycle out-of-pocket expenditure of HER2-positive breast cancer treatment from the patient perspective, in public and private clinics, evaluate the association of catastrophic health expenditure with non-adherence to treatment, and describe dissaving practices.

METHODS

This was a cross-sectional micro-costing analysis of the treatment of HER2-positive breast cancer from the patient perspective from a tertiary cancer center and select private clinics in the Philippines. Random sampling of patients with HER2-positive breast cancer was done. Using a validated questionnaire, a guided interview was administered. Catastrophic health expenditure was estimated as having OOP of >20% of the household income. OOP costs were assessed retrospectively from the time of confirmed HER2 diagnosis up to the date of survey, while household income referred to the corresponding period. The proportion of patients experiencing catastrophic health expenditure was computed. Fisher's exact was used to assess for any association between CHE and non-adherence to treatment. Descriptive statistics were used to report dissaving practices. All statistical analyses were performed using Stata analytical software version 12.

RESULTS

A total of 101 patients participated in the study. The mean age of participants from the tertiary cancer center and private clinics were 52 and 58 years old respectively. Patients from the private clinics had a median total OOP expenditure of PhP 54,737.06 (IQR = PhP 102,670.00), compared with patients from tertiary cancer center who had a median total OOP expenditure of PhP 13,920.66 (IQR = PhP 20,830.00). The overall prevalence of CHE (90.9%, 95% CI 0.81, 0.95) and nonadherence to treatment with trastuzumab (79%, 95% CI 0.70, 0.87) were high, and similar in both groups. A number of dissaving practices such as resignation from work, borrowing money from friends, selling assets were observed.

CONCLUSION

The high rate of CHE and treatment delay among patients with HER2-positive breast cancer were not addressed by the existing cancer programs. Most OOP expenditure was for trastuzumab. Current cancer support programs have potential to address the financial impact of their treatment.

Human ; Therapeutics ; Survival ; Patients ; Neoplasms ; Philippines ; Health Expenditures ; Breast Neoplasms

BACKGROUND: Preparedness before discharge correlates with good clinical outcomes. OBJECTIVE: The study described the perception, attitudes, and perceived preparedness of patients and caregivers for discharge from the Internal Medicine wards of the University of the Philippines-Philippine General Hospital (UP-PGH). METHODS: A cross-sectional survey among 142 patients about to be discharged from the Internal Medicine wards of the Philippine General Hospital and/or their caregivers from May to June 2017 was done using a validated Filipino version of B-PREPARED, an 11-item self-administered questionnaire that measures patient preparedness for home. The questionnaire has three domains: self-care information, equipment/services, and confidence. The highest possible B-PREPARED score is 22 with higher scores indicating better discharge preparedness. Mean B-PREPARED scores were calculated. Post-hoc linear regression analysis between the scores and characteristics was performed. RESULTS: The Filipino translation of the B-PREPARED questionnaire had good internal consistency (Cronbach’s alpha 0.8). One hundred forty-two patients and caregivers participated. The mean B-PREPARED score was 14.57 ± 4.34, with a median of 15. The lowest scores were for information on available community services (1.20 ± 0.76), arranged equipment (0.83 ± 0.88), information on side effects of medications (1.19 ± 0.85), and additional information sought (0.61 ± 0.92). There was no significant correlation between preparedness and age, employment status, educational attainment, diagnosis, length of hospitalization, the number of admissions one year prior, or whether the respondent was a patient or caregiver. CONCLUSION The Filipino translation of the B-PREPARED questionnaire had good internal consistency. Although most participants reported being confident and prepared for discharge, most felt they did not receive sufficient information on side effects and available community services, and assistance in arranging for the necessary equipment for home care.