The Burden of Health-Related Out-of-Pocket Cancer Costs in Canada: A Case-Control Study Using Linked Data
Abstract
:1. Introduction
2. Data and Methods
2.1. Study Design and Setting
2.2. Data
2.3. Population
2.4. Outcomes
2.5. Variables
2.6. Descriptive Analysis
2.7. Regression Analysis
2.8. Sensitivity Analyses
3. Results
3.1. Population Characteristics
3.2. Health-Related Out-of-Pocket Burden and Annual Health-Related Out-of-Pocket Costs among Case Households
3.3. Health-Related Out-of-Pocket Burden and Costs in Households with and without a Cancer Patient/Survivor
3.4. Regression Analysis
3.5. Sensitivity Analyses
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Expenditure Categories | Reference Periods |
---|---|
Care/services expenditures are the sum of: | |
| 12 months |
| 12 months |
| 12 months |
| 12 months |
| 12 months |
Medicines are the sum of: | |
| 3 months |
Eye and dental are the sum of: | |
| 12 months |
| 12 months |
| 12 months |
Insurance * is the sum of: | |
| 12 months |
| 12 months |
| 12 months |
Households with Cancer (Cases) | Matched Households without Cancer (Controls) | ||
---|---|---|---|
Characteristic | n (SD/%) | n (SD/%) | p-Value |
Number | 2318 | 2318 | |
Age, mean (SD) | 65.5 (SD:12.8) | 65.5 (SD:12.7) | 0.864 |
Age group, years | 0.964 | ||
0–39 | 80 (3.5%) | 81 (3.5%) | |
40–54 | 348 (15.0%) | 350 (15.1%) | |
55–64 | 574 (24.8%) | 566 (24.4%) | |
65–74 | 725 (31.3%) | 746 (32.2%) | |
75+ | 591 (25.5%) | 575 (24.8%) | |
Sex | 1 | ||
Female | 1228 (53.0%) | 1228 (53.0%) | |
Male | 1090 (47.0%) | 1090 (47.0%) | |
Regional groups | 1 | ||
Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick | 898 (38.7%) | 898 (38.7%) | |
Ontario and Quebec | 433 (18.7%) | 433 (18.7%) | |
Saskatchewan and Manitoba | 442 (19.1%) | 442 (19.1%) | |
British Columbia and Alberta | 528 (22.8) | 528 (22.8%) | |
Whitehorse, Yellowknife and Iqaluit | 17 (0.7%) | 17 (0.7%) | |
Household Type | 1 | ||
One-person household | 482 (20.8%) | 482 (20.8%) | |
Couples without children | 1225 (52.8%) | 1225 (52.8%) | |
Couples with children | 360 (15.5%) | 360 (15.5%) | |
Couples with other related or unrelated persons | 82 (3.5%) | 82 (3.5%) | |
Lone-parent household with no additional persons | 74 (3.2%) | 74 (3.2%) | |
Other household with related or unrelated persons | 95 (4.1%) | 95 (4.1%) | |
Income | 0.061 | ||
1st (lowest) income quintile | 442 (19.1%) | 487 (21.0%) | |
2nd | 455 (19.6%) | 474 (20.4%) | |
3rd | 501 (21.6%) | 426 (18.4%) | |
4th | 467 (20.1%) | 461 (19.9%) | |
5th (highest) income quintile | 453 (19.5%) | 470 (20.3%) | |
Owns house | 0.819 | ||
Yes | 1891 (81.6%) | 1897 (81.8%) | |
No | 427 (18.4%) | 421 (18.2%) | |
Private Health Insurance | 0.059 | ||
Yes | 1085 (46.8%) | 1021 (44.0%) | |
No | 1233 (53.2%) | 1297 (56.0%) | |
Urban size of place of residence | 0.081 | ||
Rural areas | 464 (20.0%) | 535 (23.1%) | |
Population centre 1000 to 99,999 | 615 (26.5%) | 585 (25.2%) | |
Population centre 100,000 to 999,999 | 722 (31.1%) | 710 (30.6%) | |
Population centre 1,000,000 or over | 517 (22.3%) | 488 (21.1%) | |
Total current consumption in CAD, 2019 constant dollars (1), mean (SD) | 45,503 (SD: 35,271) | 45,212 (SD: 34,836) | 0.741 |
Total expenditure in CAD, 2019 constant dollars (2), mean (SD) | 68,092 (SD: 82,271) | 67,040 (SD: 77,172) | 0.623 |
Case-specific characteristics | |||
Time between diagnosis year and survey completion | |||
0 to 1 | 772 (33.3%) | ||
1 to 2 | 784 (33.8) | ||
2 to 3 | 762 (32.9) | ||
Cancer type (3) | |||
Breast | 417 (18.0%) | ||
Colorectal | 325 (14.0%) | ||
Prostate | 320 (13.8%) | ||
Melanoma | 161 (6.9%) | ||
Lung and bronchus | 141 (6.1%) | ||
Bladder | 130 (5.6%) | ||
Non-Hodgkin’s lymphoma | 128 (5.5%) | ||
Uterus | 89 (3.8%) | ||
All other cancers | 607 (26.2%) |
Out-of-Pocket Cost Burden (% Income) | Annual Out-of-Pocket Costs | |||||
---|---|---|---|---|---|---|
Costs | Households with Cancer Patient/Survivor (Cases) | Matched Households without Cancer Patient/ Survivor (Controls) | p-Value | Households with Cancer Patient/ Survivor (Cases) | Matched Households without Cancer Patient/ Survivor (Controls) | p-Value |
Mean (SD) | Mean (SD) | |||||
Income quintile | ||||||
1st quintile (poorest) | 5.9 (12.0) | 5.3 (11.7) | 0.4 | 1187 (2448) | 1083 (1858) | 0.5 |
2nd quintile | 4.0 (6.4) | 3.8 (6.7) | 0.6 | 1679 (2367) | 1671 (2872) | 0.9 |
3rd quintile | 2.6 (3.5) | 2.3 (3.4) | 0.2 | 1694 (2364) | 1490 (2009) | 0.2 |
4th quintile | 1.7 (2.4) | 1.9 (2.4) | 0.2 | 1656 (2268) | 1830 (2311) | 0.2 |
5th quintile (richest) | 1.2 (2.2) | 1.1 (1.6) | 0.4 | 2240 (3978) | 1963 (2831) | 0.2 |
Region | ||||||
Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick | 2.9 (4.5) | 2.6 (6.1) | 0.2 | 1454 (1885) | 1277 (1780) | 0.04 |
Ontario and Quebec | 2.9 (8.7) | 2.3 (5.9) | 0.2 | 1533 (2659) | 1359 (2085) | 0.3 |
Saskatchewan and Manitoba | 3.8 (7.9) | 3.0 (4.2) | 0.06 | 2173 (3459) | 1835 (2430) | 0.09 |
British Columbia and Alberta | 2.9 (6.1) | 3.8 (9.2) | 0.06 | 1858 (3385) | 2168 (3381) | 0.1 |
Whitehorse, Yellowknife and Iqaluit | 1.6 (4.0) | 1.3 (2.2) | 0.8 | 868 (1418) | 1696 (2124) | 0.2 |
Urban size of place of residence | ||||||
Rural areas | 3.4 (5.0) | 3.6 (8.4) | 0.6 | 1556 (1842) | 1515 (1864) | 0.7 |
Population centre 1000 to 99,999 | 3.3 (6.4) | 2.9 (5.7) | 0.3 | 1664 (2718) | 1538 (2626) | 0.4 |
Population centre 100,000 to 999,999 | 2.8 (5.8) | 2.4 (5.2) | 0.2 | 1702 (2724) | 1636 (2656) | 0.6 |
Population centre 1,000,000 or over | 3.0 (8.6) | 2.8 (7.3) | 0.7 | 1840 (3495) | 1739 (2414) | 0.6 |
Owns house | ||||||
Yes | 2.9 (6.0) | 2.7 (5.8) | 0.3 | 1816 (2949) | 1717 (2532) | 0.3 |
No | 3.6 (8.6) | 3.8 (9.5) | 0.7 | 1149 (1669) | 1099 (1855) | 0.7 |
Private health insurance | ||||||
Yes | 2.5 (5.0) | 2.5 (5.7) | 1 | 1814 (3095) | 1692 (2372) | 0.3 |
No | 3.6 (7.6) | 3.3 (7.3) | 0.3 | 1587 (2446) | 1536 (2482) | 0.6 |
Cancer type | ||||||
Colorectal | 3.7 (8.6) | 1530 (2072) | ||||
Lung and bronchus | 3.4 (4.5) | 1752 (2342) | ||||
Bladder | 3.3 (4.0) | 1758 (2208) | ||||
Uterus | 3.0 (7.0) | 1784 (2436) | ||||
Breast | 2.9 (6.2) | 1729 (2691) | ||||
Non-Hodgkin lymphoma | 2.6 (3.4) | 1716 (2880) | ||||
Prostate | 2.5 (3.4) | 1565 (1855) | ||||
Melanoma | 2.3 (3.5) | 1898 (3487) | ||||
All other cancers | 3.3 (8.4) | 1724 (3479) |
Households with Cancer | Matched Households without Cancer | Mean Difference | ||
---|---|---|---|---|
Outcome | Mean (SD) | Mean (SD) | (95% Confidence Interval) | p-Value |
Health-related OOP cost burden 1, % | ||||
OOP costs/income | 3.1 (6.9) | 2.9 (6.6) | 0.1 (−0.2, 0.5) | 0.4 |
OOP costs/total expenditure | 3.4 (4.7) | 3.2 (4.6) | 0.2 (−0.1, 0.4) | 0.5 |
Health-related OOP costs | ||||
Mean (including health insurance), CAD | 2494 (3117) | 2406 (2969) | 88 (−79, 256) | 0.3 |
Mean (excluding health insurance), CAD | 1693 (2770) | 1605 (2435) | 88 (−56, 233) | 0.2 |
By category, CAD | ||||
Care and services 2 | 279 (1705) | 244 (1122) | 35 (−46, 116) | 0.4 |
Medicines 3 | 832 (1517) | 748 (1491) | 85 (1, 168) | 0.05 |
Eye and dental 4 | 582 (1242) | 613 (1227) | −31 (−99, 37) | 0.4 |
Insurance 5 | 800 (1264) | 801 (1447) | −0.1 (−73, 72) | 1 |
Out-of-Pocket Burden | ||||||
---|---|---|---|---|---|---|
95% CI | ||||||
Beta | SE | p-Value | Adjusted Mean % | Low | High | |
Household with cancer | 0.24 | 0.19 | 0.2 | 3.08 | 2.55 | 3.62 |
Matched control household without cancer | ref | 2.84 | 2.31 | 3.38 | ||
Sex | ||||||
Male | −0.35 | 0.19 | 0.07 | 2.79 | 2.25 | 3.33 |
Female | ref | 3.14 | 2.61 | 3.67 | ||
Region | ||||||
Ontario | −0.33 | 0.32 | 0.3 | 2.59 | 2.07 | 3.11 |
Saskatchewan and Manitoba | 0.81 | 0.27 | 0.003 | 3.73 | 3.24 | 4.23 |
British Columbia and Alberta | 0.73 | 0.31 | 0.02 | 3.66 | 3.18 | 4.14 |
Whitehorse, Yellowknife and Iqaluit | −1.00 | 1.13 | 0.4 | 1.92 | −0.30 | 4.14 |
Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick | ref | 2.92 | 2.55 | 3.29 | ||
Urban size of place of residence | ||||||
Population centre 1000 to 99,999 | −0.60 | 0.29 | 0.04 | 2.98 | −1.17 | −0.04 |
Population centre 100,000 to 999,999 | −0.95 | 0.28 | <0.001 | 2.63 | −1.50 | −0.41 |
Population centre 1,000,000 or over | −0.92 | 0.37 | 0.01 | 2.67 | −1.64 | −0.19 |
Rural areas | ref | 3.58 | 2.92 | 4.24 | ||
Owns house | ||||||
No | 0.82 | 0.26 | 0.002 | 3.37 | 2.75 | 4.00 |
Yes | ref | 2.56 | 2.08 | 3.04 | ||
Private health insurance | ||||||
No | 0.74 | 0.20 | <0.001 | 3.34 | 2.81 | 3.86 |
Yes | ref | 2.59 | 2.04 | 3.14 |
Out-of-Pocket Burden | ||||||
---|---|---|---|---|---|---|
95% CI | ||||||
Beta | SE | p-Value | Adjusted Mean % | Low | High | |
Household with breast cancer | −0.01 | 0.37 | 0.97 | 2.83 | 2.02 | 3.64 |
Household with prostate cancer | −0.23 | 0.41 | 0.58 | 2.62 | 1.73 | 3.50 |
Household with lung cancer | 0.43 | 0.57 | 0.45 | 3.27 | 2.11 | 4.44 |
Household with colorectal cancer | 0.78 | 0.39 | 0.05 | 3.62 | 2.77 | 4.47 |
Household with “other” cancer | 0.28 | 0.24 | 0.24 | 3.13 | 2.52 | 3.73 |
Matched control household without cancer | ref | 2.84 | 2.31 | 3.37 | ||
Sex | ||||||
Male | −0.34 | 0.21 | 0.11 | 2.88 | 2.30 | 3.46 |
Female | ref | 3.22 | 2.65 | 3.80 | ||
Region | ||||||
Ontario | −0.33 | 0.32 | 0.3 | 2.68 | 2.12 | 3.24 |
Saskatchewan and Manitoba | 0.81 | 0.27 | 0.003 | 3.82 | 3.28 | 4.35 |
British Columbia and Alberta | 0.74 | 0.31 | 0.02 | 3.75 | 3.23 | 4.27 |
Whitehorse, Yellowknife and Iqaluit | −1.00 | 1.14 | 0.38 | 2.01 | −0.22 | 4.23 |
Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick | ref | 3.01 | 2.59 | 3.43 | ||
Urban size of place of residence | ||||||
Population centre 1000 to 99,999 | −0.60 | 0.29 | 0.04 | 3.07 | 2.47 | 3.66 |
Population centre 100,000 to 999,999 | −0.95 | 0.28 | <0.001 | 2.71 | 2.09 | 3.33 |
Population centre 1,000,000 or over | −0.90 | 0.37 | 0.01 | 2.76 | 2.05 | 3.48 |
Rural areas | ref | 3.66 | 2.97 | 4.36 | ||
Owns house | ||||||
No | 0.81 | 0.26 | 0.002 | 3.46 | 2.80 | 4.11 |
Yes | ref | 2.65 | 2.12 | 3.17 | ||
Private health insurance | ||||||
No | 0.72 | 0.20 | <0.001 | 3.41 | 2.86 | 3.97 |
Yes | ref | 2.69 | 2.10 | 3.28 |
Annual Out-of-Pocket Costs | ||||||
---|---|---|---|---|---|---|
95% CI | ||||||
Beta | SE | p-Value | Adjusted Mean | Low | High | |
Household with cancer | 0.08 | 0.06 | 0.17 | 1600 | 1456 | 1759 |
Matched control household without cancer | ref | 1511 | 1377 | 1659 | ||
Sex | ||||||
Male | 0.04 | 0.06 | 0.51 | 1592 | 1447 | 1751 |
Female | ref | 1519 | 1385 | 1666 | ||
Region | ||||||
Ontario | −0.08 | 0.10 | 0.45 | 1327 | 1216 | 1449 |
Saskatchewan and Manitoba | 0.33 | 0.09 | <0.001 | 1921 | 1773 | 2081 |
British Columbia and Alberta | 0.36 | 0.10 | <0.001 | 1944 | 1797 | 2104 |
Whitehorse, Yellowknife and Iqaluit | −0.20 | 0.36 | 0.57 | 1347 | 906 | 2003 |
Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick | ref | 1362 | 1280 | 1448 | ||
Urban size of place of residence | ||||||
Population centre 1000 to 99,999 | 0.01 | 0.09 | 0.91 | 1573 | 1427 | 1735 |
Population centre 100,000 to 999,999 | 0.001 | 0.09 | 0.99 | 1543 | 1393 | 1710 |
Population centre 1,000,000 or over | 0.01 | 0.12 | 0.91 | 1583 | 1406 | 1781 |
Rural areas | ref | 1522 | 1359 | 1704 | ||
Owns house | ||||||
No | −0.30 | 0.09 | <0.001 | 1387 | 1240 | 1552 |
Yes | ref | 1743 | 1602 | 1897 | ||
Private health insurance | ||||||
No | −0.03 | 0.06 | 0.63 | 1576 | 1436 | 1729 |
Yes | ref | 1535 | 1394 | 1690 | ||
Income quintile | ||||||
1st quintile (lowest) | ref | 1186 | 1062 | 1325 | ||
2nd quintile | 0.33 | 0.10 | <0.001 | 1576 | 1414 | 1756 |
3rd quintile | 0.27 | 0.10 | <0.001 | 1484 | 1329 | 1655 |
4th quintile | 0.38 | 0.10 | <0.001 | 1681 | 1506 | 1876 |
5th quintile (highest) | 0.54 | 0.10 | <0.001 | 1951 | 1749 | 2176 |
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Essue, B.M.; Oliveira, C.d.; Bushnik, T.; Fung, S.; Hwee, J.; Sun, Z.; Navas, E.G.; Yong, J.H.E.; Garner, R. The Burden of Health-Related Out-of-Pocket Cancer Costs in Canada: A Case-Control Study Using Linked Data. Curr. Oncol. 2022, 29, 4541-4557. https://doi.org/10.3390/curroncol29070359
Essue BM, Oliveira Cd, Bushnik T, Fung S, Hwee J, Sun Z, Navas EG, Yong JHE, Garner R. The Burden of Health-Related Out-of-Pocket Cancer Costs in Canada: A Case-Control Study Using Linked Data. Current Oncology. 2022; 29(7):4541-4557. https://doi.org/10.3390/curroncol29070359
Chicago/Turabian StyleEssue, Beverley M., Claire de Oliveira, Tracey Bushnik, Sharon Fung, Jeremiah Hwee, Zhuolu Sun, Elba Gomez Navas, Jean Hai Ein Yong, and Rochelle Garner. 2022. "The Burden of Health-Related Out-of-Pocket Cancer Costs in Canada: A Case-Control Study Using Linked Data" Current Oncology 29, no. 7: 4541-4557. https://doi.org/10.3390/curroncol29070359
APA StyleEssue, B. M., Oliveira, C. d., Bushnik, T., Fung, S., Hwee, J., Sun, Z., Navas, E. G., Yong, J. H. E., & Garner, R. (2022). The Burden of Health-Related Out-of-Pocket Cancer Costs in Canada: A Case-Control Study Using Linked Data. Current Oncology, 29(7), 4541-4557. https://doi.org/10.3390/curroncol29070359