The Burden of Out-of-Pocket Expenditure Related to Gynaecological Cancer in Malaysia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Statistical Analysis
3. Results
3.1. Health-Related Out-of-Pocket Expenditure
3.2. Poverty Impact
3.3. Catastrophic Health Expenditure
Variables | Univariate Crude Odds Ratio (95% Confidence Interval) | p-Value | Multivariate Adjusted Odds Ratio (95% Confidence Interval) | p-Value |
---|---|---|---|---|
Household income categories | ||||
Low-income B40 | Reference | Reference | ||
Middle-income M40 | 0.399 (0.178–0.896) | 0.026 | 0.225 (0.090–0.567) | 0.002 * |
High-income T20 | 0.060 (0.006–0.565) | 0.014 | 0.048 (0.005–0.500) | 0.011 * |
Stage of cancer at the beginning of the 12 months’ recall period | ||||
Stage I and stage II | Reference | Reference | ||
Stage III and stage IV | 2.762 (1.264–6.033) | 0.011 | 2.026 (0.821–5.001) | 0.126 |
Cancer treatment received within 12 months’ recall period | ||||
Chemotherapy | ||||
Yes | Reference | Reference | ||
No | 0.206 (0.073–0.583) | 0.003 | 0.159 (0.049–0.523) | 0.002 * |
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | n (%) | Mean (SD)/Median (IQR) |
---|---|---|
Sociodemographic profile Age (years) Under 40 41–59 60 and older Ethnicity Chinese Malay Indian Other races | 14 (11.7) 39 (32.5) 67 (55.8) 61 (50.8) 40 (33.3) 17 (14.2) 2 (1.7) | 60 (14)/ 61 (18) (min = 22; max = 88) - |
Education level No formal primary Primary Secondary Diploma Undergraduate degree Post-graduate degree | 8 (6.7) 27 (22.5) 54 (45.0) 17 (14.2) 10 (8.3) 4 (3.3) | - |
Healthcare insurance Yes No | 9 (7.5) 111 (92.5) | - |
Employment status Working full-time Working part-time Retired Not working | 20 (16.7) 4 (3.3) 15 (12.5) 81 (67.5) | - |
Household income (per month) Q1 Q2 Q3 Q4 Q5 | 24 (20.0) 24 (20.0) 24 (20.0) 24 (20.0) 24 (20.0) | 809 (333)/980 (500) (min = 200; max = 1400) 1995 (443)/2000 (300) (min = 1450; max = 3250) 3000 (437)/3000 (835) (min = 2500; max = 3850) 5248 (871)/5000 (1500) (min = 4000; max = 6800) 14,104 (11,988)/10,000 (4000) (min = 7000; max = 60,000) |
Variable | n (%) | |
Type of cancer Ovarian cancer Cervical cancer Endometrial cancer | 52 (43.3) 37 (30.8) 31 (25.8) | |
Most recent staging of cancer Stage I Stage II Stage III Stage IV | 47 (39.2) 15 (12.5) 22 (18.3) 36 (30.0) | |
Number of years since initial gynaecological cancer diagnosis 1st year 2nd year–5th year 6th year–10th year 11th year and above | 17 (14.2) 49 (40.8) 24 (20.0) 30 (25.0) | |
Experienced disease progression in the past 12 months Yes No | 10 (8.3) 110 (91.7) | |
Clinical treatment received in the past 12 months Cancer treatment with management of comorbidities Cancer treatment without management of comorbidities Cancer surveillance with management of comorbidities Cancer surveillance without management of comorbidities | 26 (21.7) 19 (15.8) 69 (57.5) 6 (5.0) | |
Cancer * treatment received in the past 12 months (n = 45) Chemotherapy Radiotherapy Surgery Hormonal therapy Both chemotherapy and radiotherapy Both chemotherapy and hormonal therapy Both chemotherapy and surgery Both radiotherapy and surgery Chemotherapy, radiotherapy and surgery | 10 (22.2) 1 (2.2) 5 (11.1) 2 (4.4) 2 (4.4) 1 (2.2) 17 (37.8) 2 (4.4) 5 (11.1) |
Components of Out-of-Pocket (OOP) Expenditure | Overall Results | |
---|---|---|
% | Mean (RM) SD/Median (IQR) Mean (USD) (SD)/Median (IQR) | |
Medical charges and fees | 30.4 | RM 3710 (RM 11,130)/RM 218 (2286) USD 844 (USD 2532)/USD 50 (520) |
Complementary and alternative therapy | 14.1 | RM 1727 (RM 7247)/RM 150 (780) USD 393 (USD 1649)/USD 34 (177) |
Vitamins and supplements | 12.6 | RM 1544 (RM 2568)/RM 450 (2000) USD 351 (USD 584)/USD 102 (455) |
Transport to study institution | 9.7 | RM 1186 (RM 1827)/RM 515 (1010) USD 270 (USD 416)/USD 117 (230) |
Community pharmacy expenditure | 6.6 | RM 809 (RM 2393)/RM 58 (588) USD 184 (USD 544)/USD 13 (134) |
Homecare expenditure | 6.5 | RM 797 (RM 2104)/RM 0 (38) USD 181 (USD 479)/USD 0 (9) |
Laboratory and diagnostic investigations | 6.0 | RM 728 (RM 1624)/RM 3 (745) USD 166 (USD 370)/USD 1 (170) |
Medication | 5.5 | RM 671 (RM 3746)/RM 0 (91) USD 153 (USD 852)/USD 0 (21) |
Health treatment | 2.8 | RM 338 (RM 2502)/RM 0 (0) USD 77 (USD 569)/USD 0 (0) |
Food expenditure | 2.3 | RM 278 (RM 557)/RM 60 (219) USD 63 (USD 127)/USD 14 (50) |
Parking charges | 1.0 | RM 127 (RM 295)/RM 20 (126) USD 29 (USD 67)/USD 5 (29) |
Accommodation expenditure | 0.9 | RM 111 (RM 774)/RM 0 (0) USD 25 (USD 176)/USD 0 (0) |
Medical devices expenditure | 0.9 | RM 109 (RM 349)/RM 0 (0) USD 25 (USD 79)/USD 0 (0) |
Nursing home expenditure | 0.5 | RM 63 (RM 685)/RM 0 (0) USD 14 (USD 156)/USD 0 (0) |
Other expenditures related to health needs | 0.2 | RM 19 (RM 109)/RM 0 (0) USD 4 (USD 25)/USD 0 (0) |
Total OOP expenditure per patient household | 100 | RM 12,218 (RM 17,255)/RM 6134 (13,243) USD 2780 (USD 3926)/USD 1396 (3013) |
Household Income Quintiles | OOP Expenditure Mean (RM) (SD)/Median (IQR) Mean (USD) (SD)/Median (IQR) | Households That Experienced Catastrophic Health Expenditure (CHE) n (%) | Households Living below the National Poverty Threshold before OOP Expenditure n (%) | Households Living below the National Poverty Threshold after OOP Expenditure n (%) |
---|---|---|---|---|
Q1 (n = 24) | RM 3859 (RM 3962)/RM 2196 (6013) USD 878 (USD 901)/USD 500 (1368) | 20 (83.3) | 24 (100.0) | 24 (100.0) |
Q2 (n = 24) | RM 8698 (RM 7733)/RM 6798 (13,313) USD 1979 (USD 1759)/USD 1547 (3029) | 19 (79.2) | 21 (87.5) | 23 (95.8) |
Q3 (n = 24) | RM 11,261 (RM 12,226)/RM 6748 (13,247) USD 2562 (USD 2782)/USD 1535 (3014) | 15 (62.5) | 0 (0.0) | 11 (45.8) |
Q4 (n = 24) | RM 19,005 (RM 22,252)/RM 7422 (26,924) USD 4324 (USD 5063)/USD 1689 (6126) | 15 (62.5) | 0 (0.0) | 5 (20.8) |
Q5 (n = 24) | RM 18,267 (RM 25,442)/RM 11,207 (17,695) USD 4156 (USD 5789)/USD 2550 (4026) | 8 (33.3) | 0 (0.0) | 2 (8.3) |
Household Income Categories | OOP Expenditure Mean (RM) (SD)/Median (IQR) Mean (USD) (SD)/Median (IQR) | Households That Experienced CHE n (%) | Households Living below the National Poverty Threshold before OOP Expenditure n (%) | Households Living below the National Poverty Threshold after OOP Expenditure n (%) |
---|---|---|---|---|
B40 (n = 56) | RM 6408 (RM 7022)/RM 3733 (7497) USD 1458 (USD 1598)/USD 849 (1706) | 43 (76.8) | 45 (80.4) | 50 (89.3) |
M40 (n = 58) | RM 17,976 (RM 22,409)/RM 8993 (22,397) USD 4090 (USD 5099)/USD 2046 (5096) | 33 (56.9) | 0 (0.0) | 15 (25.9) |
T20 (n = 6) | RM 10,781 (RM 7350)/RM 12,621 (15,730) USD 2453 (USD 1672)/USD 2872 (3579) | 1 (16.7) | 0 (0.0) | 0 (0.0) |
Variables | Univariate Crude Odds Ratio (95% Confidence Interval) | p-Value | Multivariate Adjusted Odds Ratio (95% Confidence Interval) | p-Value |
---|---|---|---|---|
Monthly household income quintiles Q1 Q2 Q3 Q4 Q5 | Reference 1.750 (0.442–6.928) 2.500 (0.613–10.195) 3.000 (0.774–11.627) 10.000 (2.545–39.293) | 0.425 0.201 0.112 0.001 | Reference 0.600 (0.146–2.473) 0.400 (0.102–1.572) 0.333 (0.086–1.292) 0.100 (0.025–0.393) | 0.480 0.189 0.112 0.001 * |
Stage of cancer at the beginning of the 12 months’ recall period | ||||
Stage I and stage II | Reference | Reference | ||
Stage III and stage IV | 2.762 (1.264–6.033) | 0.011 | 2.049 (0.785–5.344) | 0.143 |
Cancer treatment received during 12 months’ recall period | ||||
Chemotherapy | ||||
Yes | Reference | Reference | ||
No | 0.206 (0.073–0.583) | 0.003 | 0.120 (0.033–0.443) | 0.001 * |
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Liew, C.H.; Shabaruddin, F.H.; Dahlui, M. The Burden of Out-of-Pocket Expenditure Related to Gynaecological Cancer in Malaysia. Healthcare 2022, 10, 2099. https://doi.org/10.3390/healthcare10102099
Liew CH, Shabaruddin FH, Dahlui M. The Burden of Out-of-Pocket Expenditure Related to Gynaecological Cancer in Malaysia. Healthcare. 2022; 10(10):2099. https://doi.org/10.3390/healthcare10102099
Chicago/Turabian StyleLiew, Chee Hui, Fatiha Hana Shabaruddin, and Maznah Dahlui. 2022. "The Burden of Out-of-Pocket Expenditure Related to Gynaecological Cancer in Malaysia" Healthcare 10, no. 10: 2099. https://doi.org/10.3390/healthcare10102099
APA StyleLiew, C. H., Shabaruddin, F. H., & Dahlui, M. (2022). The Burden of Out-of-Pocket Expenditure Related to Gynaecological Cancer in Malaysia. Healthcare, 10(10), 2099. https://doi.org/10.3390/healthcare10102099