TY - JOUR
T1 - Out-of-pocket payments for complementary medicine following cancer and the effect on financial outcomes in middle-income countries in southeast Asia
T2 - a prospective cohort study
AU - ACTION Study Group
AU - Kong, Yek Ching
AU - Kimman, Merel
AU - Subramaniam, Shri Devi
AU - Yip, Cheng Har
AU - Jan, Stephen
AU - Aung, Soe
AU - Khoa, Mai Trong
AU - Ngelangel, Corazon A.
AU - Nyein, Htun Lwin
AU - Sangrajrang, Suleeporn
AU - Tanabodee, Jitraporn
AU - Bhoo-Pathy, Nirmala
AU - Arounlangsy, Phetsamone
AU - Balete, Soledad L.
AU - Bounxouei, Bounthaphany
AU - Bui, Dieu
AU - Datukan, Jay
AU - Gorospe, Agnes E.
AU - Yip, Cheng Har
AU - Khopaibul, Prasit
AU - Khuayjarernpanishk, Thanut
AU - Khuhaprema, Thiravud
AU - Khin, Myo
AU - Kingston, David
AU - Klinwimol, Tawin
AU - Lalitwongsa, Somkiet
AU - Lawbundis, Dhanoo
AU - Lola, Conrado
AU - Cristal-Luna, Gloria
AU - Marbella, Leo
AU - Mai Trong, Khoa
AU - Maung, Soe Oo
AU - Mon, Shu
AU - Naing, Win Pa Pa
AU - Ong-Cornel, Annielyn Beryl
AU - Oo, Khin May
AU - Orolfo-Real, Irisyl
AU - Pham Xuan, Dung
AU - Pharin, Seang
AU - Pujianto,
AU - Rattanavong, Oudayvone
AU - Samnang, Kouy
AU - Sangkittipaiboon, Somphob
AU - Santiago-Ferreras, Cherelina
AU - Sarnianto, Prih
AU - Shwe, San
AU - Sokha, Eav
AU - Sinthusake, Thanadej
AU - Suanplu, Darunee
AU - Ashariati, Ami
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
PY - 2022/3
Y1 - 2022/3
N2 - Background: Complementary medicine, which refers to therapies that are not part of conventional medicine, comprising both evidence-based and non-evidence-based interventions, is increasingly used following a diagnosis of cancer. We aimed to investigate out-of-pocket spending patterns on complementary medicine and its association with adverse financial outcomes following cancer in middle-income countries in southeast Asia. Methods: In this prospective cohort study, data on newly diagnosed patients with cancer were derived from the ASEAN Costs in Oncology (ACTION) cohort study, a prospective longitudinal study in 47 centres located in eight countries in southeast Asia. The ACTION study measured household expenditures on complementary medicine in the immediate year after cancer diagnosis. Participants were given cost diaries at baseline to record illness-related payments that were directly incurred and not reimbursed by insurance over the 12-month period after study recruitment. We assessed incidence of financial catastrophe (out-of-pocket cancer-related costs ≥30% of annual household income), medical impoverishment (reduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs), and economic hardship (inability to make necessary household payments) at 1 year. Findings: Between March, 2012, and September, 2013, 9513 participants were recruited into the ACTION cohort study, of whom 4754 (50·0%) participants were included in this analysis. Out-of-pocket expenditures on complementary medicine were reported by 1233 households. These payments constituted 8·6% of the annual total out-of-pocket health costs in lower-middle-income countries and 42·9% in upper-middle-income countries. Expenditures on complementary medicine significantly increased risks of financial catastrophe (adjusted odds ratio 1·52 [95% CI 1·23–1·88]) and medical impoverishment (1·75 [1·36–2·24]) at 12 months in upper-middle-income countries only. However, the risks were significantly higher for economically disadvantaged households, irrespective of country income group. Interpretation: Integration of evidence-supported complementary therapies into mainstream cancer care, along with interventions to address use of non-evidence-based complementary medicine, might help alleviate any associated adverse financial impacts. Funding: None.
AB - Background: Complementary medicine, which refers to therapies that are not part of conventional medicine, comprising both evidence-based and non-evidence-based interventions, is increasingly used following a diagnosis of cancer. We aimed to investigate out-of-pocket spending patterns on complementary medicine and its association with adverse financial outcomes following cancer in middle-income countries in southeast Asia. Methods: In this prospective cohort study, data on newly diagnosed patients with cancer were derived from the ASEAN Costs in Oncology (ACTION) cohort study, a prospective longitudinal study in 47 centres located in eight countries in southeast Asia. The ACTION study measured household expenditures on complementary medicine in the immediate year after cancer diagnosis. Participants were given cost diaries at baseline to record illness-related payments that were directly incurred and not reimbursed by insurance over the 12-month period after study recruitment. We assessed incidence of financial catastrophe (out-of-pocket cancer-related costs ≥30% of annual household income), medical impoverishment (reduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs), and economic hardship (inability to make necessary household payments) at 1 year. Findings: Between March, 2012, and September, 2013, 9513 participants were recruited into the ACTION cohort study, of whom 4754 (50·0%) participants were included in this analysis. Out-of-pocket expenditures on complementary medicine were reported by 1233 households. These payments constituted 8·6% of the annual total out-of-pocket health costs in lower-middle-income countries and 42·9% in upper-middle-income countries. Expenditures on complementary medicine significantly increased risks of financial catastrophe (adjusted odds ratio 1·52 [95% CI 1·23–1·88]) and medical impoverishment (1·75 [1·36–2·24]) at 12 months in upper-middle-income countries only. However, the risks were significantly higher for economically disadvantaged households, irrespective of country income group. Interpretation: Integration of evidence-supported complementary therapies into mainstream cancer care, along with interventions to address use of non-evidence-based complementary medicine, might help alleviate any associated adverse financial impacts. Funding: None.
UR - http://www.scopus.com/inward/record.url?scp=85124510347&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(21)00595-7
DO - 10.1016/S2214-109X(21)00595-7
M3 - Article
C2 - 35180423
AN - SCOPUS:85124510347
SN - 2214-109X
VL - 10
SP - e416-e428
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 3
ER -