Treatment Cost of Cervical Cancer, As a Barrier to Health Equity in Ethiopia

Background: Cervical cancer is a leading cause of death from cancer among women in low-resource settings, affecting women at a time of life when they are critical to social and economic stability. Corresponding to its magnitude, the economic burden is significant.

Objectives: To estimate economic burden of cervical cancer among patients and to determine predictors for variation in patient related cost of cervical cancer.     

Methods: Cost of illness study on 227 cervical cancer cases at Tikur Anbessa Hospital was conducted. Consecutive sampling technique was used. We employed a bottom-up approach in order to estimate direct cost. Indirect costs were calculated in terms of productivity time losses, using human capital approach. Societal perspective, prevalence-based model was used. Multiple liner regression analysis was employed to analyze the separate effects of the various predictor variables on the cost of treatment.

Results: The mean outpatient cost per patient for cervical cancer was $407.2 (Median = $206.9). Direct outpatient cost (Mean=$334.2) takes the largest share compared with the indirect counterpart ($150).  The outpatient cost for half of the respondent fails in a range between $93.7 and $478. Mean inpatient cost for hospitalized patients was $404.4. The average direct inpatient cost was $329 (74% medical costs and 26% non medical costs). The mean value for total inpatient cost for half of the respondent were in a range of $133.5 and $493.9. For every single day increment in inpatient hospital stay there is equivalent increment of $4.2 on total inpatient patient side cost.

Conclusion: Cervical cancer creates an immense economic burden on patients. Outpatient treatment cost was found to be dependent on patient residence distance from the hospital, number of employed household members, number of facility visited and occupation. Longer duration of inpatient hospital stay and existence of co-morbidity were associated with higher inpatient cost.