Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study

Jane Bates, M. et al. (2021) Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study. Lancet Global Health, 9(12), e1750-e1757. (doi: 10.1016/S2214-109X(21)00408-3) (PMID:34756183) (PMCID:PMC8600125)

Abstract

Background: Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. Methods: In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed. Findings: We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was -36% (95% CI -94 to 594; p=0·707). Interpretation: Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified.

• Item Type: Articles
• Additional Information: Funding for the study is from the Wellcome Trust Strategic Award to Malawi—Liverpool—Wellcome Trust Clinical Research Programme (grant: 206545/Z/17/Z), a crowdfunding campaign, and EMMS International. We also thank the National Institute for Health Research’s Global Health Research Unit on Lung Health and Tuberculosis in Africa at Liverpool School of Tropical Medicine—“IMPALA” for helping to make this work possible. In relation to IMPALA (grant number 16/136/35) specifically: IMPALA was commissioned by the National Institute for Health Research using Official Development Assistance funding.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Jane Bates, M., Gordon, M. R.P., Gordon, S. B., Tomeny, E. M., Muula, A. S., Davies, H., Morris, C., Manthalu, G., Namisango, E., Masamba, L., Henrion, M. Y.R., MacPherson, P., Squire, S. B., and Niessen, L. W.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Lancet Global Health
• Publisher: Elsevier
• ISSN: 2214-109X
• ISSN (Online): 2214-109X
• Copyright Holders: Copyright © 2021 The Author(s)
• First Published: First published in Lancet Global Health 9(12):e1750-e1757
• Publisher Policy: Reproduced under a Creative Commons licence