A1 Refereed original research article in a scientific journal
Global Variation in Out-of-Pocket Payments for Cancer Surgery
Authors: Simoes, Joana F. F.; Picciochi, Maria; Ademuyiwa, Adesoji; Adisa, Adewale; Anyomih, Theophilus; Bhangu, Aneel; Calvache, Jose A.; Ghosh, Dhruva; Jolly, Kate; Kachapila, Mwayi; Lawani, Ismail; Nepogodiev, Dmitri; Ntirenganya, Faustin; Oppong, Raymond; Tabiri, Stephen; de la Medina, Antonio; NIHR Global Health Research Unit on Global Surgery
Publisher: WILEY
Publishing place: HOBOKEN
Publication year: 2025
Journal:World Journal of Surgery
Journal name in sourceWORLD JOURNAL OF SURGERY
Journal acronym: WORLD J SURG
Volume: 49
Issue: 8
First page : 2207
Last page: 2216
Number of pages: 10
ISSN: 0364-2313
eISSN: 1432-2323
DOI: https://doi.org/10.1002/wjs.12637
Introduction: Cancer is one of the most expensive global health challenges and surgery is needed in most cases. This study aimed to describe out-of-pocket payments for cancer surgery across country income groups. Methods: This was a preplanned secondary analysis from an international prospective cohort study of consecutive patients undergoing cancer surgery in October 2020. Out-of-pocket payments (OOPP) to cover most of the cost of cancer surgery were compared across country income groups. Other funding sources were also described as follows: public funds, insurance, or others. A logistic regression model was used to identify variables independently associated with OOPP in low- and middle-income countries. Results: There were 24,498 patients included from 1332 hospitals from 108 countries. Overall, 6.4% (1571/24,498) had OOPP to cover most of the cost of their cancer surgery. OOPP rates varied across country income groups: 0.5% (89/16,680) in HICs, 5.7% (272/4784) in UMICs, 38.6% (1008/2614) in LMICs, and 48.1% (202/429) in LICs. Besides the country income, male sex (OR 1.16, 95% CI 1.02-1.32, and p = 0.024) and elective surgery (OR 1.31, 1.04-1.67, and p = 0.022) were associated with OOPP for cancer surgery. Discussion: Patients accessing cancer surgery in LMICs are at an increased risk of catastrophic expenditure. Governments should prevent this by developing health insurance plans that cover elective cancer surgery, possibly involving diverse stakeholders. The interpretation of gender-related risks demands deeper understanding of the ability to pay out-of-pocket and access care.
