The evaluation of household economic burden of secondary treatment for childhood leukemia and informal payments to physicians in Armenia

Abstract

Background: Leukemia is the most common blood cancer. Worldwide, leukemia accounts for 2.8% of all new cancer cases and 222,000 deaths each year. It accounts for 30% of all cancers diagnosed in children aged less than 15 years. On the other hand, the economic burden of cancer is substantial and growing. The economic burden on patients and their families for cancer treatment may include the immediate cost of treatment, out-of-pocket and future costs required for cancer surveillance, follow-up care, and treatment of persistent symptoms. Information on economic burden due to cancer is largely absent from common literature that offer information to cancer patients and their families-leaving patients in the untenable position of having to make treatment choices without fully understanding the costs and the impact on their ability to work. Objective: The study assessed the financial problems faced by the households from Yerevan, having a child with leukemia registered in the Hematology Center in Yerevan, Armenia. Methods: The analytical cross-sectional telephone survey was conducted with the study population that consisted of a sample of 97 participants, with children registered at the Hematology Center from 2005-2008. Among survey items were questions adopted from Prescription Drug Affordability: A 2004 AARP Montana Survey and also from Access & Affordability of Prescription Drugs: An AARP Study of New Jersey’s Hispanic Population. Results: Among the respondents 33% reported that it was a major financial problem for them to pay for the secondary treatment of leukemia, 29% reported that it was a minor financial problem and only 12% reported that it was not a financial problem. Among the respondents 16% reported that their doctor suggested a specific pharmacy from which to purchase the prescribed drugs. About 31% of those interviewed are very concerned about affording the costs of prescribed secondary-treatment drugs for their child with leukemia over the next two months, 46% were somewhat concerned and only 11% were not concerned et al. According to the bivariate analysis, household financial problems connected with secondary-treatment drugs for leukemia was associated with having cut back on other necessary items such as food or utilities to be able to afford a prescription medication for secondary treatment was also associated with household financial problems connected with secondary-treatment drugs for leukemia: the parents of patients with leukemia who cut back on other necessary items such as food or utilities were 4.4 times likely to have major financial problem compared to those that did not cut back on above mention items ( OR=4.4, 95%CI=1.46;13.21). Conclusion: Consistent with the literature, the factors associated to financial problems faced by the households, having a child with leukemia were concern about being able to afford secondary treatment, and having cut back on other necessary items such as food or utilities to be able to afford a prescription medication. Almost one third of the household with a child with leukemia face major financial problems in Armenia. Additional means should be applied to target these families for further financial assistance. For the real measurement of economic burden further more detailed study could be conducted considering the direct and indirect costs of the treatment.