Title

Estimating the impact of "Khyber Pakhtunkhwa cancer project" on household economic : cost analysis of chronic myeloid leukemia in Khyber Pakhtunkhwa before & after the cancer project

Date of Award

2018

Document Type

Thesis

Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

Department

Community Health Sciences

Abstract

Cancer treatment has made remarkable progress over the years. The wave of innovation especially the targeted therapies have transformed cancer management but at a huge cost. High Out of pocket expenses in cancer management has dire economic consequences on households. The KPK cancer project was launched in order to reduce the catastrophic health expenditure on state of the art cancer medication through a public private partnership. Besides providing the health benefits, this project also provided financial risk protection to these households, which is a critical marker of effectiveness of a health care system. Objectives: The study aimed to estimate the total cost of CML treatment on each household enrolled in the project before and after the KPK cancer project. To estimate the total cost saved by household enrolled in the project. Method: In order to estimate the total cost of CML on households in the province of KPK, a sample based cost of Illness approach was adopted. Bottom up costing methods were applied using facility level costing to arrive at project level estimate. A secondary review of financial records of the patients was done using electronic & non-electronic database of the Oncology Department of Hayatabad Medical Complex, Peshawar (l-IMC). Direct medical cost, Direct non-medical cost and Productive cost estimation was done on a sample. The study participants were the Chronic Phase CML patients aged 16 years and above who have purchased medicine form their own pocket before the initiation of this project and were then enrolled in this project. Arithmetic mean of cost of illness for CML was estimated. Direct Medical cost included consultation fee, lab fee and cost of medicine. Direct Non-Medical Cost included transportation cost for the patient and the accompanying person. This also included cost for food and the overnight stay. Patient and caregiver productivity cost while travelling to institution was included in this cost by using the Human Capital Approach. Average cost estimates of the above mentioned data was used to estimate the total cost of CML treatment. A retrospective cohort study, a secondary analysis of the financial records of the patients was done by the Paired Sample T- Test method using SPAS in order to estimate the level of significance in the mean difference of the cost of CML treatment before and after the initiation of the project. Results: The mean age was 43.66 years (16 — 77 years). Almost 81% of study sample was married (n = 75). The mean annual income of the sample household was PKR 386,204.301/- (mean monthly income of PKR 32,183.69). Approx. 46% of the patients were dependent on their own income for treatment related costs. The overall reduction in distance travelled to and from the facility after the initiation of the project was significant which reduced from a mean value of 846 Km to 306 Km. The Direct Non-Medical Cost before the initiation of the project was PKR 58,544/- which was almost twice of the mean household income and the productive cost was PKR 26,431/- which was almost equal to a mean monthly income of the household. There was reduction of these two cost by more than 50% after the initiation of the KPK project. The total cost saved for an individual CML household in terms of Direct Medical Cost was PKR 1, 39,829.72/- and in Direct Non-Medical Cost was PKR 38,667.01/ and for Productive cost was PKR 13,686.09 /- the total of which comes to PKR 1, 92,182.82/- per household per year. By multiplying this amount to the total number of patient household enrolled in this project the net saving for 800 patients is PKR 153.74 M. For eight years the government will spend PKR 576 million against which the household savings will be PKR 1230 million. Conclusion: Financial risk protection is an important aspect of success of a health care system. The impact of out of pocket expenses in dealing with the direct and indirect cost of cancer management is tremendous on households and it requires government support. The government support in cancer management will result in huge potential saving for the household and these can be used in further meaningful economic activities.

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