Background: Cancer a leading cause of death globally, poses a growing challenge to public health and health systems. In 2024, cancer-related deaths are expected to reach 9.6 million annually, with the economic burden projected to be $25.2 trillion between 2020 and 2050. High-income countries face a higher cancer burden in terms of DALYs. Still, they account for only 49.5% of the global economic cost, leaving low-middle-income countries with a significant financial burden. Nepal contributed to 10% of total deaths due to cancer in 2017, and there is no information available on whether the financial protection provided is sufficient to protect the patients from financial catastrophe. Thus, this study aims to assess the cost and utilization of financial protection in cancer treatment among patients attending Bhaktapur Cancer Hospital in Bhaktapur, Nepal.
Methodology: A hospital-based cross-sectional study conducted among cancer patients and service providers involved in cancer treatment using both qualitative and quantitative methods. The quantitative study included 120 participants, while the qualitative study involved key informant interviews and six in-depth interviews. Non-probability sampling was employed for both qualitative and quantitative sampling. Data were exported from Excel and analyzed in SPSS version 11.5. For bivariate analysis, t-tests, ANOVA, and Pearson’s correlation were used while multiple linear regression was applied for multivariate analysis to assess the association between variables at 95% CI. Thematic analysis was conducted for the qualitative data.
Results: The total cancer treatment costs had a median of NPR 431675 (IQR = 266550) and a mean of NPR 481137.43 (SD = 205267.95), with direct medical costs accounting for 74.2% of total treatment expenses. Oropharyngeal had the highest costs for male patients, while breast cancer was the costliest for females. Expenses increased with cancer stage, peaking at Stage III, and were higher for treatment duration of 3-7 months. Factors such as family type, treatment duration, and processed meat consumption were found to explain the total cancer treatment cost. Both service users and providers agreed that the financial protection offered was inadequate.
Conclusion: The study was conducted among cancer patients and service providers at Bhaktapur Cancer Hospital. The total cost of cancer treatment surpasses the financial protection provided and varies by gender, stage, and duration of treatment. Qualitative insights highlighted inadequate financial protection, urging increased government funding at all levels and recommending a “one-door policy” to streamline resource allocation.