Financial Hardship Among Women With Breast Cancer in Addis Ababa Ethiopia: A Comparative Cross-Sectional Study

Abstract

PURPOSE Breast cancer (BC) is the leading cause of cancer morbidity and mortality in Ethiopia, yet financial hardship is often overlooked. Herein, we examined the financial hardship of BC among women newly diagnosed with the disease in Addis Ababa, Ethiopia. MATERIALS AND METHODS We conducted a comparative cross-sectional study of financial hardship between 353 women diagnosed with BC from 2017 to 2018 in Addis Ababa and 618 women without a history of the disease but with medical expenses selected by multistaging sampling from the city's general population. Financial hardship measures, coded as binary variables (yes, no), included selling assets to pay for medical expenses, borrowing money to meet medical expenses, and worrying about family's financial security. The associations between BC diagnoses and each of the financial hardship measures were evaluated using the multivariable logistic regression model. RESULTS Women with BC compared with those without a history of the disease were more likely to report out-of-pocket costs (98% v 38.9%), sell properties (10.2% v 4.2%), and worry about families' financial security (53.8% v 41.8%), but they were equally likely to report borrowing money (19.8% v 17.8%). In the multivariable-adjusted model, women with BC compared with those without the disease were three times as likely to sell their property to cover medical expenses (adjusted odds ratio [AOR], 2.94 [95% CI, 1.49 to 5.83]) and 1.4 more likely to worry about their family's financial security (AOR, 1.42 [95% CI, 1.02 to 1.96]). CONCLUSION The material and psychological burden of BC is considerably high among women in Addis Ababa, Ethiopia, suggesting the need for discussion of cost as part of delivering high-quality care and expanding health care coverage.