Abstract
BackgroundThe financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML) who have been treated with imatinib.MethodsA questionnaire was distributed to 1200 patients between May and August 2009. We retrospectively surveyed their household incomes, out-of-pocket medical expenses, final co-payments after refunds, and the perceived financial burden of their medical expenses in 2000, 2005 and 2008.ResultsA total of 577 patients completed the questionnaire. Their median age was 61 years (range, 15–94). A financial burden was felt by 41.2 % (28 of 68) of the patients treated with imatinib in 2000, 70.8 % (201 of 284) in 2005, and 75.8 % (400 of 528) in 2008. Overall, 182 patients (31.7 %) considered its discontinuation because of the financial burden and 15 (2.6 %) temporarily stopped their imatinib prescription. In 2000, 2005 and 2008, the patients’ median annual household incomes were 49,615 US Dollars (USD), 38,510 USD and 36,731 USD, respectively, with an average currency exchange rate of 104 Yen/USD in 2008. Their median annual out-of-pocket expenses were 11,548, 12,067 and 11,538 USD and their median final annual co-payments were 4,375, 4,327 and 3,558 USD, respectively. Older patients (OR = 0.96, 95 % CI: 0.95–0.98, p ≪ 0.0001 for 1-year increments), and patients with higher household incomes (OR = 0.92, 95 % CI: 0.85–0.99, p = 0.03 for 10,000 USD-increments) were less likely to have considered discontinuing their imatinib treatment. Conversely, patients with higher annual final co-payments (OR = 2.21, 95 % CI: 1.28–4.28, p = 0.004 for 10,000 USD-increments) were more likely to have considered discontinuing their imatinib treatment.ConclusionsThe proportion of CML patients who sensed a financial burden increased between 2000 and 2008. During this period, their annual incomes fell by 13,000 USD, although their medical expenses did not change. Financial support for patients being treated with expensive drugs remains a major problem in Japan.
Highlights
The financial burden of medical expenses has been increasing for cancer patients
Financial support for patients being treated with expensive drugs remains a major problem in Japan
The 95 % confidence intervals (CI) for these three variables do not include an odds ratios (OR) of 1, we conclude that the likelihood of having considered discontinuing imatinib treatment decreased with increasing patient age and income, and increased with final co-payments for medical expenses. This is the first study to demonstrate that the use of imatinib places a large financial burden on Japanese chronic myelogenous leukaemia (CML) patients, who live in a nation with universal health insurance coverage
Summary
The financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML) who have been treated with imatinib. Following the global financial crisis triggered by the collapse of Lehman Brothers in 2008, many developed countries have faced a severe economic recession. Along with a nationwide recession, household income. Japan established a universal public medical insurance system in 1961. All Japanese citizens must join public health insurance programs and can access all hospitals, regardless of income or insurance policy [4]. This system has been frequently revised to adapt to social changes [4]. All patients have to pay a part of their medical costs; these payments vary according to patient age, and range from 10 % to 30 % of the costs: 20 % for those under 6 years old, 30 % for 6 to 69 year olds, 20 % for 70 to 74 year olds, and 10 % for those over 75 years old
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