Cost drivers and financial burden for cancer-affected families in China: a systematic review

Abstract

Abstract Background: Cancer has been the leading cause of death in China and imposes heavy burdens on individuals and the health system. China’s cancer control plan includes efforts to mitigate financial hardship for the affected households in the context of ongoing health system reform. However, evidence is limited about how the affected families afford cancer care. Methods: This systematic review is to map medical, non-medical, and indirect costs incurred by cancer care, the financial burden for patients, and their economic coping strategies from 2009 onwards. We included original quantitative studies conducted in mainland China that reported out-of-pocket payment for cancer care and patients’ coping strategies in English or Chinese We searched PubMed, Embase, Ovid, Web of Science, Cochrane and two Chinese databases (CNKI and WanFang Data) from January 1st 2009 to 10th August 2022. We introduced ten quality criteria for quality assessment of the included studies according to the standards for reporting observational studies. We reported components of costs and coping strategies narratively and presented costs as a percentage of household income. Results: Annual mean medical costs (including inpatient and outpatient costs and fees for self-purchasing drugs) ranged from US$7421 to US$10297 (an unweighted average of US$8794) per patient. In a study that investigated medical costs for five years, inpatient costs accounted for 51.6% of total medical costs, followed by self-purchasing drugs (43.9%). The estimation of non-medical and indirect costs varied considerably. Annual medical costs as a percentage of annual household income ranged from 36.0% to 63.1% with a meta-proportion of 51.0%. The common coping strategies included borrowing money, reduction of household expenses and expenses from basic health services. Conclusions: Costs of inpatient care and self-purchasing drugs are major drivers of medical costs for cancer care, and many affected households shoulder a very heavy financial burden. This will require strengthening stewardship for cancer control and multi-sector cooperation to mitigate the risk of financial hardship.