Out-of-pocket payments for complementary medicine following cancer and the effect on financial outcomes in middle-income countries in southeast Asia: a prospective cohort study
Authors: Yek-Ching Kong, Merel Kimman, ShriDevi Subramaniam, Cheng-Har Yip, Stephen Jan, Soe Aung, Mai Trong Khoa, Corazon A Ngelangel, Htun Lwin Nyein, Suleeporn Sangrajrang, Jitraporn Tanabodee, Nirmala Bhoo-Pathy, Phetsamone Arounlangsy, Soe Aung, Soledad L Balete, Nirmala Bhoo-Pathy, Bounthaphany Bounxouei, Dieu Bui, Jay Datukan, Agnes E Gorospe, Cheng Har Yip, Prasit Khopaibul, Thanut Khuayjarernpanishk, Thiravud Khuhaprema, Myo Khin, David Kingston, Tawin Klinwimol, Somkiet Lalitwongsa, Dhanoo Lawbundis, Conrado Lola, Gloria Cristal-Luna, Leo Marbella, Khoa Mai Trong, Soe Oo Maung, Shu Mon, Win Pa Pa Naing, Corazon A Ngelangel, Htun Lwin Nyein, Annielyn Beryl Ong-Cornel, Khin May Oo, Irisyl Orolfo-Real, Dung Pham Xuan, Seang Pharin, None Pujianto, Oudayvone Rattanavong, Kouy Samnang, Somphob Sangkittipaiboon, Suleeporn Sangrajrang, Cherelina Santiago-Ferreras, Prih Sarnianto, San Shwe, Eav Sokha, Thanadej Sinthusake, Darunee Suanplu, Jitraporn Tanabodee, Hasbullah Thabrany, Kitisak Thepsuwan, Yin Yin Htun, Heng Viroath, Le Le Win, Swe Swe Win, Tin Moe Win, Ami Ashariati, Djumhana Atmakusuma, I Made Bakta, Tuan Diep Bao, Ario Djatmiko, Andi Fachruddin, Pik-Pin Goh, Dang Thi Kim Loan, Johan Kurnianda, Helen Monaghan, Abdul Muthalib, Trang Ngo Thuy, Dang Thi Ngoc Phung, Thao Nguyen Hoang, Nguyen Thi Hoai Nga, Sonar S Panigoro, Huy Pham Quang, Khanh Quach Thanh, Dradjat R Suardi, ShriDevi Subramaniam, Aru W Sudoyo, Khoa Tran Dang, Ha Tran Dinh, Catharina Suharti, None Suyatno, Mark Woodward
Journal: The Lancet Global Health (2022)

BackgroundComplementary medicine, which refers to therapies that are not part of conventional medicine, comprising both evidence-based and non-evidence-based interventions, is increasingly used following a diagnosis of cancer. We aimed to investigate out-of-pocket spending patterns on complementary medicine and its association with adverse financial outcomes following cancer in middle-income countries in southeast Asia.MethodsIn this prospective cohort study, data on newly diagnosed patients with cancer were derived from the ASEAN Costs in Oncology (ACTION) cohort study, a prospective longitudinal study in 47 centres located in eight countries in southeast Asia. The ACTION study measured household expenditures on complementary medicine in the immediate year after cancer diagnosis. Participants were given cost diaries at baseline to record illness-related payments that were directly incurred and not reimbursed by insurance over the 12-month period after study recruitment. We assessed incidence of financial catastrophe (out-of-pocket cancer-related costs ≥30% of annual household income), medical impoverishment (reduction in annual household income to below poverty line following subtraction of out-of-pocket cancer-related costs), and economic hardship (inability to make necessary household payments) at 1 year.FindingsBetween March, 2012, and September, 2013, 9513 participants were recruited into the ACTION cohort study, of whom 4754 (50·0%) participants were included in this analysis. Out-of-pocket expenditures on complementary medicine were reported by 1233 households. These payments constituted 8·6% of the annual total out-of-pocket health costs in lower-middle-income countries and 42·9% in upper-middle-income countries. Expenditures on complementary medicine significantly increased risks of financial catastrophe (adjusted odds ratio 1·52 [95% CI 1·23–1·88]) and medical impoverishment (1·75 [1·36–2·24]) at 12 months in upper-middle-income countries only. However, the risks were significantly higher for economically disadvantaged households, irrespective of country income group.InterpretationIntegration of evidence-supported complementary therapies into mainstream cancer care, along with interventions to address use of non-evidence-based complementary medicine, might help alleviate any associated adverse financial impacts.FundingNone.