Background

Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE.

Methods

This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified.

Results

Among the 19 studies included, an average of 43.3% (95% CI 36.7–50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex.

Conclusion

The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients.

中文翻译：

---

癌症患者灾难性健康支出的发生率及其决定因素：系统评价和荟萃分析

背景

癌症是世界上第三大死亡原因，与其他疾病相比，癌症患者更容易面临经济困难。本文旨在回顾癌症患者灾难性医疗保健支出 (CHE) 的研究，测量他们接触 CHE 的水平，并确定与 CHE 发生率相关的因素。

方法

本研究是一项系统评价和荟萃分析。到 2020 年 2 月，搜索了几个数据库，包括 MEDLINE、Web of Science、Scopus、ProQuest、ScienceDirect 和 EMBASE。使用随机效应模型提取和分析所选研究的结果。此外，还确定了 CHE 的决定因素。

结果

在纳入的 19 项研究中，平均 43.3%（95% CI 36.7-50.1）的癌症患者发生了 CHE。CHE 因研究所在国家的人类发展指数 (HDI) 而异。在 HDI 最高的国家，23.4% 的癌症患者发生了 CHE，而在 HDI 最低的国家，这一比例为 67.9%。在家庭层面与 CHE 发病率相关的关键因素包括家庭收入、户主性别，在患者层面包括医疗保险类型、患者教育水平、癌症和治疗类型、生活质量、年龄和性。

结论

发生 CHE 的癌症患者比例非常高，尤其是在 HDI 较低的国家。本综述的结果可以帮助决策者制定更公平、更可持续的卫生筹资机制，解决与癌症患者 CHE 相关的因素。