Household costs of breast cancer and coping mechanisms in Kenya: A case of Kenyatta National Hospital.

Abstract

11051 Background: In 2020, cancer was the third leading cause of mortality in Kenya, with breast cancer the most prevalent cancer and the second leading cause of cancer-related deaths. Patients and the health system faced a substantial economic burden due to breast cancer, which requires long-term medical attention as a chronic condition. Research has identified cost as a primary obstacle to accessing breast cancer healthcare services, particularly in low- and middle-income countries (LMICs). Objectives: The objective of this study was to examine the household costs of breast cancer among patients receiving treatment at Kenyatta National Hospital, Kenya’s national referral hospital. Specifically focusing on cost incurred, drivers of cost and cost coping mechanisms. Methods: Cross-sectional descriptive research design was utilized to quantify the cost of breast cancer among 103 breast cancer patients at the Kenyatta National Hospital in 2024. Data were collected via a semi-structured questionnaire on the direct medical costs, direct non-medical costs, and indirect costs incurred, as well as cost coping mechanisms. To assess the drivers of cost, multivariable linear regression model was used to determine associations between the independent variables and cost outcomes. Results: The mean total costs of breast cancer were estimated to be USD 14,255 (KES 2,138,330). Direct medical costs (USD 8,916/KES 1,337,475) were the largest component, followed by direct non-medical costs (USD 1,917/KES 287,625) and indirect costs (USD 3,421/KES 513,229). Targeted therapy was the largest cost component within direct medical costs, representing 45.37% of direct medical costs. Luminal B and Stage IV breast cancer incurred the highest total costs. Patients primarily relied on public health insurance and personal income and savings to cater for the costs. Despite all participants using the National Health Insurance Fund (NHIF), now Social Health Authority (SHA), it only covered 25-50% of the direct medical costs. Out-of-pocket expenditures were significant, with 97% of respondents using personal income and savings, 29% liquidating assets, and 22% taking loans. Conclusions: Breast cancer patients and their households incur significant costs in Kenya. This underscores the need for urgent health financing reforms that ensure broadened insurance coverage, and social protection systems that ensure Kenyans have access to comprehensive cancer care and prevent cancer-related financial toxicity and impoverishment.