Out-of-pocket cost assessment of breast cancer treatment among Egyptian women

The breast cancer treatment out-of-pocket (OOP) disbursement among women in Egypt is exorbitant and may delay diagnosis and treatment. The objective of this study is to conduct cost analysis to 1) assess OOP-expenditures for breast cancer treatment among diagnosed women in Egypt, and 2) assess respondents’ earned income capacity to afford OOP-treatment.

Descriptive cost analysis was used to assess the magnitude of OOP disbursements among 86 sampled breast cancer respondents in both public and private facilities. Direct costs of treatment include surgery, chemotherapy, radiation, pre-treatment examinations, and consultation/visitation expenditures. Indirect costs included in the OOP estimation are transportation, medication, follow-up visitation, mental health treatment expenses, physical support (diet, drug, bra, wig, arm brace items), and baksheesh/tip expenditures. On average, out-of-pocket (OOP) treatment expenditures are 13,468 LE (Egyptian Pounds). This is more than eleven times greater than the average monthly household income of 1,140 LE and 212 LE less than the average yearly income of 13,680 LE. High OOP breast-cancer disbursements apply to all women, even when stratified according to insured, marital, literacy, and stage-of-cancer status. 93.83% of respondents indicated inability to afford OOP-breast cancer treatment costs.

OOP cost findings may benefit Egypt’s health and policy decision makers as breast cancer prevention and detection strategies,  health-insurance system, and health-care provider infrastructure reform is considered. These findings may also be beneficial to providers, public health professionals, and policymakers in the broader Middle-East, as well as professionals serving Arab-American immigrants.