OBJECTIVES

Mortality and morbidity studies suggest increasing incidence and prevalence of Non-Communicable diseases in Low and Middle-Income Countries (LMICs). This presents potentially catastrophic cost burden especially to Social Health Insurers (SHIs). A 24M retrospective study was conducted on cancers managed at different hospitals and financed the National Hospital Insurance Fund (NHIF) to profile the financial impact of cancer care in Kenya.

METHODS

Claims data between July 2017 and June 2019 was abstracted from electronic health insurance records. All cases with cancer diagnosis, International Classification of Diseases (ICD) 10 codes, C00 – D49, were included. Cases with incomplete demographics or intervention documentation were excluded. The data was assessed for variances in access, intervention, cost and payment mechanism. Stata/MP Version 14.2 and 5% statistical significance was used for all tests.

RESULTS

Of the 15.6 million insured, 15,833 (0.1%) made 28,657 hospital visits in the 24M period for cancer management, 87.73% being adults. 82.98% of care was accessed at urban or semi-urban hospitals. 1.53% (USD10.09 million) of total payout was spent on cancers; USD3.15 million on radio/chemotherapy. The average cost per visit was USD409, with the average cost per admission (87.74% of all cases) being significantly higher than outpatient management, USD452.9 and USD98.0 (p<0.001) respectively. Odds of inpatient management in adults was higher; OR=2.17 (1.94–2.42). The cost per childhood cancer was higher; USD 421 to USD408 (p=0.509).

CONCLUSIONS

The rising cases and average cost per case are likely to impact negatively on sustainability of SHI financing for cancer management in LMICs. The associated lifetime cost of cancers would make preventive and promotive health, and early diagnosis most integral in cost management. For sustainable SHI funding, risk pooling and strategic procurement of radio/chemotherapy would be vital. We recommend further studies on cancer incidence and prevalence in the general population to adequate project the financial risk.