Financial burden of cervical cancer in Bhutan and Zambia: a multiple low- and middle-income country cost survey

BackgroundZambia and Bhutan have a high prevalence of cervical cancer (CC). The financial burden on affected households is substantial yet potentially mitigable through effective interventions. This study assessed the financial burden of CC in these countries by quantifying the proportion of households facing catastrophic costs and exploring their financial coping mechanisms. MethodsBetween January and July 2023, two cost surveys were conducted using the COEUS (Costing Surveys to Assess the Economic Burden of Cervical Cancer in Society) framework, from a societal perspective to assess household financial burden. In Bhutan, we used an outreach-based survey, while in Zambia, the surveys were completed at a health facility. Women or members of their household with CC were interviewed using a standardized questionnaire. We excluded individuals with multiple cancers or communication barriers. The survey captured direct medical, direct non-medical, and indirect costs related to diagnosis through treatment, including information on alternative remedy expenses. Catastrophic expenditure was defined as out-of-pocket expenses exceeding 10% of the annual household income. We also assessed perceptions of financial hardship according to households and coping strategies. All costs were reported in 2022 International Dollars (I$). ResultsOut of 164 interviews, 162 responses were analysed: 87 from Bhutan and 75 from Zambia. The total costs in Bhutan were higher than the spending in Zambia (median[min-max] I$4,025[90-4,0912] vs. I$1,703[315-11,059]). This was mainly due to treatment costs at professional health care facilities, and significantly more in Bhutan than Zambia for alternative remedies (I$587[0-15,749] vs. I$0[0-3,036]). In Bhutan, higher costs were reported among households of women with stage 2 CC, while in Zambia, higher costs were reported among households of women with distant cancer. Over half of affected households lost income, and the majority faced catastrophic costs: 85% in Bhutan and 89% in Zambia. Most Zambian women (68%) reported that cervical cancer severely impacted their financial situation and coped by seeking help from relatives, religious bodies, or non-government organizations (72%) as well as reducing food and other purchases (69%). ConclusionCC care seeking and treatment often have catastrophic financial consequences to affected women living in low- and middle-income countries. Strengthening CC prevention through HPV vaccine, screening, and early detection are required to reduce the incidence of catastrophic costs due to CC.