Out-of-pocket-payments and the financial burden of 502 cancer patients of working age in Germany: results from a longitudinal study
Cancer patients in Germany often face payments related to their disease or treatment which are not covered by their health insurance. The aim of this study was to analyze the amount of out-of-pocket payments (OOPPs) among cancer patients in Germany, to explore potential socioeconomic determinants of OOPPs, and to identify how cancer patients are burdened by these payments.
Cancer ptients were consecutively enrolled in 16 clinics in Leipzig, Germany. Data on OOPPs for the past 3 months and on socioeconomic status were obtained at the end of their hospital stay (t0) and 3 (t1) and 15 months (t2) after t0. Financial burden was calculated by dividing the monthly OOPPs by the midpoint of the income category, and the perceived burden was assessed by using the financial difficulties scale of the EORTC QLQ-C30. A two-part regression model was used to estimate the determinants of OOPPs.
At baseline (t0), 502 cancer patients participated in the study and provided data on OOPPs and socioeconomic status. The mean 3-month OOPPs were the following: €205.8 at baseline, €179.2 at t1, and €148.1 at t2. Compared to the lowest income group (< €500 monthly), all other income groups (€500–999, €1000–1499, and ≥ €1500) had higher 3-month OOPPs of €52.3 (p = 0.241), €90.2 (p = 0.059), or €62.2 (p = 0.176). Financial burden at t0 was 6.4% (SD 9.2%) on average, 5.4% (SD 9.9%) at t1, and to 3.9% (SD 7.0%) of monthly income at t2.
German cancer patients face relatively high OOPPs during their cancer journey. These payments may burden cancer patients, especially certain subgroups like low-income groups.
KeywordsOut-of-pocket-payments Cancer Financial burden Germany Financial toxicity
This work was supported by German Pension Insurance (#8011-106-31/31.81).
Compliance with ethical standards
Conflict of interest
The authors confirm that they have full control of all primary data and agree to allow the journal to review the data if requested.
Matthias Büttner has nothing to disclose.
Hans-Helmut König has nothing to disclose.
Margrit Löbner reports grants from German Pension Insurance, during the conduct of the study.
Susanne Briest has nothing to disclose.
Alexander Konnopka has nothing to disclose.
Andreas Dietz has nothing to disclose.
Steffi Riedel-Heller reports grants from German Pension Insurance, during the conduct of the study.
Susanne Singer reports grants from German Pension Insurance, during the conduct of the study; grants and personal fees from Pfizer, personal fees from Bristol-Myers Squibb, personal fees from Boehringer-Ingelheim, personal fees from Lilly, outside the submitted work.
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