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. 2023 Jul 15;31(8):467.
doi: 10.1007/s00520-023-07913-1.

Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya

Sandra Langat  1   2 , Festus Njuguna  3 , Gilbert Olbara  3 , Hugo Martijn  4 , Cenne Sieben  4 , Moniek Haverkort  4 , Dennis Njenga  5 , Terry A Vik  3   6 , Gertjan Kaspers  4   7 , Saskia Mostert  4   7
Affiliations

Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya

Sandra Langat et al. Support Care Cancer. .

Abstract

Background: Few governments in low and middle-income countries (LMIC) have responded favourably to the international plea for Universal Health Coverage. Childhood cancer survival in LMIC is often below 20%. Limited health-insurance coverage may contribute to this poor survival. Our study explores the influence of health-insurance status on childhood cancer treatment outcomes in a Kenyan academic hospital.

Methods: This was a retrospective medical records review of all children diagnosed with cancer at Moi Teaching and Referral Hospital between 2010 and 2016. Socio-demographic and clinical data was collected using a structured data collection form. Fisher's exact test, chi-squared test, Kaplan-Meier method, log-rank test and Cox proportional hazard model were used to evaluate relationships between treatment outcomes and patient characteristics. Study was approved by Institutional Research Ethics Committee.

Findings: From 2010-2016, 879 children were newly diagnosed with cancer. Among 763 patients whose records were available, 28% abandoned treatment, 23% died and 17% had progressive/relapsed disease resulting in 32% event-free survival. In total 280 patients (37%) had health-insurance at diagnosis. After active enrolment during treatment, total health-insurance registration level reached 579 patients (76%). Treatment outcomes differed by health-insurance status (P < 0.001). The most likely treatment outcome in uninsured patients was death (49%), whereas in those with health-insurance at diagnosis and those who enrolled during treatment it was event-free survival (36% and 41% respectively). Overall survival (P < 0.001) and event-free survival (P < 0.001) were higher for insured versus uninsured patients. The hazard-ratio for treatment failure was 0.30 (95% CI:0.22-0.39; P < 0.001) for patients insured at diagnosis and 0.32 (95% CI:0.24-0.41; P < 0.001) for patients insured during treatment in relation to those without insurance.

Interpretation: Our study highlights the need for Universal Health Coverage in LMIC. Children without health-insurance had significantly lower survival. Childhood cancer treatment outcomes can be ameliorated by strategies that improve health-insurance access.

Keywords: Childhood cancer; Health-insurance; Low and middle-income countries.

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Conflict of interest statement

The authors declare no competing interests.

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Distribution of different types of cancer diagnosed at MTRH between January 2010 and December 2016 (n = 879)
Fig. 2
Fig. 2
Treatment outcomes of children diagnosed with cancer at MTRH between January 2010 and December 2016 (n = 763)
Fig. 3
Fig. 3
Kaplan–Meier estimates of overall survival (panel a) and event-free survival (panel b) in children diagnosed with cancer at MTRH between January 2010 and December 2016 (n = 763). Events included abandonment of treatment, death and progressive or relapsed disease
Fig. 4
Fig. 4
Kaplan–Meier estimates of overall survival (P < 0.001) (panel a) and event-free survival (P < 0.001) (panel b) in children diagnosed with cancer at MTRH between January 2010 and December 2016 per health-insurance status. Events included abandonment of treatment, death and progressive or relapsed disease
See this image and copyright information in PMC

References

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