MATERIALS & METHODS INTRODUCTION ● Oral cancer and oral potentially malignant disorders (OPMD) causes a significant disease burden and financial distress ● It often occurs in disadvantaged groups, trapping them in economic crisis from catastrophic healthcare expenditures (CHE) ● While Malaysian public healthcare is highly subsidized, out-of-pocket expenditure (OOP) for treatment of OPMD and oral cancer remains unknown Sivaraj Raman 1,2 , Asrul Akmal Shafie 1 , Mannil Thomas Abraham 3 , Shim Chen Kiong 4 , Thaddius Herman Maling 5 , Senthilmani Rajendran 6 , Sok Ching Cheong 6,7 Household Catastrophic Health Expenditure amongst OPMD and Oral Cancer patients in Public Healthcare of Malaysia 1 Universiti Sains Malaysia; 2 Hospital Keningau, MOH; 3 Hospital Tengku Ampuan Rahimah, MOH; 4 Hospital Umum Sarawak, MOH; 5 Samarahan Divisional Dental Office, MOH; 6 Digital Health Research Unit, Cancer Research Malaysia; 7 University of Malaya NMRR NO: 18 - 3842 - 45321 To estimate household expenditures amongst OPMD and oral cancer patients To determine extent of CHE among households To explore predictors of CHE 1 2 3 3. Simulation Model for Cost Estimation ● OPMD and oral cancer patients were recruited from oral maxillofacial specialist clinics in Hospital Tengku Ampuan Rahimah and Hospital Umum Sarawak. ● The study consisted of 3 workstreams: 1. Prospective Patient Survey 2. Retrospective Medical Record Abstraction Sociodemographic data, income, healthcare OOP expenditures Healthcare utilization, hospitalization and visit details To generate hospital fees, travel and transport cost Healthcare OOP expenditure* X 100% Household income CHE= 10% 1. Average OOP Expenditures & Income share 3. Factors associated with CHE Race Income % of income share OBJECTIVES * ALL cost estimated for the first 1 year after diagnosis 65.5 % 22.3 % 9.1 % 85.5% 19.2% Predictor Odds Ratio p-value Indian vs Malay 5.07 0.046 B40 vs T20/M40 14.3 0.023 Regression indicated only Race and Income group were significant predictors of CHE: χ 2 (7) = 68.95, p < 0.001 Not associated with CHE ● Age, Gender, Location, Education, Employment OOP expenditures (MYR) 2. Prevalence of CHE OPMD Oral Cancer Other Healthcare Expenditure Public Healthcare Fees Travel & Transport ▪ Traveling to access health services can become a financial barrier , even if treatments are highly subsidized ▪ Current provision of subsidies and accessibilities of financial supports may still be inadequate to shield the more vulnerable group from CHE DISCUSSION Oral cancer in Malaysia echoed similar financial burden with other ASEAN countries, despite the high healthcare subsidization Larger travel cost in late stage cancer was contributed by frequent visits for multidisciplinary care and longer distance travelled by patients in rural areas B40 households overall spent larger percentages of their income on healthcare than M40/T20 groups Race may be interlinked with CHE through other socio- economic factors While PeKa B40 to incentivise patients was timely, none of the current respondents benefitted from the initiative CONCLUSION REFERENCES 1. Amarasinghe H, et al. Economic burden of managing oral cancer patients in Sri Lanka: a cross-sectional hospital-based costing study. BMJ open. 2019;9(7):e027661 2. Kimman M, et al. Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: Results from a longitudinal study in eight countries. BMC Medicine. 2015;13(1):190 3. Yap S-L, et al. Assessing the Relationship between Socio-demographic, Clinical Profile and Financial Toxicity: Evidence from Cancer Survivors in Sarawak. Asian Pacific Journal of Cancer Prevention. 2020;21(10):3077-83 ● Association of sociodemographic factors with CHE was analyzed via multivariate binary logistic regression RESULTS The authors would like to thank the Malaysian Ministry of Higher Education for the financial support under the Fundamental Research Grant Scheme. We also express our thanks to the Director-General of Health Malaysia for his permission to present this study. [ n=52 ] [ n=10 ] [ n=42 ] MYR MYR MYR