Background: The economic impact of cancer is substantial whether due to direct medical or non-medical costs, or lost productivity due to disability and premature mortality. Economic evidence to guide policymakers in developing affordable and equitable cancer control plans are scarce in low- and middle-income countries. We examined the economic impact of cancer in Malaysia, an upper middle-income country.

Methods:  The 2012-2014 ASEAN Costs in Oncology Study included 1662 cancer patients with incident solid tumors and hematologic malignancies from public and private hospitals in Malaysia. Patients were followed-up to 12 months for incidence of financial catastrophe (out-of-pocket cancer-related [OOP] costs exceeding 30% of annual household income), economic hardship (inability to make necessary household payments), medical impoverishment (annual household income below national poverty line following OOP expenditures), and death. Stepwise multinomial regression was used to disentangle the impact of health insurance, cancer stage, and treatment in explaining risk of adverse outcomes.

Results: The median age of participants was 52 years; 60% were women. Fifty-five percent of participants had paid work, and 18% had private health insurance. Excluding 430 patients with hematologic malignancies, 60% of patients presented with stage III or stage IV cancer at initial diagnosis. A year after diagnosis, 12% of patients had died, 45% experienced FC, and only 43% were alive with no FC. Cancer patients in the low-income category had substantially higher odds of financial catastrophe (adjusted odds ratio, 9.90; 95%CI: 6.72–14.58) and death (5.92; 3.00–11.68) than patients with high income. The proportion of patients experiencing economic hardship following a diagnosis of cancer, who were previously solvent, was high (51%). Thirty-nine percent of them were unable to pay for medicines, and 22% resorted to taking personal loans. Among families who were not living in poverty at baseline, 24% were medically impoverished, incurring high OOP costs throughout the year pushing their net annual household income below the national poverty line. Late cancer stage at diagnosis largely explained the high incidence of adverse economic outcomes and death observed in this study.

Conclusion: While Malaysia had achieved universal health coverage and previously documented a high level of financial risk protection for health, this does not apply to cancer patients, who are economically incapacitated within just a year of cancer diagnosis. There is an urgent need to realign our focus on early detection of cancer and provision of affordable cancer care, while ensuring adequate financial risk protection, particularly for the poor.