Cost of treatment for children with acute lymphoblastic leukemia in Bangladesh

• In developing countries the cost of treating a child with cancer falls on the family.
• Although the costs are lower than in high income countries they are still not affordable if you live on 2–9$ per day as 84% of parents in this study in Bangladesh.
• Solutions are urgently required to ensure essential drugs are available, accessible and affordable in all countries.

BackgroundAcute lymphoblastic leukemia (ALL) is the most common childhood malignancy seen in Bangladesh and is potentially curable. However since parents currently have to pay for the full cost of therapy, high rates of treatment refusal and abandonment are observed, principally as a result of non-affordability. To date, no published data on the exact costs has existed for Bangladesh which makes clear parental counselling at diagnosis impossible.MethodsA cross-sectional study of the costs incurred by 50 families of children with ALL during therapy was conducted at the Pediatric Hematology & Oncology Department of the Bangabandhu Sheikh Mujib Medical University Hospital in Dhaka (BSMMU) from 2010 to 2011. The patients were all treated on a modified United Kingdom Medical Research Council ALL X1 protocol. Each family was asked to retain and submit all receipts for drugs bought from pharmacies, investigations and hospital procedures (LPs and Bone marrow sampling), transport, food and accommodation. Blood and blood products carried a standard hospital fee.ResultsThe basic cost of all treatment for each family was 3234 USD (local currency BDT 226,400) of which 48.6% was for essential and cytotoxic drugs (1571 USD); 9.3% for investigations(299 USD); 2.5% for procedures (79 USD); 0.6% for blood and blood products (20 USD); 12.9% for general treatment costs (416 USD) and 26% (848 USD) for other aspects of care including transport to and from hospital, food and parental lodging. However with an average of three episodes of febrile neutropenia/sepsis the mean overall cost rose to 4443 USD. Where there was refractory fever requiring changes in the antibiotic regimen, an additional average sum of 1740 USD was incurred. In such patients the total costs rose to 7672 USD.ConclusionThe mean treatment cost for Children with ALL in Bangladesh treated on this protocol was 4443 USD (BDT 311,028) with a range of 3234 USD (BDT 226,400) to 7672 USD (BDT 537,040). This data enables more realistic family counselling regarding the financial burden they face for their child's treatment. Although the costs are considerably lower than recorded in high income countries they remain prohibitively high for most parents in low-middle income countries like Bangladesh. During the period of this study treatment abandonment rates were 16%; 62% of which were reported to be due to families not being able to afford the costs. In a parallel project to our study family monthly incomes were recorded. 33% of families earned less than 5000 BDT/month (71 USD), 51% between 5000 and 20,000 (71–285 USD) and only16% more than 20,000 (greater than 285 USD). Solutions to reduce the cost to families in all low-middle income countries are urgently required. To achieve that requires a National and Global effort from medical professionals, the pharmaceutical industry, International agencies and individual Governments. In the long run only universal health coverage can significantly reduce the financial burden for families.