Rebalancing cancer care financing: Resource utilization patterns from the COST-FIN trial in Nigeria.

Abstract

17 Background: In low- and middle-income countries, patients face high out-of-pocket expenses for consultations, diagnostics, chemotherapy, radiotherapy, and surgery contributing to treatment delays or discontinuation. COST-FIN is the first randomized controlled trial evaluating whether structured financial navigation (FN) reduces financial catastrophe, financial distress, and cost-related treatment non-adherence among cancer patients in Nigeria. While prior studies have described these costs, less is known about how patients mobilize financial resources over time. This sub-study describes how patients combine financial resources during their care. Methods: We conducted a prospective analysis within COST-FIN to assess financing patterns among cancer patients. Patients were randomized to receive either FN or routine care (RC). Financial navigation included structured financial assessment, individualized financial planning, and linkage to available resources. Data were collected at baseline and longitudinal follow-up over 12 months to capture sources of financing. We examined the distribution of these resources among patients in the FN arm. Results: Of 1,224 patients screened for eligibility, 220 were enrolled across three sites, and 159 were randomized to FN (n=81) or RC (n=78) arms. At baseline, cancer care financing was largely driven by out-of-pocket payments. In the FN arm, insurance coverage increased from 25 patients (30.9%) at baseline to 54 at follow-up, a 116% increase. Navigation facilitated access to National Health Insurance Scheme enrollment (60.5%), discounted pharmaceuticals (53.1%), additional pharmaceutical support (18.5%), philanthropy (19.8%), NGO support (2.5%), external diagnostic discounts (4.9%), and fully funded treatment programs (6.2%). Among patients followed for up to 12 months, single-resource use ranged from 25% to 85.7%, while use of two resources ranged from 12.5% to 27.8%. Use of three resources was observed in a smaller subset (2%). Overall, patients receiving FN demonstrated more diverse financing strategies. Conclusions: Cancer care financing in Nigeria remains fragmented and heavily reliant on OOP. Within COST-FIN, FN increased access to health insurance and structured support resources, helping patients combine various financial resources for their treatment. However, delayed insurance activation remained a barrier to timely use. Integrating FN into routine cancer care may strengthen financial protection and treatment continuity in resource-limited settings. Clinical trial information: HREC#: ERC/2024/05/12.