This study, in addition to confirming the costliness of cervical cancer as disclosed by other studies , has produced some important key findings related to the economics of cervical cancer that can be used as inputs for further economic evaluation.
The large differences between mean and median values of the various cost items indicated in this study could be due to the skewedness of the cost data. The standard deviations presented in this study are large, sometimes exceeding the means. Such a pattern is commonly observed when there is wide variation in treatment patterns among patients, even amongst those apparently exhibiting the same pattern of disease .
The mean age of the respondents was 48.7 years, which is an early menopausal period. Most (54.6%) of the respondents were illiterate followed by 23.2% of the respondents that hadn’t attended any formal schooling but can read and write. The vast majority (52%) were housewives. These findings show that the poor, marginalized and uneducated segments of the population are most affected by the disease. This may be useful information for policy actions aimed at addressing issues of inequity. These characteristics of the study participants were also consistent with other studies conducted in Ethiopia, and some other African and Latin American countries [9, 17, 19–21].
The median duration of illness was 180 days. Number of working days lost was also quite large (Median = 60 days). The delay may be due to low health seeking behavior, unawareness about available treatment options and lack of access to transportation or financial problems. The quality and structure of the referral linkage and mis-diagnosis due to lack of access to diagnostic instruments and skilled professionals at the peripheral health facilities may also be raised as reasons. Above all the status of women in decision making at household level may be one of the main contributing factors [22–26].
Any cost-of-illness study should always be viewed in the context of potential limitations. Some of the costs may be underestimated, some costs may be overestimated and some costs may be totally omitted. This cost of illness study is limited to the patient side cost, even though it would be more comprehensive if it includes other costs to the health system, health care provider, the family and to society at large. Intangible costs (pain, suffering, stigma and discrimination) were not also included due to difficulties in measurement . The limitations of self-reported data must also be recognized in interpreting the findings of this study.
The outpatient cost for almost half of the respondent falls in a range between Birr 6,933 ($478) and Birr 1,359 ($93.7). The mean inpatient cost for hospitalized patients was Birr 5,863.2 ($404.4). The average direct inpatient cost was Birr 4,771 ($329) (74% medical costs and 26% non-medical costs). The mean value for total inpatient cost for nearly half of the respondents were in a range of Birr 7,161 ($493.9) and Birr 1,936 ($133.5). Even though it is difficult to compare the aforementioned findings with other studies done elsewhere it is quite clear that these cost estimates were big enough to be huge economic burden for the patients and their family members .
In terms of stages of illness, we found, the cost for stage I was lower compared with stage II and stage III. This finding was similar to findings from other study on cervical cancer [18, 27]. The cost for stage IV was less compared with other lower stages. This could be due to the reason that cases at stage one might be recovered with minor procedures while other cases at other stages demand intensive diagnostic and therapeutic procedures as evidenced by the cervical cancer treatment protocol recommended by FIGO . It may also be due to limited availability of treatment option for stage III and stage IV cervical cancer in Ethiopia so that the patients die quickly while a patient who has diagnosed at stage two tried all treatment options available.
This study showed that distance of patients’ residence from the Hospital, the number of employed household members, number of facilities visited, occupation (farmer), companion, source of energy used by patients household (animal dug) and residency (out of Addis Ababa) were significantly associated with costs. Some previous study reported in line with this finding [28, 29].
There is no previous study which estimates the cost of cervical cancer in sub Saharan Africa. A comparison of our findings with those of other cost of illness studies of cervical cancer in other countries or other disease in Ethiopia would be of limited value because of the difference in the categories of cost, the methods, and the pattern of health services utilization. This could be the main weakness of any cost of illness study.