Esophageal cancer patients in Addis Ababa, Ethiopia: cost of illness and factors associated with cost variability

Background:Esophageal cancer is the sixth leading cause of cancer-related death worldwide, causing approximately 500,000 deaths annually. Eastern Africa, including Ethiopia, bears a disproportionate burden of the disease. However, evidence on its economic burden remains limited.Objective:To estimate the cost of illness and identify factors associated with cost variability among esophageal cancer patients in Addis Ababa, Ethiopia.Methods:A facility-based cross-sectional study was conducted among 338 esophageal cancer patients attending six healthcare facilities in Addis Ababa between February 2019 and August 2020. Data were entered into Epi Info version 7 and analyzed using SPSS version 23. Descriptive statistics were used to summarize study variables. As cost data were not normally distributed, non-parametric tests were applied. The Mann–Whitney U test and Kruskal–Wallis test were used to compare costs between groups. Statistical significance was declared at p < 0.05.Results:The median outpatient cost of esophageal cancer care was 11,380.4 ETB (IQR: 6,700.0–17,200.0), with investigation costs accounting for the largest share of expenditures. Total direct outpatient and inpatient costs were 4,981,337.0 ETB and 1,769,002.0 ETB, respectively. Nearly half (46.5%) of patients required hospitalization, with a median inpatient cost of 9,450.0 ETB (IQR: 6,016.0–14,275.0). Cost variation was significantly associated with surgical intervention, stage at diagnosis, sex, and frequency of healthcare visits.Conclusions:Esophageal cancer imposes a substantial economic burden on patients. Higher costs were associated with advanced-stage disease, surgical treatment, male sex, and frequent healthcare visits. Strategies promoting early diagnosis may help reduce the financial burden of care.