Hospitalization costs of breast cancer before and after the implementation of the Health Sector Evolution Plan (HSEP), Iran, 2017: a retrospective single-centre study

Abstract Background An important objective of health systems is financial protection against out-of-pocket health expenditure. In Iran, the Health Sector Evolution Plan (HSEP) has been implemented so as to achieve universal health coverage and decrease out-of-pocket health expenditure as a percentage of total health expenditure. Objectives This study aimed to compare the hospitalization costs of breast cancer before and after the implementation of the HSEP and its impact on patient co-payment in Iran (2017). Methods This study was a prevalence-based cost-of-illness study. A total of 151 patients (75 patients 3 years before and 76 patients 3 years after HSEP implementation) were included from a public hospital by the census method. Data were extracted from patients’ records and analyzed using SPSS software (Version 22). Results The total mean hospitalization costs increased significantly after the implementation of HSEP. Before and after the implementation of HSEP the total means (SDs) of hospitalization costs were estimated at 1489.44 (1609.33) PPP (purchasing power parity) and 4343.69 (5389.51) PPP, respectively. The percentage of patient co-payment decreased from 19.61% before the implementation of HSEP to 6.47% after its implementation, whereas the mean (SD) of patient contributions increased from 272.26 (334.50) PPP before the implementation of HSEP to 281.13 (307.22) PPP after its implementation. Conclusion The cost of breast cancer is substantial. After the implementation of HSEP, the percentage of patient co-payment decreased, but due to the increase in tariffs, hospitalization costs of breast cancer and the amount paid by a patient rose substantially. HSEP certainly requires more attention from health policy-makers.