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BP11. Budget impact of implementing a financial navigation program for cancer patients in Nigeria

Friday, March 6, 2026
9:12 AM - 9:19 AM MST
Location: 301A

    Co-Author(s)

  • CK

    Ciaran Kohli-Lynch, PhD

    Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
    Chicago, Illinois, United States

  • RH

    Ricky Hill, PhD

    Northwestern University
    Chicago, Illinois, United States

  • KD

    Kristina M. Diaz, MSN RN CNL

    Department of Surgery, Robert J. Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine
    Chicago, Illinois, United States

  • FW

    Funmilola O. Wuraola, MBBS FWACS ChM

    Obafemi Awolowo University Teaching Hospitals Complex
    Ife-Ife, Osun, Nigeria

  • Chinenye Iwuji, BM BSc MSc PhD (she/her/hers)

    Head of Medical Oncology
    Department of Oncology, Lakeshore Cancer Center
    Lagos, Lagos, Nigeria

  • OI

    Oge Ilegbune, MBBS

    Lakeshore Cancer Center
    Lagos, Lagos, Nigeria

  • CN

    Chukumere Nwogu, MD, PhD

    Professor of Surgery
    Lakeshore Cancer Center; Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center
    New York, New York, United States

  • BC

    Bindiya Chugani, MSc

    Lakeshore Cancer Center
    Lagos, Lagos, Nigeria

  • LH

    Lisa Hirshchhorn, MD, MPH

    Department of Medical Social Sciences and Robert Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University
    Chicago, Illinois, United States

  • DS

    Dan Sherman, MA, LPC

    The NaVectis Group
    Grand Rapids, Michigan, United States

  • CL

    Clara Lambert, BBA, CPH

    TailorMed
    Chicago, Illinois, United States

  • Andrei Adin-Cristian, PhD

    Professor
    Department of Preventive Medicine, Division of Biostatistics and Informatics, Northwestern University, Feinberg School of Medicine
    Chicago, Illinois, United States

  • TK

    T. Peter Kingham, MD

    Professor
    Memorial Sloan Kettering Cancer Center
    New York, New York, United States

  • RC

    Ruohui Chen, PhD

    Department of Preventive Medicine, Division of Biostatistics and Informatics, Northwestern University, Feinberg School of Medicine
    Chicago, Illinois, United States

  • Juliet S. Lumati, MD MPH

    Assistant Professor| Department of Surgery| Division of Surgical Oncology
    Department of Surgery, Robert J. Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine
    Chicago, Illinois, United States

    • Primary Presenter(s)

  • Segun Afolaranmi, MD, MSc

    Resident
    Mayo Clinic
    Rochester, Minnesota, United States

Introduction: Out-of-pocket (OOP) spending is a leading cause  of financial catastrophe for cancer patients in low- and middle-income countries (LMICs). The COST-FIN randomized controlled trial tested whether a Financial Navigation Program (FNP) could mitigate financial toxicity (FT) and improve treatment adherence (TA) among Nigerian cancer patients. This analysis evaluated the budget impact (BI) and economic value of FNP implementation from both health-system and societal perspectives.


Methods: A BI analysis of the COST-FIN trial was conducted. The trial enrolled 159 adults with breast, colorectal, or prostate cancer across three Nigerian centers. 100 participants received 6 months of a structured FNP. Program costs—including navigator salaries, training, and administrative expenses—were prospectively collected.
Patient-level data on OOP expenditures, health-care utilization, and TA were abstracted from medical records. Financial catastrophe (FC) was defined as OOP spending exceeding 25% of total household expenditure (HHE). OOP costs were derived from patient receipts collected throughout the study, and household expenditure data were obtained at baseline. BI was estimated as mean differences in costs between trial arms. ROI was estimated as the ratio of financial benefit to program cost.


Results:

Median OOP costs decreased more rapidly among FNP participants than controls ($20 [₦30,000] vs $40 [₦60,000] at six months; $23 [₦30,000] reduction). The routine-care (RC) arm incurred approximately twice the median OOP cost of the FNP arm (Figure 1). FNP participants were less likely to experience FC than controls (OR 0.10; 95% CI 0.01–0.91; p = 0.04). No FNP participants discontinued treatment due to cost, compared with 15% of controls (p = 0.05).


At the program level, total implementation—including navigator salaries and coaching—averaged $19,000 [₦29 million] over the 15-month period (≈ $9,500 per navigator), corresponding to an average cost of $214 [₦320,000] per patient. Downstream benefits yielded mean savings of $300 [₦456,000] per patient, producing a net benefit of $8,000 [₦12 million] and an ROI of 40%, with greater efficiency observed at the public than the private sites.


Conclusions:

The FNP represents a low-cost, feasible, and economically favorable strategy to reduce FT and improve TA to cancer care in LMICs. ROI estimates indicate modest short-term returns with a strong trajectory toward long-term value. These results support integrating FNPs into national cancer-control strategies to enhance financial protection, treatment continuity, and equity in resource-limited settings.

Learning Objectives:

  • To evaluate the budget impact and economic value of a Financial Navigation Program for Nigerian cancer patients and demonstrate its potential for health-system adoption in LMICs.
  • To analyze the effects of financial navigation on out-of-pocket spending, treatment adherence, and financial catastrophe among cancer patients in resource-limited settings.
  • To identify key implementation factors influencing the scalability, cost-effectiveness, and sustainability of financial navigation programs in low- and middle-income health systems.