Potential Catastrophic Health Expenditure Related to Treatment Cost for Families of Children With Orofacial Cleft in a Low-Middle-Income Country

ObjectiveTo investigate the likelihood of families with a child with orofacial cleft falling into catastrophic healthcare expenditure (CHE) due to financial burden of caring for the child.DesignCross-sectional descriptive study using a 35-item interviewer administered proforma.SettingA tertiary health institution in Lagos, Nigeria.ParticipantsAll consenting caregivers attending the orofacial cleft clinic within the study period.Main outcome measureThe primary outcome was the capacity of families to make out-of-pocket payment (CTP) for treatment.ResultsThis study enrolled 84 respondents, with CHE analysis based on 83 participants with complete income data. The approximate combined family monthly income of 77.4% was below ₦300,000(∼$222), supporting a median of five family members. A single government-subsidized surgical intervention can cost as much as ₦600,000(∼$444) out-of-pocket. Applying the WHO threshold of out-of-pocket expenditure exceeding 40% of household's capacity to pay(CTP), and using phenotype-specific cost pathways, an estimated 53.0% to 59.0% of families would face CHE from direct treatment costs, with no statistically significant difference across cleft phenotypes. For unilateral and bilateral cleft lip and palate, the 10-year direct cost of comprehensive cleft care at our center ranges from ₦2,975,000 to ₦3,980,000 (∼$2204-$2948), which exceeds the total annual income of many participating families.ConclusionThe result of this study reveals the frailty of the current healthcare financing model for orofacial cleft management in Nigeria and the urgent need for policy intervention to extend insurance coverage to the full multidisciplinary care pathway.