1
|
Muralidharan S, Gore M, Katkuri S. Cancer care and economic burden-A narrative review. J Family Med Prim Care 2023; 12:3042-3047. [PMID: 38361876 PMCID: PMC10866236 DOI: 10.4103/jfmpc.jfmpc_1037_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/05/2023] [Accepted: 08/09/2023] [Indexed: 02/17/2024] Open
Abstract
Cancer care poses a significant economic burden in India, where noncommunicable diseases contribute to a large number of deaths and disability-adjusted life-years. Despite economic growth, equitable wealth distribution remains a challenge, leading to inequalities in healthcare access. India's healthcare system is primarily privatized, financed through out-of-pocket expenditure (OOPE), and lacks coverage for a majority of the population. As a result, individuals without financial means face catastrophic health consequences when seeking necessary healthcare. OOPE in India's healthcare system is a major concern, with medicines accounting for a significant portion of expenses, followed by diagnostic tests and consultation fees. Nonmedical expenses also contribute to the financial burden. Cancer care specifically faces substantial financial challenges, with high treatment costs, reduced workforce participation, and the need for distress financing. Cancer-related OOPE is predominantly borne by patients and their families, leading to significant financial strain. The lack of comprehensive health insurance coverage and limited access to publicly funded healthcare services exacerbate the problem. Catastrophic health expenditure (CHE) in cancer care is prevalent, pushing households into financial distress and potentially impoverishment. Efforts have been made to address this issue, such as increasing public spending on healthcare and implementing health insurance schemes. However, challenges remain in ensuring their effectiveness and reach. The role of family care physicians is crucial in supporting patients and their families during catastrophic health expenditures related to cancer-related palliative care. They coordinate care, provide advocacy, emotional support, symptom management, and facilitate end-of-life discussions. Comprehensive measures are needed to strengthen healthcare infrastructure, improve access to affordable cancer care, enhance health insurance coverage, and implement supportive measures for cancer patients. Additionally, promoting preventive measures and early detection can help reduce the need for expensive treatments and decrease the risk of catastrophic health expenditures.
Collapse
Affiliation(s)
- Shrikanth Muralidharan
- PhD Scholar, Faculty of Medical and Health Sciences, Symbiosis Community Outreach Programme and Extension, Symbiosis International (Deemed University), Lavale, Tal: Mulshi, Pune, Maharashtra, India
| | - Manisha Gore
- Assistant Professor, Faculty of Medical and Health Sciences, Symbiosis Community Outreach Programme and Extension, Symbiosis International (Deemed University), Lavale, Tal: Mulshi, Pune, Maharashtra, India
| | - Sushma Katkuri
- Professor and PG Guide, Department of Community Medicine, Mallareddy Institute of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
2
|
Nanda M, Sharma R. A comprehensive examination of the economic impact of out-of-pocket health expenditures in India. Health Policy Plan 2023; 38:926-938. [PMID: 37409740 DOI: 10.1093/heapol/czad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 03/27/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023] Open
Abstract
More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.
Collapse
Affiliation(s)
- Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, Vivek Vihar Phase 2, Delhi 110095, India
| | - Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Vivek Vihar Phase 2, Delhi 110095, India
| |
Collapse
|
3
|
Shukla V, Arora R. The Economic Cost of Rising Non-communicable Diseases in India: A Systematic Literature Review of Methods and Estimates. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:719-730. [PMID: 37505413 DOI: 10.1007/s40258-023-00822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND OBJECTIVES India has one of the world's highest proportions of out-of-pocket expenditure (OOPE) payments. The low share of public health expenditure coupled with the double burden of disease (communicable and non-communicable) has a direct financial impact on individual OOPE and an indirect impact in the form of decreasing life expectancy, reduced productivity, and hence a negative impact on economic growth. This systematic review aims to compare and assess the estimated economic cost of non-communicable diseases (NCDs) in India and ascertain the methods used to derive these estimates. METHODS This paper reviews the past 12-year (2010-22) literature on the economic impact of health shocks due to NCDs. Three databases were searched for the literature: PubMed, Scopus, and Google Scholar. Thematic analysis has been performed to analyse the findings of the study. RESULTS The OOPE was very high for NCDs. The increasing cost was high and unaffordable, pushing many people into financial distress measured by catastrophic payments and rising impoverishment. CONCLUSION The results indicate both the direct and indirect impact of NCDs, but the indirect burden of loss of employment and productivity, despite its relevance, has been less studied in the literature. A robust economic analysis will allow an evidence-based policy decision perspective to reduce the rising burden of NCDs.
Collapse
Affiliation(s)
- Varsha Shukla
- Department of Economics and Finance, Birla Institute of Technology and Science, Pilani, Pilani Campus, Pilani, Rajasthan, 333031, India.
| | - Rahul Arora
- Department of Economics and Finance, Birla Institute of Technology and Science, Pilani, Pilani Campus, Pilani, Rajasthan, 333031, India
| |
Collapse
|
4
|
Mahajan H, Reddy N, Devi NGM, Poli UR, Jayaram M, Tetali S, Murthy GVS. Projected cancer burden, challenges, and barriers to cancer prevention and control activities in the state of Telangana. PLoS One 2023; 18:e0278357. [PMID: 37450553 PMCID: PMC10348541 DOI: 10.1371/journal.pone.0278357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/25/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND AIM The Telangana cancer care program is a proactive, comprehensive initiative encompassing infrastructure development, human resource skilling and ensuring financial protection to those below poverty line. The broad aim of this exercise was to identify modalities to augment the Telangana State Cancer Control Plan to implement a sustainable comprehensive cancer care model for Telangana. METHODS We conducted in-depth interviews of stakeholders (17 patients and 25 health care providers) to identify barriers and challenges to access existing cancer care system in Telangana; calculated the magnitude of cancer and commensurate workload (in terms of visits to tertiary cancer care system for cancer management and human and equipment requirement) for the next 15 years (from 2022 to 2037). Using the anecdotal evidence and information from stakeholders' interviews, we developed patient-journey funnels for oral, breast, and cervical cancer patients to highlight patient leakages at various levels of cancer care. RESULTS We estimated a 13%, 28%, and 44.7% increase in the number of new cancer cases and the resultant workload (number of visits to health care centre, chemotherapy sessions, radiotherapy sessions, surgeries, specialized human resources and equipment), for the year 2027, 2032, and 2037, respectively, compared to the year 2022. The stakeholders mentioned 'delayed access' to healthcare system as the main reason for the poor prognosis of patients. The common reasons cited for 'delayed access' were: poor cancer-literacy including prevailing myths and misconception, financial barriers, and rural residence. The patient journey funnel for cancer care revealed a major leakage from 'screened-positive' to 'diagnosis confirmation' step. The estimated patient leakage varied from ~70% to 90% from 'screened-positive' till 'treatment completion'. CONCLUSION In this study, we anticipated a steady increase in the number of new cancers cases and resultant workload for the state of Telangana from the year 2022 to 2037. This may further be accompanied with limited access or utilization of cancer care system. To manage this public health issue, government should take appropriate measures to improve cancer literacy at the community level as well as increase human resources and necessary equipment.
Collapse
Affiliation(s)
- Hemant Mahajan
- Department of Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Neha Reddy
- Department of Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - N. G. Marina Devi
- Department of Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Usha Rani Poli
- Department of Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - M Jayaram
- Department of Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Shailaja Tetali
- Department of Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - G. V. S. Murthy
- Department of Public Health, Indian Institute of Public Health, Hyderabad, Telangana, India
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
5
|
Goswami S, Gupta SS, Gangane N, Vyas V, Royburman A. Financial impact of oral cancer treatment on the households in rural India. Indian J Cancer 2023; 60:379-389. [PMID: 36861695 DOI: 10.4103/ijc.ijc_224_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background Oral cancer ranks second and accounts for over 20% of all cancers reported in India. Like management of all other cancers, oral cancers bring a heavy financial burden to their families. This study analyzes the financial burden on families during the management of oral cancer at Kasturba Hospital, Sewagram, a government-aided tertiary health care facility in central India. Methods The hospital-based cross-sectional study was conducted in the cancer unit of a government-aided tertiary hospital of central India. A total of 100 patients with oral cancer being treated in the hospital were included in the study. Information regarding cost incurred on management of oral cancer was inquired from a close family member or a caregiver of the study subjects. Results The out-of-pocket expenditure on treatment of oral cancer was approximately INR 100,000 (USD 1363). It has been found that 96% of families experienced catastrophic health expenditure as a result of treatment. Conclusion Although India aims for universal health coverage, it is important to protect cancer patients from catastrophic health expenditure.
Collapse
Affiliation(s)
- Sourav Goswami
- Labcorp Scientific Services and Solutions Private Limited, Pune, Maharashtra, India
| | | | - Nitin Gangane
- Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India
| | - Virendra Vyas
- Department of Radiotherapy, MGIMS, Sevagram, Wardha, Maharashtra, India
| | - Aroop Royburman
- Regional Cancer Center, Agartala Government Medical College, Agartala, Tripura, India
| |
Collapse
|
6
|
Ostermann J, Hair N, Grzimek V, Zheng S, Gong W, Whetten K, Thielman N. How Poor Is Your Sample? A Simple Approach for Estimating the Relative Economic Status of Small and Nonrepresentative Samples. GLOBAL HEALTH: SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00394. [PMID: 37116936 PMCID: PMC10141430 DOI: 10.9745/ghsp-d-22-00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/21/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Asset-based indices of living standards, or wealth indices, are widely used proxies for economic status; however, such indices are not readily available for small and nonrepresentative samples. METHODS We describe a simple out-of-sample prediction approach that uses estimates from large and representative "reference" samples to calculate measures of relative economic status (e.g., wealth index scores) for small and/or nonrepresentative "target" samples. The method relies on the availability of common variables and assumptions about comparable associations between these variables and the underlying construct of interest (e.g., household wealth). We provide 2 sample applications that use Demographic and Health Surveys (DHS) from 5 countries as reference samples. Using ordinary least squares regression, we estimate associations between household characteristics and the DHS wealth index. We use parameter estimates to predict wealth index scores for small nonrepresentative target samples. Comparisons of wealth distributions in the reference and target samples highlight selection effects. RESULTS Applications of the approach to diverse populations, including populations at high risk of HIV infection and households with orphaned and separated children, demonstrate its usefulness for characterizing the economic status of small and nonrepresentative samples relative to existing reference samples. Women and men in northern Tanzania at high risk of HIV infection were concentrated in the upper half of the wealth distribution. By contrast, the relative distribution of household wealth among households with orphaned and separated children varied greatly across countries and rural versus urban settings. CONCLUSIONS Public health professionals who implement, manage, and evaluate programs in low- and middle-income countries may find this approach applicable because of the simplicity of the estimation methods, low marginal cost of primary data acquisition, and availability of established measures of relative economic status in many publicly available household surveys (e.g., those administered by the DHS Program, World Bank, International Labour Organization, and UNICEF).
Collapse
Affiliation(s)
| | - Nicole Hair
- University of South Carolina, Columbia, SC, USA
| | | | - Siyu Zheng
- University of South Carolina, Columbia, SC, USA
| | | | | | | |
Collapse
|
7
|
Goyanka R, Yadav J, Sharma P. Financial burden and coping strategies for cancer care in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
|
8
|
Chen S, Cao Z, Prettner K, Kuhn M, Yang J, Jiao L, Wang Z, Li W, Geldsetzer P, Bärnighausen T, Bloom DE, Wang C. Estimates and Projections of the Global Economic Cost of 29 Cancers in 204 Countries and Territories From 2020 to 2050. JAMA Oncol 2023; 9:465-472. [PMID: 36821107 PMCID: PMC9951101 DOI: 10.1001/jamaoncol.2022.7826] [Citation(s) in RCA: 146] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Importance Cancers are a leading cause of mortality, accounting for nearly 10 million annual deaths worldwide, or 1 in 6 deaths. Cancers also negatively affect countries' economic growth. However, the global economic cost of cancers and its worldwide distribution have yet to be studied. Objective To estimate and project the economic cost of 29 cancers in 204 countries and territories. Design, Setting, and Participants A decision analytical model that incorporates economic feedback in assessing health outcomes associated with the labor force and investment. A macroeconomic model was used to account for (1) the association of cancer-related mortality and morbidity with labor supply; (2) age-sex-specific differences in education, experience, and labor market participation of those who are affected by cancers; and (3) the diversion of cancer treatment expenses from savings and investments. Data were collected on April 25, 2022. Main Outcomes and Measures Economic cost of 29 cancers across countries and territories. Costs are presented in international dollars at constant 2017 prices. Results The estimated global economic cost of cancers from 2020 to 2050 is $25.2 trillion in international dollars (at constant 2017 prices), equivalent to an annual tax of 0.55% on global gross domestic product. The 5 cancers with the highest economic costs are tracheal, bronchus, and lung cancer (15.4%); colon and rectum cancer (10.9%); breast cancer (7.7%); liver cancer (6.5%); and leukemia (6.3%). China and the US face the largest economic costs of cancers in absolute terms, accounting for 24.1% and 20.8% of the total global burden, respectively. Although 75.1% of cancer deaths occur in low- and middle-income countries, their share of the economic cost of cancers is lower at 49.5%. The relative contribution of treatment costs to the total economic cost of cancers is greater in high-income countries than in low-income countries. Conclusions and Relevance In this decision analytical modeling study, the macroeconomic cost of cancers was found to be substantial and distributed heterogeneously across cancer types, countries, and world regions. The findings suggest that global efforts to curb the ongoing burden of cancers are warranted.
Collapse
Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhong Cao
- Institute for Artificial Intelligence, Tsinghua University, Beijing, China,State Key Lab of Intelligent Technologies and Systems, Beijing National Research Center for Information Science and Technology, Department of Automation, Tsinghua University, Beijing, China
| | - Klaus Prettner
- Vienna Institute of Demography, Wittgenstein Centre, International Institute for Applied Systems Analysis, OeAW, University of Vienna, Vienna, Austria,Vienna University of Economics and Business (WU), Department of Economics, Vienna, Austria
| | - Michael Kuhn
- Vienna Institute of Demography, Wittgenstein Centre, International Institute for Applied Systems Analysis, OeAW, University of Vienna, Vienna, Austria,International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Juntao Yang
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lirui Jiao
- Columbia Mailman School of Public Health, New York, New York
| | - Zhuoran Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China,Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan, China
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - David E. Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,National Clinical Research Center for Respiratory Diseases, Beijing, China,Chinese Academy of Engineering, Beijing, China
| |
Collapse
|
9
|
Panda BK, Mohanty SK. Catastrophic health spending among older adults in India: Role of multiple deprivation. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
10
|
Rao HB, Sastry NB, Venu RP, Pattanayak P. The role of artificial intelligence based systems for cost optimization in colorectal cancer prevention programs. Front Artif Intell 2022; 5:955399. [PMID: 36248620 PMCID: PMC9563712 DOI: 10.3389/frai.2022.955399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Colorectal Cancer (CRC) has seen a dramatic increase in incidence globally. In 2019, colorectal cancer accounted for 1.15 million deaths and 24.28 million disability-adjusted life-years (DALYs) worldwide. In India, the annual incidence rates (AARs) for colon cancer was 4.4 per 100,000. There has been a steady rise in the prevalence of CRC in India which may be attributed to urbanization, mass migration of population, westernization of diet and lifestyle practices and a rise of obesity and metabolic risk factors that place the population at a higher risk of CRC. Moreoever, CRC in India differs from that described in the Western countries, with a higher proportion of young patients and more patients presenting with an advanced stage. This may be due to poor access to specialized healthcare and socio-economic factors. Early identification of adenomatous colonic polyps, which are well-recognized pre-cancerous lesions, at the time of screening colonoscopy has been shown to be the most effective measure used for CRC prevention. However, colonic polyps are frequently missed during colonoscopy and moreover, these screening programs necessitate man-power, time and resources for processing resected polyps, that may hamper penetration and efficacy in mid- to low-income countries. In the last decade, there has been significant progress made in the automatic detection of colonic polyps by multiple AI-based systems. With the advent of better AI methodology, the focus has shifted from mere detection to accurate discrimination and diagnosis of colonic polyps. These systems, once validated, could usher in a new era in Colorectal Cancer (CRC) prevention programs which would center around “Leave in-situ” and “Resect and discard” strategies. These new strategies hinge around the specificity and accuracy of AI based systems in correctly identifying the pathological diagnosis of the polyps, thereby providing the endoscopist with real-time information in order to make a clinical decision of either leaving the lesion in-situ (mucosal polyps) or resecting and discarding the polyp (hyperplastic polyps). The major advantage of employing these strategies would be in cost optimization of CRC prevention programs while ensuring good clinical outcomes. The adoption of these AI-based systems in the national cancer prevention program of India in accordance with the mandate to increase technology integration could prove to be cost-effective and enable implementation of CRC prevention programs at the population level. This level of penetration could potentially reduce the incidence of CRC and improve patient survival by enabling early diagnosis and treatment. In this review, we will highlight key advancements made in the field of AI in the identification of polyps during colonoscopy and explore the role of AI based systems in cost optimization during the universal implementation of CRC prevention programs in the context of mid-income countries like India.
Collapse
Affiliation(s)
- Harshavardhan B. Rao
- Department of Gastroenterology, M.S. Ramaiah Medical College, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
- *Correspondence: Harshavardhan B. Rao
| | - Nandakumar Bidare Sastry
- Department of Gastroenterology, M.S. Ramaiah Medical College, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| | - Rama P. Venu
- Department of Gastroenterology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Preetiparna Pattanayak
- Department of Gastroenterology, M.S. Ramaiah Medical College, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| |
Collapse
|
11
|
Karan A, Farooqui HH, Hussain S, Hussain MA, Selvaraj S, Mathur MR. Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017-18. BMC Health Serv Res 2022; 22:1151. [PMID: 36096819 PMCID: PMC9469515 DOI: 10.1186/s12913-022-08509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure. METHODS We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017-2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households. RESULTS Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674-46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359-63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest. CONCLUSIONS Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.
Collapse
Affiliation(s)
- Anup Karan
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Suhaib Hussain
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Sakthivel Selvaraj
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, 122002, India
| | - Manu Raj Mathur
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India. .,Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, New Road, London, E1 2AT, UK.
| |
Collapse
|
12
|
Harsvardhan R, Arora T, Singh S, Lal P. Cost Analysis on Total Cost Incurred (Including Out-of-pocket Expenditure and Social Cost) During Palliative Care in Cases of Head-and-Neck Cancer at a Government Regional Cancer Centre in North India. Indian J Palliat Care 2022; 28:419-427. [DOI: 10.25259/ijpc_23_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives:
Palliative care involves providing symptomatic relief from the pain and stress of a severe illness to markedly improve the quality of life for both the patients and their families. It imposes high indirect costs on the patients. The study was conducted at SGPGIMS, which caters to 500 head-and-neck cancer patients annually. Out of these, 30–40% of cases require dedicated palliative care. Unfortunately, often, when patients reach the stage of palliative care, they have exhausted their all financial reserves. Therefore, a cost analysis of total cost incurred (including out-of-pocket expenditure and social cost) during palliative care in cases of head-and-neck cancer at a Government Regional Cancer Centre was undertaken.
Material and Methods:
The study is a descriptive study and the study sample consisted of (a) patients who had undergone surgery, chemotherapy, or radiotherapy and had recurred/relapsed and were now candidates for palliative care and (b) patients who presented de novo to the Regional Cancer Centre, SGPGIMS with advanced-stage disease, where the cure was not possible. The expenditure incurred was obtained retrospectively and prospectively from the study samples.
Results:
The out-of-pocket expenditure per patient per day was INR 2044.21. The social cost per patient per day was INR 518.21. Out of the total expenditure of INR 2562.42/patient/day, 80% of the cost was out-of-pocket expenditure and the remaining 20% was social cost borne by the patient.
Conclusion:
The study thus added to perspective on the average expenditure on out-of-pocket expenses and social costs being incurred as of date, while getting palliative care for head-and-neck cancer at a Regional Cancer Centre.
Collapse
Affiliation(s)
- Rajesh Harsvardhan
- Department of Hospital Administration, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,
| | - Tanvi Arora
- Department of Hospital Administration, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,
| | - Saurabh Singh
- Department of Hospital Administration, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,
| | - Punita Lal
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,
| |
Collapse
|
13
|
Sharma B, Mehta A, Farooqui HH, Negandhi H, Selvaraj S. Impact of the Drug Prices Control Order (2013) on the Utilization of Anticancer Medicines in India: An Interrupted Time-Series Analysis. Cureus 2022; 14:e26367. [PMID: 35911346 PMCID: PMC9329597 DOI: 10.7759/cureus.26367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives The National Pharmaceutical Pricing Authority introduced a series of Drug Prices Control Orders since 1970 to regulate the prices of essential medicines in India. This study evaluated the impact of the Drug Prices Control Order of 2013 on the utilization of anticancer medicines in the Indian private sector. Methods We used monthly sales audit data for a period of 2012-15, provided by Intercontinental Medical Statistics (IMS) Health. Through interrupted time series design and segmented regression models, we estimated the change in utilization of anticancer medicines following the drug pricing policy implementation. Results Of 1556 anticancer drug packs, 22.3% (n= 347) were price-controlled. The policy led to an immediate monthly reduction of 27.3% (95% CI -38.6%, -13.9%; p=0.001) and a long-term monthly reduction of 0.7% (95% CI -1.6%, 0.3%; p=0.16) in price-controlled formulation’s utilization. In the final study month, the price-controlled formulation’s utilization was 5.03 thousand standard units lower than what would have been expected without the policy. Melphalan showed the highest immediate reduction, and alpha-interferon showed the highest long-term reduction in utilization. Conclusion Drug prices control order 2013 caused an immediate and long-term decline in the utilization of anticancer medicines in the Indian private sector. However, study data was limited to a specific part of the Indian anticancer drug market, which must be considered when interpreting findings.
Collapse
|
14
|
Choudhury HK, Borah RK. Can financial incentives encourage women to participate in a cervical cancer screening programme? Evidence from a randomized controlled trial analysis. J Cancer Policy 2022; 32:100324. [DOI: 10.1016/j.jcpo.2022.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/18/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
|
15
|
Boby JM, Rajappa S, Mathew A. Financial toxicity in cancer care in India: a systematic review. Lancet Oncol 2021; 22:e541-e549. [PMID: 34856151 DOI: 10.1016/s1470-2045(21)00468-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022]
Abstract
Although financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and outcome among the Indian population. In this study, we systematically reviewed the prevalence, determinants, and consequences of financial toxicity among patients with cancer in India. 22 studies were included in the systematic review. The determinants of financial toxicity include household income, type of health-care facility used, stage of disease, area of residence, age at the time of diagnosis, recurrent cancer, educational status, insurance coverage, and treatment modality. Financial toxicity was associated with poor quality of life, accumulation of debts, premature entry into the labour market, and non-compliance with therapy. Our findings emphasise the need for urgent strategies to mitigate financial toxicity among patients with cancer in India, especially in the most deprived sections of society. The qualitative evidence synthesised in this systematic review could provide a basis for the development of such interventions to reduce financial toxicity among patients with cancer.
Collapse
Affiliation(s)
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Aju Mathew
- Malankara Orthodox Syrian Church Medical College, Kolenchery, India.
| |
Collapse
|
16
|
Catastrophic expenditure rates and barriers for treatment adherence in patients with colorectal cancer in India: The CROCODILE study protocol. Colorectal Dis 2021; 23:2161-2172. [PMID: 33848062 DOI: 10.1111/codi.15674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
Abstract
AIM Little is known about the delivery of colorectal cancer treatment in India and its associated costs. The aim of this study is to identify financial and nonfinancial barriers to adherence to colorectal cancer treatment in India. METHOD CROCODILE is a mixed-methods study with a quantitative and a qualitative workstream. The quantitative workstream will be a prospective cohort study to assess treatment adherence and catastrophic expenditure rates among patients with colorectal cancer in India. Consecutive newly diagnosed patients with histopathologically proven colorectal cancer from five tertiary hospitals in India will be included. Catastrophic expenditure will be defined as a treatment cost higher than 40% of nonsubsistence annual household income. Treatment costs will include medical, nonmedical and indirect expenses. Income assessment will be compared between three methods: patient-reported income, the International Wealth Index and the Gapminder tool. The qualitative workstream will explore the views and experiences of colorectal cancer patients and professionals about barriers to and facilitators for treatment adherence. Individual semistructured interviews with three to five patients and cancer care professionals in each centre will be performed. An analytical framework will be developed to perform the analysis, through a combined approach (deductive and inductive). The results will be triangulated with the quantitative workstream for mutual knowledge enrichment. CONCLUSION The CROCODILE study will identify barriers to and facilitators for colorectal cancer delivery in India, influencing research and policy decisions. It will explore the feasibility of collecting data on patient-level costs and income to inform future economic evaluations in cancer and surgical care.
Collapse
|
17
|
Slavova-Azmanova NS, Newton JC, Johnson CE, Hohnen H, Ives A, McKiernan S, Platt V, Bulsara M, Saunders C. A cross-sectional analysis of out-of-pocket expenses for people living with a cancer in rural and outer metropolitan Western Australia. AUST HEALTH REV 2021; 45:148-156. [PMID: 33587885 DOI: 10.1071/ah19265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/15/2020] [Indexed: 11/23/2022]
Abstract
Objective To determine the extent of medical and non-medical out-of-pocket expenses (OOPE) among regional/rural and outer metropolitan Western Australian patients diagnosed with cancer, and the factors associated with higher costs. Methods Cross-sectional data were collected from adult patients living in four regional/rural areas and two outer metropolitan regions in Western Australia who had been diagnosed with breast, prostate, colorectal or lung cancer. Consenting participants were mailed demographic and financial questionnaires, and requested to report all OOPE related to their cancer treatment. Results The median total OOPE reported by 308 regional/rural participants and 119 outer metropolitan participants were A$1518 (interquartile range (IQR): A$581-A$3769) and A$2855 (IQR: A$958-A$7142) respectively. Participants most likely to experience higher total OOPE were younger than 65 years of age, male, resided in the outer metropolitan area, worked prior to diagnosis, had private health insurance, were in a relationship, and underwent surgery. Multivariate analysis of regional/rural participants revealed that receiving care at a rural cancer centre was associated with significantly lower non-medical OOPE (estimated mean A$805, 95% confidence interval (CI): A$735-A$875, P=0.038; compared with other rural participants (A$1347, 95% CI: A$743-A$1951, P<0.001)). Conclusion The cancer patients who participated in this study experienced variation in OOPE, with outer metropolitan participants reporting higher OOPE compared with their regional/rural counterparts. There is a need for cost transparency and access to care close to home, so that patients can make informed choices about where to receive their care. What is known about the topic? In recent years, OOPE for health care in general and cancer in particular have been widely debated by consumers and not-for-profit organisations; the topic has attracted much political attention because it affects both equity and access to care and has wider financial implications for the community. Research studies and reports from both consumer organisations and a Ministerial Advisory Committee found that cancer patients can face exorbitant out-of-pocket costs, and that individuals with private health insurance and those with prostate and breast cancer reported higher costs. In Western Australia, a cancer centre providing comprehensive cancer care was established in the second most populous region to ameliorate the high costs for travel and accommodation that regional cancer patients are known to experience. What does this paper add? This study is unique because it collected detailed cost information from patients and reports on the OOPE of regional/rural and outer metropolitan Western Australian patients receiving care for one of the four most common cancers; it therefore offers novel insight into the experiences of these groups. This study demonstrates that outer metropolitan cancer patients are experiencing much higher OOPE compared with regional/rural cancer patients. Additionally, regional/rural study participants who accessed a Regional Cancer Centre experienced significantly lower non-medical OOPE, compared with regional/rural study participants receiving care elsewhere. What are the implications for practitioners? First, there is a need for improved communication of OOPE to minimise costs to the patient, for example, by facilitating access to local cancer care. Health service providers and insurance companies can improve cost transparency for cancer patients by making this information more readily available, allowing patients to make informed financial choices about where to seek care. Second, the needs of working patients deserve specific attention. These patients face significant work uncertainty and additional distress following a cancer diagnosis.
Collapse
Affiliation(s)
- Neli S Slavova-Azmanova
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ; ; and Corresponding author.
| | - Jade C Newton
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
| | - Claire E Johnson
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ; ; and School of Nursing and Midwifery, Monash University, Wellington Road, Clayton, Vic. 3800, Australia; and Eastern Health, 5 Arnold Street, Box Hill, Vic. 3128, Australia.
| | - Harry Hohnen
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
| | - Angela Ives
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
| | - Sandy McKiernan
- Cancer Council Western Australia, Perth, WA 6008, Australia.
| | - Violet Platt
- WA Cancer and Palliative Care Network, North Metropolitan Health Service, 4th Floor A Block, Verdun Street, Nedlands, WA 6009, Australia.
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, 32 Mouat Street, Fremantle, WA 6959, Australia.
| | - Christobel Saunders
- UWA Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6099, Australia. ; ; ;
| |
Collapse
|
18
|
Singh AG, Chaukar D, Gupta S, Pramesh CS, Sullivan R, Chaturvedi P, Badwe R. A prospective study to determine the cost of illness for oral cancer in India. Ecancermedicalscience 2021; 15:1252. [PMID: 34267808 PMCID: PMC8241452 DOI: 10.3332/ecancer.2021.1252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 12/24/2022] Open
Abstract
India accounts for almost a third of the global burden of oral cancer, a situation worsened by the inability to afford care. When available, aid is often insufficient, and costing is based on informal estimations. This study objectively determines direct healthcare costs of oral cancer in India. The study was performed from a healthcare provider's perspective using a validated bottom-up method. Care pathways were determined by prospectively observing the natural management of 100 oral cancer patients treated between October 2019 and March 2020. Specific costing categories were built across services, and apportioned values for each interaction was averaged. Costs of treatment and service utilisation were obtained using probabilistic sensitivity analyses. The unit cost of treating advanced stages (United States Dollar (USD) 2,717) was found to be 42% greater than early stages (USD1,568). There was an 11% reduction in unit costs with increases in socioeconomic status. Medical equipment accounted for 97.8% of capital costs, with the highest contributor being imaging services. Variable costs for surgery in advanced stages were 1.4 times higher than early stages. Compared to surgery alone, the average cost of treatment increased by 44.6% with adjuvant therapy. These results show that over the next decade, India will incur an economic burden of USD 3 billion towards the direct healthcare of oral cancer. Early detection and prevention strategies leading to 20% reduction in advanced stage disease could save USD 30 million annually. These results are critical to deliver a disease-driven and objective reform for oral cancer care.
Collapse
Affiliation(s)
| | | | - Sudeep Gupta
- Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - C S Pramesh
- Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Richard Sullivan
- Institute of Cancer Policy, Guy’s Hospital, St Thomas Street, London SE1 9RT, UK
| | | | | |
Collapse
|
19
|
Socioeconomic Impact of Hospitalization Expenditure for Treatment of Noncommunicable Diseases in India: A Repeated Cross-Sectional Analysis of National Sample Survey Data, 2004 to 2018. Value Health Reg Issues 2021; 24:199-213. [PMID: 33845450 DOI: 10.1016/j.vhri.2020.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This article explores the consequences of hospitalization expenditure on noncommunicable diseases (NCD) and its impact on out-of-pocket expenditure (OOPE), catastrophic health expenditure, impoverishment, and hardship financing of households in India. METHODS Data on hospitalized cases of NCDs from the 3 rounds of National Sample Surveys (NSS) (2004, 2014, 2018) were used. Bivariate and multivariate analyses were conducted to investigate the socioeconomic differentials of the impact of OOPE on catastrophic health expenditure, impoverishment, and exposure to hardship financing. RESULTS Rural households had greater exposure to catastrophic health expenditure but urban households had higher risk of impoverishment due to OOPE. Older patients (aged ≥60 years) had the highest hospitalization rate per 100 000, including increase in average healthcare expenditure from 2004 to 2018. At 10% and 30% thresholds, 50% and 25% of the households, respectively, faced catastrophic health expenditure across all the 3 rounds. Due to OOPE on hospitaliation treatment for NCDs, about 3.8%, 7.4% and 4.8% of households fell below poverty line, and percentage shortfall in income for the population from the poverty line was 3%, 4.9% and 3%, in 2004, 2014 and 2018 respectively. Percentage of households facing hardship financing reduced from 49.2% in 2004 to 24.4% 2014 and 12.7% in 2018. CONCLUSION OOPE by households are still very high and hence the higher effects of CHE, impoverishment and exposure to hardship financing due to health expenditure in India. This study proposes that along with increase in budgetary allocations for healthcare, the government should develop suitable policies to expand the effectiveness of government-sponsored health insurance, such as developing a specific NCD service package to be included in the health insurance program.
Collapse
|
20
|
Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review. Curr Oncol 2021; 28:1216-1248. [PMID: 33804288 PMCID: PMC8025828 DOI: 10.3390/curroncol28020117] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. METHODS A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. RESULTS Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15-400 in Canada, USD 4-609 in Western Europe, and USD 58-438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40-71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. CONCLUSIONS We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.
Collapse
Affiliation(s)
- Nicolas Iragorri
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| | - Claire de Oliveira
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M6J 1H4, Canada
| | | | - Beverley Essue
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| |
Collapse
|
21
|
Dhankhar A, Kumari R, Bahurupi YA. Out-of-Pocket, Catastrophic Health Expenditure and Distress Financing on Non-Communicable Diseases in India: A Systematic Review with Meta-Analysis. Asian Pac J Cancer Prev 2021; 22:671-680. [PMID: 33773528 PMCID: PMC8286691 DOI: 10.31557/apjcp.2021.22.3.671] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this systematic review is to determine pooled estimates of out-of-pocket (OOPE) and catastrophic health expenditure (CHE), correlates of CHE, and most common modes of distress financing on the treatment of selected non-communicable disease (cancer) among adults in India. Methods: PubMed, Scopus and Embase were searched for eligible studies using strict inclusion and exclusion criteria. Data was extracted and pooled estimates using random effects model of meta-analysis were determined for different types of costs. Forest plots were created and heterogeneity among studies was checked. Results: The pooled estimate of direct OOPE on inpatient and outpatient cancer care were 83396.07 INR (4405.96 USD) (95% CI = 44591.05-122202.0) and 2653.12 (140.17 USD) INR (95% CI = -251.28-5557.53), respectively, total direct OOPE was 47138.95 INR (2490.43 USD) (95% CI = 37589.43-56690.74), indirect OOPE was 11908.50 INR (629.15 USD) (95% CI=-5909.33-29726.31) and proportion of individuals facing CHE was 62.7%. However, high heterogeneity was observed among the studies. Savings, income, borrowing money and sale of assets were the most common modes of distress financing for cancer treatment. Conclusion: Income- and treatment-related cancer policies are needed to address the evidently high and unaffordable cancer treatment cost. Economic studies are needed for estimating all types of costs using standardised definitions and tools for precise estimates. Robust cancer database/registries and programs focusing on affordable cancer care can reduce the economic burden and prevent impoverishment.
Collapse
Affiliation(s)
- Anushikha Dhankhar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Ranjeeta Kumari
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh A Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| |
Collapse
|
22
|
Joshi S, Joshi U, Bahl A, Arya D, Anand AK, Arora RS. Exploring the Financial Toxicities of Patients with Locally Advanced Head and Neck Malignancies, Being Treated in a Private Sector Hospital in North India: A Thematic Analysis. Indian J Palliat Care 2021; 27:118-125. [PMID: 34035629 PMCID: PMC8121222 DOI: 10.4103/ijpc.ijpc_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The high cost of cancer diagnosis and treatment is a global concern. Evidence derived, mostly from high-income countries, shows how it gradually impacts the personal and household financial condition causing the increased psychosocial burden of the patient and their families (termed “financial toxicity”). Aim: To qualitatively explore the financial toxicities in patients with advanced head and neck malignancies in India, and to consider how it impacts the patient and his family. Methods: Interviewing a purposive sample of 8 patients using semi-structured interviews face to face. Interviews were transcribed verbatim, and a thematic content analysis was carried out. Results: Four major themes were identified: burden and amplifying factors, impact, rescue and relieving factors, and learning and innovation. The burden of cost relates to diagnosis, treatment and non-medical costs which gets amplified while navigating the healthcare labyrinth. Emerging themes describe financial journey of cancer patients, the issues faced by them and the ways they tackle these issues during their treatment. Healthcare system factors like limited availability of adequate/comprehensive/meaningful insurance and reimbursements potentiate the toxicity. The financial toxicity leads to a significant adverse financial, psychological and social impact on the patient and the family. While moving through the process of care, there were a few learnings and innovations which patients proposed. Conclusion: This study provides qualitative evidence of the considerable and pervasive nature of financial toxicity in head and neck cancer patients in India. The findings have implications for all cancer patients and highlight the unmet need of psychosocial support for these patients.
Collapse
Affiliation(s)
- Saurabh Joshi
- Consultant Palliative and Pain Medicine, Hospice India, New Delhi, India
| | - Upkar Joshi
- Senior Finance and Economics Expert, Founder Ascent Wealth Desk, Visiting Faculty- Delhi University, New Delhi, India
| | - Ankur Bahl
- Senior Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - Devavrat Arya
- Principal Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - A K Anand
- Chief Radiation Oncology and Senior Director, Max Super Specialty Hospital, New Delhi, India
| | - Ramandeep Singh Arora
- Senior Consultant, Paediatric Oncology, Max Super Speciality Hospital, New Delhi, India
| |
Collapse
|
23
|
Sleeman KE, Gomes B, de Brito M, Shamieh O, Harding R. The burden of serious health-related suffering among cancer decedents: Global projections study to 2060. Palliat Med 2021; 35:231-235. [PMID: 32945226 PMCID: PMC7797611 DOI: 10.1177/0269216320957561] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. AIM To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. DESIGN Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016-2060) with estimates of serious health-related suffering among cancer decedents. RESULTS By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016-2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. CONCLUSIONS Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.
Collapse
Affiliation(s)
- Katherine E Sleeman
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Barbara Gomes
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maja de Brito
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Richard Harding
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| |
Collapse
|
24
|
Singh MP, Chauhan AS, Rai B, Ghoshal S, Prinja S. Cost of Treatment for Cervical Cancer in India. Asian Pac J Cancer Prev 2020; 21:2639-2646. [PMID: 32986363 PMCID: PMC7779435 DOI: 10.31557/apjcp.2020.21.9.2639] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cervical cancer is a major public health problem in India leading to high economic burden, which is disproportionately borne by the patients as out-of-pocket expenditure (OOPE). Several publicly financed health insurance schemes (PFHIs) in India cover the treatment for cervical cancer. However, the provider payment rates for health benefit packages (HBP) under these PFHIs are not based on scientific evidence. We undertook this study to estimate the cost of services provided for treatment of cervical cancer and cost of the package of care for cervical cancer in India. METHODS The study was undertaken at a large public tertiary hospital in North India. The health system cost was assessed using a mixed micro-costing approach. The data were collected for all the resources utilized during service delivery for cervical cancer patients. To evaluate the OOPE, randomly selected 248 patients were interviewed following the cost of illness approach. Logistic regression was used to assess the factors associated with catastrophic health expenditure (CHE). RESULTS Health system cost for different cervical cancer treatment modalities i.e. radiotherapy, brachytherapy, chemotherapy and surgery, ranges from INR 19,494 to 41,388 (USD 291 - 617). Furthermore, patients spent INR 4,042 to 23,453 ( USD 60 - 350) as OOPE. Nearly 62% patients incurred CHE, and 30% reported distress financing. The odds of CHE (OR: 25.39, p-value: <0.001) and distress financing (OR: 15.37, p-value: 0.001) were significantly higher in poorest-income quintile. The HBP cost varies from INR 45,364 to 64,422 (USD 676 - 960) for brachytherapy and radiotherapy respectively. CONCLUSION Cervical cancer treatment leads to high OOPE in India, which imposes financial hardship, especially for the poorest. The coverage of risk pooling mechanisms like PHFIs should be enhanced. The findings of our study should be used to set the reimbursement rates of providing cervical cancer treatment under PFHI schemes.
Collapse
Affiliation(s)
- Maninder Pal Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Bhavana Rai
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sushmita Ghoshal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| |
Collapse
|
25
|
Vias P, Pandey A, Mangwana S, Kaur S, Dimri K, Walia D. The hospital-based socioeconomic study to assess the financial toxicity among cancer survivors. CLINICAL CANCER INVESTIGATION JOURNAL 2020. [DOI: 10.4103/ccij.ccij_26_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
26
|
Bose M, Banerjee S. Equity in distribution of public subsidy for noncommunicable diseases among the elderly in India: an application of benefit incidence analysis. BMC Public Health 2019; 19:1735. [PMID: 31878911 PMCID: PMC6933745 DOI: 10.1186/s12889-019-8089-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/15/2019] [Indexed: 12/02/2022] Open
Abstract
Background Rapid ageing of the population and increasing non-communicable diseases (NCDs) among the elderly is one of the major public health challenges in India. To achieve the Universal Health Coverage, ever-growing elderly population should have access to needed healthcare, and they should not face any affordability related challenge. As most of the elderly suffers from NCDs and achieving health-equity is a priority, this paper aims to - study the utilization pattern of healthcare services for treatment of NCDs among the elderly; estimate the burden of out-of-pocket expenditure for the treatment of NCDs among the elderly and analyze the extent of equity in distribution of public subsidy for the NCDs among the elderly. Methods National Sample Survey data (71st round) has been used for the study. Exploratory data analysis and benefit incidence analysis have been applied to estimate the utilization, out-of-pocket expenditure and distribution of public subsidy among economic classes. Concentration curves and indices are also estimated. Results Results show that public-sector hospitalization for NCDs among the elderly has a pro-rich trend in rural India. However, in urban sector, for both inpatient and outpatient care the poorest class has substantial share in utilization of public facilities. Same result is also observed for rural outpatient care. Analysis shows that out-of-pocket expenditure is very high for both medicine and medical care even in public facilities for all economic groups. It is also observed that medicine has the highest share in total medical expenses during treatment of NCDs among the elderly in both the region. Benefit incidence analysis shows that the public subsidy has a pro-rich distribution for inpatient care treatment in both the sectors. In case of outpatient care, subsidy share is the maximum among the richest in the urban sector and in the rural region the poorest class gets the maximum subsidy benefit. Conclusions It is evident that a substantial share of the public subsidies is still going to the richer sections for the treatment of NCDs among the elderly. Evidences also suggest that procuring medicines and targeted policies for the elderly are needed to improve utilization and equity in the public healthcare system.
Collapse
Affiliation(s)
- Montu Bose
- Department of Business & Sustainability, TERI School of Advanced Studies, New Delhi, India.
| | - Somdutta Banerjee
- Department of Economics, Indian Institute of Foreign Trade, New Delhi, India
| |
Collapse
|
27
|
Dong X, Chen L, Xu Z, Xu X. An assessment of the economic burden of senile chronic diseases in China based on China Health and Retirement Longitudinal Survey. Expert Rev Pharmacoecon Outcomes Res 2019; 20:305-312. [PMID: 31675261 DOI: 10.1080/14737167.2020.1688661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study assessed the economic burden of senile chronic diseases (SCD) in China. METHODS Based on China Health and Retirement Longitudinal Survey data, we used propensity score matching to compare the economic burden of SCD for families with and without members with SCD. RESULTS We examined three aspects of economic burden: health service utilization, including health care utilization and expenditure, family daily consumption spending, and workforce participation of family members in labor markets. SCD-families showed a higher hospitalization rate and number of outpatient visits than the control group. SCD-families also consumed less per capita. Additionally, the negative influence of SCD on total family income may be partially offset by increasing the labor force participation rate of healthy family members. Finally, we also discussed the burden of SCD in different educational status. CONCLUSIONS Relevant results may provide insight into formulating health and labor policies by the Chinese government. The study significance consists of the selection of matching variables and robustness, whereas study limitations include the omission of other important variables.
Collapse
Affiliation(s)
- Xiayan Dong
- School of Public Administration, Southwestern University of Finance and Economics , Chengdu, China
| | - Linhong Chen
- School of Mathematics and Statistics, Chongqing Technology and Business University , Chongqing, China.,School of Public Administration, Sichuan University , Chengdu, China
| | - Zhiming Xu
- Department of Business, ESCP Europe Business School , Paris, France
| | - Xiaocang Xu
- School of Economics, Chongqing Technology and Business University , Chongqing, China
| |
Collapse
|
28
|
Family Economic Burden of Elderly Chronic Diseases: Evidence from China. Healthcare (Basel) 2019; 7:healthcare7030099. [PMID: 31438602 PMCID: PMC6787659 DOI: 10.3390/healthcare7030099] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 01/12/2023] Open
Abstract
Chronic diseases among the elderly and their huge economic burden on family have caught much attention from economists and sociologists over the past decade in China. This study measured the economic burden of elderly chronic disease (ECD) in families using the China Health and Retirement Longitudinal Study (CHARLS) data set from Peking University (China). We studied some aspects of this burden, including health-service utilization, out-of-pocket expenditure on inpatient and outpatient, total family expenditures on items, and labor force participation rates of family members, etc. Some interesting things were found, for example, the additional annual expenditure on inpatient care (per member) in ECD-families was 37 to 45 percent of the annual expenditure in the control group; the labor-force participation rate in ECD-families was 2.4 to 3.3 percent of points lower than in the control group.
Collapse
|
29
|
Nair CK, Selvaraj K, Raghavan V, A M, Shenoy PK, Kurup AR, Duraisamy K, Shringarpure K, Venugopal V. Limiting factors for autologous transplantation among transplant-eligible multiple myeloma patients: Lesson from a Tertiary Cancer Centre in rural India. Leuk Res 2019; 83:106167. [PMID: 31200146 DOI: 10.1016/j.leukres.2019.106167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/22/2022]
Abstract
There is limited data from low and middle income countries on the exact proportion of Myeloma patients undergoing transplant even if they are eligible for the same. In this retrospective analysis of all newly diagnosed transplant eligible Myeloma treated between January 2011 to June 2017, number of patients undergoing transplant were recorded and among those not opting for transplant, reasons for the same were noted. Among 89 eligible patients, 23 (26%) patients could undergo transplantation. Most common reasons for not undergoing transplant were fear of the complications in 42 (47%) and financial reasons in 41 (46%) of patients. The transplanted group had better progression free survival when compared against the non-transplanted group (3 year PFS of 80% versus 36%, HR = 0.09, 95%CI 0.02-0.4, p = 0.001). Future studies may be conducted to arrive at measures, for correcting the transplant related concerns and fears, through psycho-social interventions.
Collapse
Affiliation(s)
- Chandran K Nair
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Vineetha Raghavan
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Manuprasad A
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Praveen Kumar Shenoy
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | - Anju R Kurup
- Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
| | | | - Kalpita Shringarpure
- Department of Preventive and Social Medicine, Medical College Baroda, Vadodara, Gujarat, India
| | - Vinayagamoorthy Venugopal
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| |
Collapse
|
30
|
Banegas MP, Schneider JL, Firemark AJ, Dickerson JF, Kent EE, de Moor JS, Virgo KS, Guy GP, Ekwueme DU, Zheng Z, Varga AM, Waiwaiole LA, Nutt SM, Narayan A, Yabroff KR. The social and economic toll of cancer survivorship: a complex web of financial sacrifice. J Cancer Surviv 2019; 13:406-417. [PMID: 31123985 PMCID: PMC6724195 DOI: 10.1007/s11764-019-00761-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 04/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the financial outcomes and associated social and economic effects on cancer survivors and their families. METHODS We assessed the responses of 1656 cancer survivors to a survey with both closed- and open-ended questions about cancer-related financial sacrifices they and their family experienced and evaluated differences in financial sacrifice by reported levels of cancer-related debt. RESULTS The most commonly reported financial sacrifices included cutbacks on household budgets, challenges with health care insurance and costs, career/self-advancement constraints, reduction/depletion of assets, and inability to pay bills. Survivors who incurred $10,000 or more in debt were significantly more likely to report social and economic impacts, including housing concerns and strained relationships. CONCLUSIONS Our analysis demonstrates both the frequency with which cancer survivors and families must make financial sacrifices as a result of their cancer, and the variety of forms that this sacrifice can take, even for individuals who have health insurance. The many types of financial hardship create challenges that are unique to each survivor and family. IMPLICATIONS FOR CANCER SURVIVORS Interventions that allow for personalized assistance with the specific financial and social needs of cancer survivors and their families have the potential to address a critical aspect of the long-term wellbeing of this important population.
Collapse
Affiliation(s)
- Matthew P Banegas
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - Jennifer L Schneider
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Alison J Firemark
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
- ICF International, Fairfax, VA, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Gery P Guy
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhiyuan Zheng
- Economics & Healthcare Delivery Research, American Cancer Society, Atlanta, GA, USA
| | - Alexandra M Varga
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Lisa A Waiwaiole
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | | | | | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| |
Collapse
|
31
|
Hack B, Piddock K, Stanway S, Balachandran K, Board R, Chopra N, Okonji D, Sirohi B, Sullivan R, Wakeham K. Cancer control in low- and middle-income countries: time for action. J R Soc Med 2019; 112:213-217. [PMID: 31124403 DOI: 10.1177/0141076819843653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Berkin Hack
- University College London Hospital, London NW1 2PG, UK
| | - Katy Piddock
- University College London Hospital, London NW1 2PG, UK
| | | | | | - Ruth Board
- University College London Hospital, London NW1 2PG, UK
| | - Neha Chopra
- University College London Hospital, London NW1 2PG, UK
| | - David Okonji
- University College London Hospital, London NW1 2PG, UK
| | - Bhawna Sirohi
- University College London Hospital, London NW1 2PG, UK
| | | | - Katie Wakeham
- University College London Hospital, London NW1 2PG, UK
| |
Collapse
|
32
|
Abstract
INTRODUCTION Palliative care coverage and opioid consumption in India are relatively low compared with global data. The literature suggests commonplace concealment and collusion in withholding information, but these hypotheses lack evidence. OBJECTIVES This study aimed to develop an explanatory evidence-based model of stigma, communication and access to cancer palliative care in India that can be used to develop, test and implement future interventions. DESIGN This cross-sectional qualitative study sampled advanced cancer patients (n=10), their family caregivers (n=10) and oncologists (n=10). Grounded theory procedures were utilised to analyse transcripts, and a theoretical model generated. SETTING A tertiary teaching hospital in South India. RESULTS The model explains how stigma associated with communicating a diagnosis of advanced cancer is enacted by treating oncologists, family members and community. This leads to patient expectations of cure and futile treatment uptake. Patients commonly only present needs with respect to pain, not within psychological, social or spiritual domains, likely due to the lack of patients' insight into their diagnosis and prognosis. As a result of oncologists' and families' unwillingness to disclose the prognosis, and patient focus on pain due to their lack of insight, palliative care clinicians view their services as under-utilised, and patients perceive palliative care as a pain management service that is not 'different' from other clinical services. Advanced care needs and purchase of futile treatments lead to lost employment among families, increased family debt and high care costs, which are rarely disclosed due to their unwillingness to discuss their needs. CONCLUSION Our novel theoretical model is an essential first step to ensure that complex interventions are plausible, with mechanisms of action that address the needs of relevant stakeholders. A family-centred approach with an oncology workforce skilled in communication and an enabled patient population could increase access to palliative care, and improved outcomes may be attainable.
Collapse
Affiliation(s)
- Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Department of Pain and Palliative Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Shoba Nair
- Department of Pain and Palliative Medicine, St John's Medical College Hospital, Bangalore, Karnataka, India
| | - Maria Ekstrand
- Division of Prevention Science- Department of Medicine, University of California San Francisco, San Franscisco, California, USA
- St John's Research Institute, Bangalore, Karnataka, India
| |
Collapse
|
33
|
Chauhan AS, Prinja S, Ghoshal S, Verma R. Economic Burden of Head and Neck Cancer Treatment in North India. Asian Pac J Cancer Prev 2019; 20:403-409. [PMID: 30803199 PMCID: PMC6897025 DOI: 10.31557/apjcp.2019.20.2.403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The rising cost of cancer treatment has imposed a huge financial burden on the affected households,
leading to catastrophic outcomes and impoverishment. The present study was designed to estimate the economic
burden incurred by households for the treatment of head and neck cancer (HNC) in India. Methods: The present study
was undertaken in a large public sector tertiary care hospital of North India. A total of 159 patients were recruited
at time of their first registration in the department of Radiation Oncology, and were followed after completion of
their treatment. Another 288 were recruited within one month after completion of treatment. Economic burden was
assessed in terms of out of pocket (OOP) expenditure incurred, prevalence of catastrophic health expenditure and
distress financing (borrowing or selling of assets) related to different modalities of cancer treatment. Results: The
average OOP expenditure incurred by a patient of HNC patient was INR 37, 845 (USD 563), which varied from INR
32,379 (USD 482) when a patient undergoes radiotherapy alone to INR 67,480 (USD 1,004) for surgery along with
chemo-radiotherapy. Specifically, patients undergoing 2-DRT and IMRT alone had to spend INR 31,487 (USD 469) and
INR 42,405 (USD 631) respectively. The prevalence of catastrophic health expenditure (CHE) and distress financing
(DF) was 34% and 45% respectively. The odds of incurring both CHE and DF were found to be higher for patients in
the lowest income quartile and for those in the younger age groups. Conclusion: Cancer imposes significant economic
burden on households. The existing public health system should be strengthened to reduce OOP expenditure incurred
by patients. In addition, enhanced coverage of risk pooling mechanisms should be ensured.
Collapse
Affiliation(s)
- Akashdeep Singh Chauhan
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | |
Collapse
|
34
|
Rijal A, Adhikari TB, Khan JAM, Berg-Beckhoff G. The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review. PLoS One 2018; 13:e0205745. [PMID: 30462648 PMCID: PMC6248902 DOI: 10.1371/journal.pone.0205745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 10/01/2018] [Indexed: 12/31/2022] Open
Abstract
Background Out of pocket payment (OOPP), is the major health financing mechanism in South Asia region. With the rising burden of non-communicable diseases (NCDs), the region is facing a high financial burden. However, the extent and nature of economic impact caused by treatment and management of NCDs at the household level is yet unknown. Method We conducted a systematic review using Medline and Embase databases. Only peer-reviewed quantitative studies published between January 2000 to December 2016 assessing OOPP or catastrophic health expenditure or impoverishment or financial coping strategy due to at least one of the four major NCDs—cardiovascular diseases(CVDs), diabetes, cancer, chronic respiratory disease in South Asia region was included in the review. The review is registered in PROSPERO no: CRD42017059345. Results A total of 21 studies (of 2693 records identified) met the inclusion criteria. The economic impact was most frequently studied in CVDs and in terms of OOPP. The studies collectively indicated high OOPP, higher likelihood of catastrophic expenditure and impoverishment for inpatient care for these major NCDs which was visible in all income levels. Borrowing and selling off assets were the most common forms of coping strategies adopted and varied inconsistently between urban and rural households. The true extent of the economic impact, however, remains difficult to determine due to methodological heterogeneity regarding outcomes reported and measures employed for calculation of OOPP, catastrophic expenditure, and impoverishment across these four major NCDs and between nations. Conclusion The economic impact due to treatment and management of CVDs, diabetes, cancer and chronic respiratory diseases among households in South Asia seems dire. Given the lack of sufficient evidence the review stresses the need for further research in the region to develop evidence-informed nationally tailored prepayment mechanisms covering NCDs to reduce economic vulnerability and standardization of tools measuring the economic impact for generating comparable estimates.
Collapse
Affiliation(s)
- Anupa Rijal
- Young Earth, Kathmandu, Nepal
- Nepal Development Society, Chitwan, Nepal
- * E-mail:
| | - Tara Ballav Adhikari
- Nepal Development Society, Chitwan, Nepal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jahangir A. M. Khan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | |
Collapse
|
35
|
Li Z, Aninditha T, Griene B, Francis J, Renato P, Serrie A, Umareddy I, Boisseau S, Hadjiat Y. Burden of cancer pain in developing countries: a narrative literature review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:675-691. [PMID: 30464561 PMCID: PMC6219110 DOI: 10.2147/ceor.s181192] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cancer pain is one of the most common, feared, debilitating, and often undertreated symptoms among cancer patients. It needs attention since it has a significant impact on the quality of life (QoL) of the patients. Also, since cancer has emerged as a major health problem in developing countries, there is a need to strengthen preventive strategies for effective cancer pain management and provide comfort to cancer patients. Nonetheless, various barriers limit developing countries toward optimal cancer pain management. To bridge the gap between adequate pain management and burden of cancer pain in developing countries, a comprehensive understanding of the limitations faced and the prevalence of cancer pain should be addressed. The aim of this literature review is to provide a deeper understanding on the factors associated with cancer pain as well as barriers toward optimal cancer pain management in developing countries. Some of the barriers addressed were administrative, judicial, economic, and professional barriers. Also, estimates on the prevalence of cancer pain and detrimental effects of pain on the QoL of cancer patients have been addressed. In summary, pain, which is one of the most debilitating symptoms of cancer, remains uncontrolled and undertreated in developing countries. It has a profound impact on the patient’s QoL and can have physical, psychological, and social consequences; therefore, it needs to be managed urgently and appropriately. Most importantly, optimal treatment of cancer pain should be highlighted as a priority in developing countries and concerted efforts should be made to eliminate different barriers discussed in this review for effective and humane care.
Collapse
Affiliation(s)
- Zhang Li
- Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | | | | | | | - Paulo Renato
- Anesthesiology Service and Clinical Oncological IOC Group Pain, Brazil
| | | | | | | | | |
Collapse
|
36
|
The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Oncol 2018; 19:1289-1306. [PMID: 30219626 PMCID: PMC6167407 DOI: 10.1016/s1470-2045(18)30447-9] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
Abstract
Background Previous efforts to report estimates of cancer incidence and mortality in India and its different parts include the National Cancer Registry Programme Reports, Sample Registration System cause of death findings, Cancer Incidence in Five Continents Series, and GLOBOCAN. We present a comprehensive picture of the patterns and time trends of the burden of total cancer and specific cancer types in each state of India estimated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 because such a systematic compilation is not readily available. Methods We used all accessible data from multiple sources, including 42 population-based cancer registries and the nationwide Sample Registration System of India, to estimate the incidence of 28 types of cancer in every state of India from 1990 to 2016 and the deaths and disability-adjusted life-years (DALYs) caused by them, as part of GBD 2016. We present incidence, DALYs, and death rates for all cancers together, and the trends of all types of cancers, highlighting the heterogeneity in the burden of specific types of cancers across the states of India. We also present the contribution of major risk factors to cancer DALYs in India. Findings 8·3% (95% uncertainty interval [UI] 7·9–8·6) of the total deaths and 5·0% (4·6–5·5) of the total DALYs in India in 2016 were due to cancer, which was double the contribution of cancer in 1990. However, the age-standardised incidence rate of cancer did not change substantially during this period. The age-standardised cancer DALY rate had a 2·6 times variation across the states of India in 2016. The ten cancers responsible for the highest proportion of cancer DALYs in India in 2016 were stomach (9·0% of the total cancer DALYs), breast (8·2%), lung (7·5%), lip and oral cavity (7·2%), pharynx other than nasopharynx (6·8%), colon and rectum (5·8%), leukaemia (5·2%), cervical (5·2%), oesophageal (4·3%), and brain and nervous system (3·5%) cancer. Among these cancers, the age-standardised incidence rate of breast cancer increased significantly by 40·7% (95% UI 7·0–85·6) from 1990 to 2016, whereas it decreased for stomach (39·7%; 34·3–44·0), lip and oral cavity (6·4%; 0·4–18·6), cervical (39·7%; 26·5–57·3), and oesophageal cancer (31·2%; 27·9–34·9), and leukaemia (16·1%; 4·3–24·2). We found substantial inter-state heterogeneity in the age-standardised incidence rate of the different types of cancers in 2016, with a 3·3 times to 11·6 times variation for the four most frequent cancers (lip and oral, breast, lung, and stomach). Tobacco use was the leading risk factor for cancers in India to which the highest proportion (10·9%) of cancer DALYs could be attributed in 2016. Interpretation The substantial heterogeneity in the state-level incidence rate and health loss trends of the different types of cancer in India over this 26-year period should be taken into account to strengthen infrastructure and human resources for cancer prevention and control at both the national and state levels. These efforts should focus on the ten cancers contributing the highest DALYs in India, including cancers of the stomach, lung, pharynx other than nasopharynx, colon and rectum, leukaemia, oesophageal, and brain and nervous system, in addition to breast, lip and oral cavity, and cervical cancer, which are currently the focus of screening and early detection programmes. Funding Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Collapse
|
37
|
Mirelman AJ, Trujillo AJ, Niessen LW, Ahmed S, Khan JA, Peters DH. Household coping strategies after an adult noncommunicable disease death in
Bangladesh. Int J Health Plann Manage 2018; 34:e203-e218. [DOI: 10.1002/hpm.2637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Antonio J. Trujillo
- Department of International HealthJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
| | - Louis W. Niessen
- Department of Clinical SciencesLiverpool School of Tropical Medicine Liverpool UK
| | - Sayem Ahmed
- Health Systems and Population Studies Divisionicddr,b Dhaka Bangladesh
| | - Jahangir A.M. Khan
- Department of Clinical SciencesLiverpool School of Tropical Medicine Liverpool UK
- Health Systems and Population Studies Divisionicddr,b Dhaka Bangladesh
| | - David H. Peters
- Department of International HealthJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
| |
Collapse
|
38
|
Pallegedara A. Impacts of chronic non-communicable diseases on households' out-of-pocket healthcare expenditures in Sri Lanka. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:301-319. [PMID: 29322278 DOI: 10.1007/s10754-018-9235-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/03/2018] [Indexed: 06/07/2023]
Abstract
This article examines the effects of chronic non-communicable diseases (NCDs) on households' out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.
Collapse
Affiliation(s)
- Asankha Pallegedara
- Department of Industrial Management, Faculty of Applied Sciences, Wayamba University of Sri Lanka, Kuliyapitiya, 60200, Sri Lanka.
- Chair of Development Economics, Faculty of Business Administration and Economics, University of Passau, Innstrasse 29, 94032, Passau, Germany.
| |
Collapse
|
39
|
Kumara AS, Samaratunge R. The effects of chronic non-communicable diseases on labour force outcomes: Quasi experimental evidence from Sri Lanka. ECONOMICS AND HUMAN BIOLOGY 2018; 31:40-53. [PMID: 30170296 DOI: 10.1016/j.ehb.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
We investigate the effects of experiencing non-communicable diseases (NCDs) on labour force outcomes of working-age individuals and their households in Sri Lanka. For this, quasi-experimental evidence, including average treatment effects on those treated (ATT), are generated by using the self-reported health survey of the labour force of Sri Lanka. According to the analysis, individuals with at least one NCD account for approximately 19.15% of the working-age population. On average, employment probability, labour supply, and labour earnings of them are significantly lower than those of non-NCD individuals by 9.5% (ATT=-0.102, P < 0.001), 44.6% (ATT=-0.590, P < 0.001), and 47.9% (ATT=-0.652, P < 0.001), respectively. The negative impacts on labour force outcomes are notably larger in the cases of paralysis and mental illness. These NCDs reduce individual labour supply by more than 80% and labour earnings by more than 90%. The employment probability of individuals with paralysis and mental illnesses is also relatively lower by more than 60%. Apart from these individual-level effects, the paper provides evidence on how labour force outcomes at the household level are influenced by NCDs. Our findings demonstrate that the association between individuals' NCD-prevalence and labour force outcomes is relatively stronger for males, informal sector employees, and elderly people. The results suggest several social inclusion policies.
Collapse
Affiliation(s)
- Ajantha Sisira Kumara
- Department of Public Administration, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka; Department of Management, Monash Business School, Monash University, Menzies Building, Level 11, Clayton Campus, Victoria, 3800, Australia.
| | - Ramanie Samaratunge
- Department of Management, Monash Business School, Monash University, Menzies Building, Level 11, Clayton Campus, Victoria, 3800, Australia.
| |
Collapse
|
40
|
Alam K, Renzaho A, Mahal A. Impacts of adult illness on employment outcomes of rural households in India. J Glob Health 2018; 8:020408. [PMID: 30140434 PMCID: PMC6083015 DOI: 10.7189/jogh.08.020408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Existing literature on the impacts of adult illness on household labour supply and income in low- and middle-income countries shows that adverse health conditions significantly affect household labour supply, work participation and earnings. Most of the studies, however, are not equipped to distinguish between short- and long-term consequences of adult illness. We measured the impact of adult illness on household employment outcomes both in the short- and the long-run, using a unique longitudinal data set from rural India. Methods We used two waves of India Human Development Survey (1993-94 and 2004-05) with a balanced panel of 10 726 households to assess short-run (in the year of the occurrence of adult illness) and long-run (after 11 years of the occurrence of adult illness) effects of major illness of adult household members aged 15-64 years on household employment outcomes, using multiple matching methods: nearest-neighbor matching and inverse probability weighting following propensity score matching, and coarsened exact matching to compare employment outcomes to a set of matched control households. Results Rural households affected by adult illness experienced declines in workforce participation rate by 1-3%, wage employment by 4-15 days, and wage-earnings by Indian Rupee (INR) 374 to INR 837 compared to the matched control households in the short-run. In response, adult non-sick members of the affected households increased their workforce participation sharply by 14-16% to compensate for shortfalls in the short-run. In the long-run, workforce participation rate of the affected households also declined by nearly 1-3%. The long-run declines in wage-days and wage-earnings were small and not always statistically significant across the methods. However, long-run workforce participation rate of non-sick adults were smaller (4-6%) compared to short-run, but still statistically significant. Conclusions The long-term effects were smaller in absolute magnitude than those of the short-run. This suggests coping and adjustments by the affected households using this 11-year longer time-span in a manner that helps to ameliorate the immediate impacts of adult illness. Our study also reiterates the importance of improving financial access to health services as well as access to social security benefits for the illness-affected households in rural India both in the short- and long-run.
Collapse
Affiliation(s)
- Khurshid Alam
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Andre Renzaho
- Humanitarian and Development Research Initiative, School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ajay Mahal
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
41
|
Gupta I, Roy A. Economic Studies on Non-Communicable Diseases and Injuries in India: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:303-315. [PMID: 29611047 DOI: 10.1007/s40258-018-0370-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The burden from non-communicable diseases and injuries (NCDI) in India is increasing rapidly. With low public sector investment in the health sector generally, and a high financial burden on households for treatment, it is important that economic evidence is used to set priorities in the context of NCDI. OBJECTIVE Our objective was to understand the extent to which economic analysis has been used in India to (1) analyze the impact of NCDI and (2) evaluate prevention and treatment interventions. Specifically, this analysis focused on the type of economic analysis used, disease categories, funding patterns, authorship, and author characteristics. METHODS We conducted a systematic review based on economic keywords to identify studies on NCDI in India published in English between January 2006 and November 2016. In all, 96 studies were included in the review. The analysis used descriptive statistics, including frequencies and percentages. RESULTS A majority of the studies were economic impact studies, followed by economic evaluation studies, especially cost-effectiveness analysis. In the costing/partial economic evaluation category, most were cost-description and cost-analysis studies. Under the economic impact/economic burden category, most studies investigated out-of-pocket spending. The studies were mostly on cardiovascular disease, diabetes, and neoplasms. Slightly over half of the studies were funded, with funding coming mainly from outside of India. Half of the studies were led by domestic authors. In most of the studies, the lead author was a clinician or a public health professional; however, most of the economist-led studies were by authors from outside India. CONCLUSIONS The results indicate the lack of engagement of economists generally and health economists in particular in research on NCDI in India. Demand from health policy makers for evidence-based decision making appears to be lacking, which in turn solidifies the divergence between economics and health policy, and highlights the need to prioritize scarce resources based on evidence regarding what works. Capacity building in health economics needs focus, and the government's support in this is recommended.
Collapse
Affiliation(s)
- Indrani Gupta
- Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India.
| | - Arjun Roy
- Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India
| |
Collapse
|
42
|
Selvaraj S, Farooqui HH, Karan A. Quantifying the financial burden of households' out-of-pocket payments on medicines in India: a repeated cross-sectional analysis of National Sample Survey data, 1994-2014. BMJ Open 2018; 8:e018020. [PMID: 29858403 PMCID: PMC5988077 DOI: 10.1136/bmjopen-2017-018020] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this research is to generate new evidence on financial implications of medicines out-of-pocket (OOP) payments for households. Another objective is to investigate which disease conditions contributed to a significant proportion of households' financial burden. SETTING All Indian states including union territories, 1993-2014. DESIGN Repeated cross-sectional household surveys. DATA Secondary data of nationwide Consumer Expenditure Surveys for the years 1993-1994, 2004-2005 and 2011-2012 and one wave of Social Consumption: Health for the year 2014 from National Sample Survey Organisation. OUTCOME MEASURES OOP expenditure on healthcare in general and medicines in specific. RESULTS Total OOP payments and medicines OOP payments were estimated to be 6.77% (95% CI 6.70% to 6.84%) and 4.49% (95% CI 4.45% to 4.54%) of total consumption expenditure, respectively, in the year 2011-2012 which marked significant increase since 1993-1994. These proportions were 11.46% (95% CI 11.36% to 11.56%) and 7.60% (95% CI 7.54% to 7.67%) of non-food expenditure, respectively, in the same year. Total OOP payments and medicines OOP payments were catastrophic for 17.9% (95% CI 17.7% to 18.2%) and 11.2% (95% CI 11.0% to 11.4%) households, respectively, in 2011-2012 at the 10% of total consumption expenditure threshold, implying 29 million households incurred catastrophic OOP payments in the year 2011-2012. Further, medicines OOP payments pushed 3.09% (95% CI 2.99% to 3.20%), implying 38 million persons into poverty in the year 2011-2012. Among the leading cause of diseases that caused significant OOP payments are cancers, injuries, cardiovascular diseases, genitourinary conditions and mental disorders. CONCLUSIONS Purchase of medicines constitutes the single largest component of the total OOP payments by households. Hence, strengthening government intervention in providing medicines free in public healthcare facilities has the potential to considerably reduce medicine-related spending and total OOP payments of households and reduction in OOP-induced poverty.
Collapse
Affiliation(s)
| | | | - Anup Karan
- Public Health Foundation of India, New Delhi, India
| |
Collapse
|
43
|
Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014. PLoS One 2018; 13:e0193320. [PMID: 29481563 PMCID: PMC5826535 DOI: 10.1371/journal.pone.0193320] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/08/2018] [Indexed: 12/21/2022] Open
Abstract
With the ongoing demographic and epidemiological transition, cancer is emerging as a major public health concern in India. This paper uses nationally representative household survey to examine the overall prevalence and economic burden of cancer in India. The age-standardized prevalence of cancer is estimated to be 97 per 100,000 persons with greater prevalence in urban areas. The evidence suggests that cancer prevalence is highest among the elderly and also among females in the reproductive age groups. Cancer displays a significant socioeconomic gradient even after adjusting for age-sex specifics and clustering in a multilevel regression framework. We find that out of pocket expenditure on cancer treatment is among the highest for any ailment. The average out of pocket spending on inpatient care in private facilities is about three-times that of public facilities. Furthermore, treatment for about 40 percent of cancer hospitalization cases is financed mainly through borrowings, sale of assets and contributions from friends and relatives. Also, over 60 percent of the households who seek care from the private sector incur out of pocket expenditure in excess of 20 percent of their annual per capita household expenditure. Given the catastrophic implications, this study calls for a disease-based approach towards financing such high-cost ailment. It is suggested that universal cancer care insurance should be envisaged and combined with existing accident and life insurance policies for the poorer sections in India. In concluding, we call for policies to improve cancer survivorship through effective prevention and early detection. In particular, greater public health investments in infrastructure, human resources and quality of care deserve priority attention.
Collapse
|
44
|
Haitsma G, Patel H, Gurumurthy P, Postma MJ. Access to anti-cancer drugs in India: is there a need to revise reimbursement policies? Expert Rev Pharmacoecon Outcomes Res 2018; 18:289-296. [DOI: 10.1080/14737167.2018.1444479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Gertruud Haitsma
- Department of Pharmacy Practice, JSS College of Pharmacy, Mysore, JSS University, Mysore, India
- Department of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), University of Groningen, Groningen, The Netherlands
| | - Himanshu Patel
- Department of Pharmacy Practice, JSS College of Pharmacy, Mysore, JSS University, Mysore, India
| | | | - Maarten J. Postma
- Department of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), University of Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| |
Collapse
|
45
|
Chauhan AS, Prinja S, Ghoshal S, Verma R, Oinam AS. Cost of treatment for head and neck cancer in India. PLoS One 2018; 13:e0191132. [PMID: 29324861 PMCID: PMC5764364 DOI: 10.1371/journal.pone.0191132] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022] Open
Abstract
There are no published data on the cost of cancer treatment for guiding reimbursement decisions in India. The present study was designed to estimate the cost of treating head and neck cancer (HNC) with the aim of determining package rates. The present study was undertaken in the Departments of Radiotherapy and Otolaryngology of a large tertiary care hospital in North India. Economic health system costs incurred were assessed using a bottom-up methodology. Data on all resources-capital or recurrent, incurred on the delivery of HNC treatment were collected from April 2014 to March 2015. Following the cost-of-illness approach, patients were interviewed to elicit out-of-pocket (OOP) expenditure. A total of INR 40,993,017 (USD 0.67 million) was spent on radiotherapy care for treating HNC during 1 year. Salaries constituted the major component (42.6%) of this cost, followed by equipment/furniture (29%), space rent (20.7%), overheads and consumables (7.7%). In addition, INR 47,191 (USD 773) per HNC patient was spent on the surgery. Furthermore, patients spent an average amount ranging from INR 12,575 (USD 206) to INR 65,257 (USD 1069) on the different treatment therapies. In terms of package rates, cobalt radiotherapy alone was the cheapest (INR 38,714, USD 634), while intensity modulated radiotherapy (IMRT) was most expensive (INR 192,914, USD 3161). The estimates from the present study could be used for developing package rates under various publicly financed health insurance schemes as well as for the planning for creation of new cancer centres.
Collapse
Affiliation(s)
- Akashdeep Singh Chauhan
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Sushmita Ghoshal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshan Verma
- Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun S. Oinam
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
46
|
Koirala S. Joint Families and Cancer Diagnosis in Rural India. Asian Pac J Cancer Prev 2018; 19:549-554. [PMID: 29481008 PMCID: PMC5980948 DOI: 10.22034/apjcp.2018.19.2.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Each year, there are over a million new cases of cancer in India, which causes many untimely deaths
and increases the economic burden to households. By focusing on preventative measures and finding socioeconomic
and behavioral contributors to cancer, steps can be taken to help alleviate this burden. This study aims to find the effect
living in a joint family can have on being diagnosed with cancer in rural India. Methods: The study estimates the
effect living in a joint family, along with other demographic information, has on being diagnosed with cancer using
a logit estimation model. The data for the study was collected from a survey was conducted on the households of the
Handiganur village (N=251) comprising of several demographic, social, and medical questions. Results: The study
found that living in a joint family lowers the odds of having cancer. The results indicate that living in a joint family
reduces the probability of being diagnosed by 7.23 percentage points and is significant at a 5% level. Furthermore,
among the other tested variables, eating habit is negatively significant at 5% level, suggesting that if a person eats 3 to
4 times a day his or her likelihood of suffering from cancer will be lowered by 6.55 percentage points. Access to public
wells and drinking alcohol both increase the likelihood of being diagnosed with cancer by 7.90 (p<0.1) percentage
points and 11.90 (p<0.05) percentage points respectively. Conclusions: The negative effect of joint family could be
due to two possible reasons. The first is that there is in fact a biological reason. The second reason for this result could
be a false negative, as it could be because people in joint families are not getting the necessary check-ups required to
diagnose cancer.
Collapse
Affiliation(s)
- Sushant Koirala
- School of Arts and Science, University of Pennsylvania, Philadelphia, United States,For Correspondence:
| |
Collapse
|
47
|
Aggarwal J, Chakraborty S, Ghosh Laskar S, Patil VM, Prabhash K, Bhattacharya A, Noronha V, Purandare NC, Joshi A, Mummudi N, Arora J, Badhe R. Reference Data for Standardized Quality of Life Questionnaires in Indian Patients with Brain Metastases from Non-small Cell Lung Cancer: Results from a Prospective Study. Cureus 2017; 9:e1149. [PMID: 28497011 PMCID: PMC5425287 DOI: 10.7759/cureus.1149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Reference data for European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires do not include studies from the Indian subcontinent. The objective of the current study was to establish a reference dataset for Indian patients of non-small cell lung cancer (NSCLC) presenting with brain metastases (BM). MATERIAL AND METHODS One hundred forty patients with NSCLC with BM treated between 2012-2015 were registered in a prospective cohort study (CTRI/2013/01/003299). The baseline quality of life was evaluated using the EORTC general quality of life questionnaire QLQ-C30 and lung cancer specific module LC13. Minimum important difference (MID) scores for individual domains of the EORTC QLQ-C30 and LC13 questionnaires were derived (MID = 0.2 x standard deviation) from the reference data for patients with recurrent/metastatic lung cancers. In addition, a systematic review was conducted to identify studies reporting baseline quality of life scores for recurrent/metastatic NSCLC. RESULTS Scores of several functional as well as symptom scales in the current NSCLC population differed by more than the MID from the baseline mean scores in the reference EORTC population as well as that reported from other studies. Differences in mean score from the EORTC reference data ranged from 6.2 and 9.4 points for the role functioning and cognitive functioning domains. In the symptom scales, the largest differences were observed for the financial difficulties (23.9) scores for the QLQ-C30 and peripheral neuropathy (21.7) for LC13 questionnaires. CONCLUSION The current study demonstrates that baseline reference scores need to be established for patients from the Indian subcontinent. The findings from the current study have important implications for studies employing quality of life (QOL) assessment in the Indian NSCLC patient population.
Collapse
Affiliation(s)
| | | | | | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jitendra Arora
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rupali Badhe
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
48
|
Vanderpuye VDNK, Olopade OI, Huo D. Pilot Survey of Breast Cancer Management in Sub-Saharan Africa. J Glob Oncol 2016; 3:194-200. [PMID: 28717760 PMCID: PMC5493219 DOI: 10.1200/jgo.2016.004945] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose To understand the current state of breast cancer management in sub-Saharan Africa. Methods We conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013. Results Twenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team. Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities. Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, taxanes, vinorelbine, and gemcitabine were available in few facilities. Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%). It took an average of 1 to 3 weeks to report histopathology. Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the country in seven facilities (37%), and outside the country in four facilities (21%). Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol. Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%). In three facilities (16%), receptor status did not influence the prescription of hormone treatment. Conclusion This pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier. Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.
Collapse
Affiliation(s)
- Verna D N K Vanderpuye
- , Korlebu Teaching Hospital, Accra, Ghana; and . Olopade and , University of Chicago, Chicago, IL
| | - Olufunmilayo I Olopade
- , Korlebu Teaching Hospital, Accra, Ghana; and . Olopade and , University of Chicago, Chicago, IL
| | - Dezheng Huo
- , Korlebu Teaching Hospital, Accra, Ghana; and . Olopade and , University of Chicago, Chicago, IL
| |
Collapse
|
49
|
Saraiya M, Tangka FKL, Asma S, Richardson LC. Importance of economic evaluation of cancer registration in the resource limited setting: Laying the groundwork for surveillance systems. Cancer Epidemiol 2016; 45 Suppl 1:S1-S3. [PMID: 27751693 PMCID: PMC5320865 DOI: 10.1016/j.canep.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/01/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Mona Saraiya
- Office of International Cancer Control, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States.
| | - Florence K L Tangka
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States
| | - Samira Asma
- Noncommunicable Disease Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, United States
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, United States
| |
Collapse
|
50
|
A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can’t Pay the Co-Pay. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 10:295-309. [DOI: 10.1007/s40271-016-0204-x] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|