Economic and non-economic burden of cancer

Abstract

Background: Cancer affects the well-being not only of the patients but also of the other members of the household. Objectives: In this study, we assessed the nature and magnitude of the economic and non-economic burden on patients with cancer and their families due to the inpatient and outpatient cancer care. Materials and Methods: This study was conducted using the secondary data from the 75th round of the National Sample Survey Organization survey on health and morbidity, titled “Social Consumption: Health,” for the year 2017–2018. The burden of cancer on individuals was assessed in terms of the health-care expenditure and utilization of inpatient and outpatient cancer treatment. At the household level, cancer burden was assessed in terms of per person health-care expenditure, impact on the standard of living, strategies adopted for financing the health-care expenditure, and utilization of and expenditure on health-care by other members of the family. Propensity score matching was used to generate matched data separately for inpatient and outpatient cases and at individual and household levels to control for confounders. The difference in the burden between the matched cancer-affected and unaffected individuals/households was estimated using the average treatment effect. Results: For the year 2017–2018, data were available for a total of 113,823 households with 555,352 individuals across India. The mean out-of-pocket expenditure (OOPE) for a patient with cancer exceeded that of patients with other chronic diseases by 2895 for each outpatient visit and 52393 for each inpatient admission. The mean length of the hospital stay due to cancer was found to be 7 days longer than that due to any other chronic disease. The per person inpatient health-care expenditure for the other members of a cancer-affected household was 11,000 less than that of other members of the unaffected households. More than 50% of households with cancer patients had to borrow money to pay for inpatient care compared to control households. The share of OOPE for outpatient care in the monthly consumption expenditure of a cancer-affected household was twice as high as that of an unaffected household. Moreover, the number of outpatient visits for other ailing persons in a cancer-affected household was one-fourth that of an unaffected household. Conclusion: Cancer imposes an immense economic and non-economic burden on affected individuals and households. Therefore, there is a need to design appropriate health-care strategies for providing optimal financial support to patients with cancer.

Quality of life in patients with locally advanced head and neck squamous cell carcinoma undergoing concurrent chemoradiation withonce‐a‐weekversusonce‐every‐3‐weekscisplatin

“…The per person loss in income for a cancer affected household in India is up to four times higher than that of a noncancer affected household. 22 Hence, a large number of patients borrow money or resort to selling their assets to fund their treatment. 22 An important factor in QoL analysis is the handling of missing data.…”

“…22 Hence, a large number of patients borrow money or resort to selling their assets to fund their treatment. 22 An important factor in QoL analysis is the handling of missing data. Patients with missing baseline QoL questionnaires that is, 50% were excluded from the analysis.…”

“…It also has a social security system where patients receive full pay while they are ill, and patients and their families have access to compensatory payments or social welfare assistance 19 ; minimizing individual responsibility for the cost of medical care 19,20 . In India, the majority of the population does not have health insurance, and treatment costs are borne by the patient 21,22 . Various government policies and public insurance schemes available in India do not fully cover the cost of cancer therapy for all patients.…”

“…Various government policies and public insurance schemes available in India do not fully cover the cost of cancer therapy for all patients. The mean out of pocket expenditure for treatment is higher for cancer patients as compared to patients with other chronic diseases; both in the public and private sector 22 . In India patients with cancer also spend more on nonmedical expenses (e.g., transport, food, lodging) as compared to other chronic diseases 22 .…”

“…The inability of cancer patients and their caregivers to work while on treatment leads to loss in family income. The per person loss in income for a cancer affected household in India is up to four times higher than that of a non‐cancer affected household 22 . Hence, a large number of patients borrow money or resort to selling their assets to fund their treatment 22 …”