Out of Pocket Expenditure among Cancer Patients Availing Treatment at A Tertiary Care Centre in Hyderabad, India

Syed Ahmed Mohiuddin; Vemulapalli Meghana; Surson Varshit Reddy

doi:10.55489/njcm.140520232907

Authors

Syed Ahmed Mohiuddin Osmania Medical College, Hyderabad, India
Vemulapalli Meghana Osmania Medical College, Hyderabad, India
Surson Varshit Reddy Osmania Medical College, Hyderabad, India

DOI:

https://doi.org/10.55489/njcm.140520232907

Keywords:

Cancer, Catastrophic, Medical Expenses, Non Medical Expenses, Out of Pocket expenditure, Treatment Modality

Abstract

Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medical and non-medical. About 150 million people face financial catastrophe every year due to health care payments and cancer is one of the leading causes of high OOPE.

Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality.

Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire.

Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery.

Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government initiatives consider the importance of mitigating the OOPE along with provision of cancer care.

References

Kastor A, Mohanty SK. Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: do Indian households face distress health financing?. PloS one. 2018 May 10;13(5):e0196106. Doi: https://doi.org/10.1371/journal.pone.0196106 PMid:29746481 PMCid:PMC5945043

Kulothungan V, Sathishkumar K, Leburu S, Ramamoorthy T, Stephen S, Basavarajappa D, et al. Burden of cancers in India-estimates of cancer crude incidence, YLLs, YLDs and DALYs for 2021 and 2025 based on National Cancer Registry Program. BMC cancer. 2022 Dec;22(1):1-2. Doi: https://doi.org/10.1186/s12885-022-09578-1 PMid:35546232 PMCid:PMC9092762

Sangar S, Dutt V, Thakur R. Comparative assessment of economic burden of disease in relation to out of pocket expenditure. Fron-tiers in public health. 2019 Jan 29;7:9. Doi: https://doi.org/10.3389/fpubh.2019.00009 PMid:30761284 PMCid:PMC6362399

Dinesh TA, Nair P, Abhijath V, Jha V, Aarthy K. Economics of cancer care: A community-based cross-sectional study in Kerala, India. South Asian Journal of Cancer. 2020 Jan;9(01):07-12. Doi: https://doi.org/10.4103/sajc.sajc_382_18 PMid:31956610 PMCid:PMC6956579

Alexander A, Kaluve R, Prabhu JS, Korlimarla A, Srinath BS, Manjunath S, et al. The impact of breast cancer on the patient and the family in Indian perspective. Indian journal of palliative care. 2019 Jan;25(1):66

Arthapedia. Available on: http://www.arthapedia.in/index.php?title=Out_of_pocket_expenditure. Last accessed on 19/10/2022.

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. 2022 Jun 29. doi: 10.4103/ijc.IJC_224_19. Epub ahead of print. PMID: 36861695.

Brooks J, Wilson K, Amir Z. Additional financial costs borne by cancer patients: A narrative review. European Journal of Oncology Nursing. 2011 Sep 1;15(4):302-10. Doi: https://doi.org/10.1016/j.ejon.2010.10.005 PMid:21093369

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 Pacific Journal of Cancer Prevention. 2021 Mar 1;22(3):671-80. Doi: https://doi.org/10.31557/APJCP.2021.22.3.671 PMid:33773528 PMCid:PMC8286691

Kapadiya J, Sampath N, Chhabra KG, Chaudhary P. Modified BG Prasad classification for socioeconomic scale updated-2022. Indian Journal of Public Health. 2022 Oct 1;66(4):530 Doi: https://doi.org/10.4103/ijph.ijph_628_22 PMid:37039192

Barwal VK, Thakur A, Mazta SR, Sharma GA. Out-of-Pocket expenditure for diagnosis of lung cancer: A significant pretreatment fi-nancial burden-Study from a tertiary care cancer center in North India. CHRISMED Journal of Health and Research. 2019 Jan 1;6(1):18. Doi: https://doi.org/10.4103/cjhr.cjhr_16_18

Nair KS, Raj S, Tiwari VK, Piang LK. Cost of treatment for cancer: experiences of patients in public hospitals in India. Asian Pacific Journal of Cancer Prevention. 2013;14(9):5049-54. Doi: https://doi.org/10.7314/APJCP.2013.14.9.5049 PMid:24175774

Khan MN, Hueniken K, Manojlovic‐Kolarski M, Eng L, Mirshams M, Khan K,et al. Out‐of‐pocket costs associated with head and neck cancer treatment. Cancer Reports. 2022 Jul;5(7):e1528. Doi: https://doi.org/10.1002/cnr2.1528 PMCid:PMC9327650

Mohanti BK, Mukhopadhyay A, Das S, Sharma K, Dash S. Estimating the economic burden of cancer at a tertiary public hospital: a study at the all-India Institute of Medical Sciences. New Delhi, India: Indian Statistical Institute, Delhi Centre. 2011 Jul. Available on: https://www.isid.ac.in/~abhiroop/res_papers/WORKING_PAPERS_files/cancer.pdf