Economics of cancer care: A community-based cross-sectional study in Kerala, India

Dinesh T. A.; Prem Nair; V. Abhijath; Vidya Jha; K. Aarthy

doi:10.4103/sajc.sajc_382_18

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ORIGINAL ARTICLE: Epidemiology of Cancer and Cancer Screening

09 (

); 07-12

doi:

10.4103/sajc.sajc_382_18

Economics of cancer care: A community-based cross-sectional study in Kerala, India

Dinesh T. A.¹, Prem Nair¹, V. Abhijath², Vidya Jha^2,, K. Aarthy²

1 Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala

2 Amrita Institute of Medical Sciences and Research Center, Department of Hospital Administration, Amrita Vishwa Vidyapeetham, Kochi, Kerala

*Corresponding author: Dr. Vidya Jha. vidyajha29@gmail.com

Published: 2020-12-14

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Bacground: The estimated incidence of cancer cases in Kerala for 2014 was 31,400 and the mortality associated with it was 13,816. Although the treatment of cancer has shown remarkable advances, it has come with increasing costs. Objective: The objective of this study is to estimate the economic burden of cancer in Vypin Block Panchayat at Ernakulam by analyzing the average total direct and indirect cost of cancer care, socioeconomic status, and cost of cancer care between government and private hospitals. Materials and Methods: A cross-sectional study was conducted for 2 months from March to April 2018. The study was conducted by utilizing an annotated cost questionnaire for completion by patients. Total direct and indirect cost was estimated. Appropriate statistical tests were used. Results: Direct cost for cancer care contributed 75% toward the cost of illness and the remaining was found to be indirect cost. Loss of income (44%) contributed to the largest chunk of indirect cost. The average direct cost for cancer care was found to be Rs. 25,606 and the average indirect cost was Rs. 8772. The average total cost of cancer care was calculated to be Rs. 34,378. Significant statistical variation was found between the cost of cancer care in private and government hospitals. The economic burden of cancer in this Vypin Block Panchayat was found to be Rs. 218,256,977/- Conclusion: The ratio of average income to average cost in this study is skewed which indicates the lack of affordability for cancer care in this population. A very large gap, therefore, exits between income levels and cost of cancer care clearly indicating a vast gap between affordability and cost of treatment, which clearly necessitates the need for a definite policy and state intervention for a mass cancer care program.

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References

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Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, et al. The financial toxicity of cancer treatment: A pilot study assessing out-of-pocket expenses and the insured cancer patient's experience. Oncologist 2013;18:381-90.
Brooks J, Wilson K, Amir Z. Additional financial costs borne by cancer patients: A narrative review. Eur J Oncol Nurs 2011;15:302-10.
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: A multicountry analysis. Lancet 2003;362:111-7.
Guilford JP, Fruchter B. Fundamental Statistics in Psychology and Education. 5th ed. New York: McGraw-Hill; 1973.
An Annotated Cost Questionnaire for Completion by Patients by Sally Thompson and Sarah Wordsworth On Behalf of the UK Working Party on Patient Costs HERU Discussion Paper No. [03/01]. Available from: https://www.abdn.ac.uk/heru/documents/BP/HERU_Discussion_paper_03-01.pdf. [Last accessed on 2018 Feb 14].
Nair KS, Raj S, Tiwari VK, Piang LK. Cost of treatment for cancer: Experiences of patients in public hospitals in India. Asian Pac J Cancer Prev 2013;14:5049-54.
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Augustine P, Jose R, Peter A, Lal AA, Prabhakar J, Sreedharan J, et al. Risk factors of breast cancer in Kerala, India- a case control study. Acad Med J 2014;2:7-13.
Mathew IE, Mathew A. Rising thyroid cancer incidence in Southern India: An epidemic of overdiagnosis? J Endocr Soc 2017;1:480-7.
Hassanipour-Azgomi S, Mohammadian-Hafshejani A, Ghoncheh M, Towhidi F, Jamehshorani S, Salehiniya H. Incidence and mortality of prostate cancer and their relationship with the human development index worldwide. Prostate Int 2016;4:118-24.
World Health Organization, International Agency for Research on Cancer. World Cancer Report. Geneva: World Health Organization; 2008.
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, Discussion Paper; 2011. p. 11-09.
International Agency for Research on Cancer. Cancer Incidence and Mortality Worldwide: IARC Cancer Base No 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globocan.iarc.fr. [Last accessed on 2018 Mar 10].
Amma JP, Paul S. Burden of cancers – Registry based data from Kerala, India. J Health Syst 2016;2:3-7. Available from: http://www.journals.publishmed.com/index.php/JHS/article/view/100>. [Last accessed on 2018 Sep 19].
Dror DM, van Putten-Rademaker O, Koren R. Cost of illness: Evidence from a study in five resource-poor locations in India. Indian J Med Res 2008;127:347-61.
Kulkarni BB, Hiremath SV, Kulkarni SS, Hallikeri UR, Patil BR, Gai PB. Decade of breast cancer-trends in patients profiles attending tertiary cancer care centre in South India. Asian J Epidemiol 2012;5:103-13.
Mahal A, Karan A, Engelgau M. The Economic Implications of Non-Communicable Diseases for India. Washington, D.C.: World Bank; 2010.
Jain M, Mukherjee K. Economic burden of breast cancer to the households in Punjab, India. Int J Med Public Health 2016;6:13-8.
Goyal S, Tiwari VK, Nair KS, Raj S. Risk factors and costs of oral cancer in a tertiary care hospital in Delhi. Asian Pac J Cancer Prev 2014;15:1659-65.

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[1] Indian Council of Medical Research. Publications. Available from: http://www.icmr.nic.in/Publications/Publications.html. [Last accessed on 2018 Jan 29].

[2] Indian Council of Medical Research. Based on Cancer Incidence Report (2009-2011) and the Report on Time Trends in Cancer Incidence Rates (1982-2010). Bangalore: NCDIR-NCRP (Indian Council of Medical Research); 2013.

[3] Indian Council of Medical Research. Based on Cancer Incidence Cases and Pooled M/I Ratio of Mumbai Data (2009-2011) Report. NewDelhi: National Cancer Registry Programme of Indian Council of Medical Research; 2014.

[4] Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, et al. The financial toxicity of cancer treatment: A pilot study assessing out-of-pocket expenses and the insured cancer patient's experience. Oncologist 2013;18:381-90.

[5] Brooks J, Wilson K, Amir Z. Additional financial costs borne by cancer patients: A narrative review. Eur J Oncol Nurs 2011;15:302-10.

[6] Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: A multicountry analysis. Lancet 2003;362:111-7.

[7] Guilford JP, Fruchter B. Fundamental Statistics in Psychology and Education. 5th ed. New York: McGraw-Hill; 1973.

[8] An Annotated Cost Questionnaire for Completion by Patients by Sally Thompson and Sarah Wordsworth On Behalf of the UK Working Party on Patient Costs HERU Discussion Paper No. [03/01]. Available from: https://www.abdn.ac.uk/heru/documents/BP/HERU_Discussion_paper_03-01.pdf. [Last accessed on 2018 Feb 14].

[9] Nair KS, Raj S, Tiwari VK, Piang LK. Cost of treatment for cancer: Experiences of patients in public hospitals in India. Asian Pac J Cancer Prev 2013;14:5049-54.

[10] Regional Cancer Centre. Hospital Cancer Registry 2013 Regional Cancer Centre, Thiruvananthapuram. Trivandrum: Regional Cancer Centre; January, 2014. Available from: http://www.rcctvm.org. [Last accessed on 2018 Feb 14].

[11] Jayalekshmi P, Gangadharan P, Mani KS. Cancer in women in Kerala – a transition from a less-developed state. Asian Pac J Cancer Prev 2006;7:186-90.

[12] Augustine P, Jose R, Peter A, Lal AA, Prabhakar J, Sreedharan J, et al. Risk factors of breast cancer in Kerala, India- a case control study. Acad Med J 2014;2:7-13.

[13] Mathew IE, Mathew A. Rising thyroid cancer incidence in Southern India: An epidemic of overdiagnosis? J Endocr Soc 2017;1:480-7.

[14] Hassanipour-Azgomi S, Mohammadian-Hafshejani A, Ghoncheh M, Towhidi F, Jamehshorani S, Salehiniya H. Incidence and mortality of prostate cancer and their relationship with the human development index worldwide. Prostate Int 2016;4:118-24.

[15] World Health Organization, International Agency for Research on Cancer. World Cancer Report. Geneva: World Health Organization; 2008.

[16] 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, Discussion Paper; 2011. p. 11-09.

[17] International Agency for Research on Cancer. Cancer Incidence and Mortality Worldwide: IARC Cancer Base No 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globocan.iarc.fr. [Last accessed on 2018 Mar 10].

[18] Amma JP, Paul S. Burden of cancers – Registry based data from Kerala, India. J Health Syst 2016;2:3-7. Available from: http://www.journals.publishmed.com/index.php/JHS/article/view/100>. [Last accessed on 2018 Sep 19].

[19] Dror DM, van Putten-Rademaker O, Koren R. Cost of illness: Evidence from a study in five resource-poor locations in India. Indian J Med Res 2008;127:347-61.

[20] Kulkarni BB, Hiremath SV, Kulkarni SS, Hallikeri UR, Patil BR, Gai PB. Decade of breast cancer-trends in patients profiles attending tertiary cancer care centre in South India. Asian J Epidemiol 2012;5:103-13.

[21] Mahal A, Karan A, Engelgau M. The Economic Implications of Non-Communicable Diseases for India. Washington, D.C.: World Bank; 2010.

[22] Jain M, Mukherjee K. Economic burden of breast cancer to the households in Punjab, India. Int J Med Public Health 2016;6:13-8.

[23] Goyal S, Tiwari VK, Nair KS, Raj S. Risk factors and costs of oral cancer in a tertiary care hospital in Delhi. Asian Pac J Cancer Prev 2014;15:1659-65.

Economics of cancer care: A community-based cross-sectional study in Kerala, India

Abstract

Abstract

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References

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