Financial toxicity of cancer treatment in India: towards closing the cancer care gap
BackgroundThe rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health ben...
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| Format: | Article |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1065737/full |
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| author | Shankar Prinja Jyoti Dixit Nidhi Gupta Anushikha Dhankhar Amal Chandra Kataki Partha Sarathi Roy Nikita Mehra Lalit Kumar Ashish Singh Pankaj Malhotra Aarti Goyal Kavitha Rajsekar Manjunath Nookala Krishnamurthy Sudeep Gupta |
| author_facet | Shankar Prinja Jyoti Dixit Nidhi Gupta Anushikha Dhankhar Amal Chandra Kataki Partha Sarathi Roy Nikita Mehra Lalit Kumar Ashish Singh Pankaj Malhotra Aarti Goyal Kavitha Rajsekar Manjunath Nookala Krishnamurthy Sudeep Gupta |
| author_sort | Shankar Prinja |
| collection | DOAJ |
| description | BackgroundThe rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities.MethodsA total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression.ResultsMean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment.ConclusionThere is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies. |
| first_indexed | 2024-03-13T04:32:19Z |
| format | Article |
| id | doaj.art-bd92cd535f844615bb80348a581c0cd3 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-13T04:32:19Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-bd92cd535f844615bb80348a581c0cd32023-06-19T11:46:08ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-06-011110.3389/fpubh.2023.10657371065737Financial toxicity of cancer treatment in India: towards closing the cancer care gapShankar Prinja0Jyoti Dixit1Nidhi Gupta2Anushikha Dhankhar3Amal Chandra Kataki4Partha Sarathi Roy5Nikita Mehra6Lalit Kumar7Ashish Singh8Pankaj Malhotra9Aarti Goyal10Kavitha Rajsekar11Manjunath Nookala Krishnamurthy12Sudeep Gupta13Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Radiation Oncology, Government Medical College and Hospital, Chandigarh, IndiaDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDr. B. Booroah Cancer Institute, Guwahati, IndiaDr. B. Booroah Cancer Institute, Guwahati, IndiaDepartment of Medical Oncology, Adyar Cancer Institute, Chennai, IndiaDepartment of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaDepartment of Medical Oncology, Christian Medical College, Vellore, IndiaDepartment of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Health Research, Ministry of Health and Family Welfare, New Delhi, IndiaDepartment of Medical Oncology, Tata Memorial Centre, Mumbai, IndiaDepartment of Medical Oncology, Tata Memorial Centre, Mumbai, IndiaBackgroundThe rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities.MethodsA total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression.ResultsMean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment.ConclusionThere is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1065737/fullfinancial toxicitycatastrophic health expenditureimpoverishmentdirect out of pocket expenditureindirect cost due to loss of productivitycancer |
| spellingShingle | Shankar Prinja Jyoti Dixit Nidhi Gupta Anushikha Dhankhar Amal Chandra Kataki Partha Sarathi Roy Nikita Mehra Lalit Kumar Ashish Singh Pankaj Malhotra Aarti Goyal Kavitha Rajsekar Manjunath Nookala Krishnamurthy Sudeep Gupta Financial toxicity of cancer treatment in India: towards closing the cancer care gap Frontiers in Public Health financial toxicity catastrophic health expenditure impoverishment direct out of pocket expenditure indirect cost due to loss of productivity cancer |
| title | Financial toxicity of cancer treatment in India: towards closing the cancer care gap |
| title_full | Financial toxicity of cancer treatment in India: towards closing the cancer care gap |
| title_fullStr | Financial toxicity of cancer treatment in India: towards closing the cancer care gap |
| title_full_unstemmed | Financial toxicity of cancer treatment in India: towards closing the cancer care gap |
| title_short | Financial toxicity of cancer treatment in India: towards closing the cancer care gap |
| title_sort | financial toxicity of cancer treatment in india towards closing the cancer care gap |
| topic | financial toxicity catastrophic health expenditure impoverishment direct out of pocket expenditure indirect cost due to loss of productivity cancer |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1065737/full |
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