Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study
Summary: Background: Although colorectal cancer is increasing in India, the cost of comprehensive treatment and its consequences for patients and households are unknown. This study aimed to describe catastrophic expenditure and treatment attrition in patients with a treatment plan for colorectal ca...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | The Lancet Regional Health - Southeast Asia |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772368222000749 |
| _version_ | 1817980583516569600 |
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| author | Bodhisattva Bose Joanne Clarke James C. Glasbey Parvez D. Haque Kate Jolly Pamela A. Kingsley Rohin Mittal Dion Morton Raymond Oppong Ashwin Phillips Amrit Pipara Jitendra Rohila Avanish Saklani Rajkumar Kottayasamy Seenivasagam Joana F.F. Simoes Atul Suroy Sreejith K. Veetil Aneel Bhangu Dhruva Ghosh Joana F.F. Simoes Raymond Oppong Omar Omar Aneel Bhangu Rajkumar Kottayasamy Seenivasagam Bodhisattva Bose Deepak Sundriyal Deepa M. Joseph Amoli Tandon Sunil Kumar Singh Raunak Verma Dhruva Ghosh Parvez D. Haque Pamela A. Kingsley Ashwin Phillips Sreejith K. Veetil Rohin Mittal Thomas Samuel Ram Harish Yezzaji Mark Ranjan Jesudason Ashish Singh David John Soosan Prasad Pragnitha Chitteti Esther Daniel John Paul Laura Arthy Amrit Pipara Robin Thambudorai Mohandas Mallath Manas Kumar Roy Sonia Mathai Jyotiska Chatterjee Meenakshi Chakraborty Avanish Saklani Jitendra Rohila Ashwin DeSouza Jayesh Gori Mufaddal Kazi Anjali Daphal |
| author_facet | Bodhisattva Bose Joanne Clarke James C. Glasbey Parvez D. Haque Kate Jolly Pamela A. Kingsley Rohin Mittal Dion Morton Raymond Oppong Ashwin Phillips Amrit Pipara Jitendra Rohila Avanish Saklani Rajkumar Kottayasamy Seenivasagam Joana F.F. Simoes Atul Suroy Sreejith K. Veetil Aneel Bhangu Dhruva Ghosh Joana F.F. Simoes Raymond Oppong Omar Omar Aneel Bhangu Rajkumar Kottayasamy Seenivasagam Bodhisattva Bose Deepak Sundriyal Deepa M. Joseph Amoli Tandon Sunil Kumar Singh Raunak Verma Dhruva Ghosh Parvez D. Haque Pamela A. Kingsley Ashwin Phillips Sreejith K. Veetil Rohin Mittal Thomas Samuel Ram Harish Yezzaji Mark Ranjan Jesudason Ashish Singh David John Soosan Prasad Pragnitha Chitteti Esther Daniel John Paul Laura Arthy Amrit Pipara Robin Thambudorai Mohandas Mallath Manas Kumar Roy Sonia Mathai Jyotiska Chatterjee Meenakshi Chakraborty Avanish Saklani Jitendra Rohila Ashwin DeSouza Jayesh Gori Mufaddal Kazi Anjali Daphal |
| author_sort | Bodhisattva Bose |
| collection | DOAJ |
| description | Summary: Background: Although colorectal cancer is increasing in India, the cost of comprehensive treatment and its consequences for patients and households are unknown. This study aimed to describe catastrophic expenditure and treatment attrition in patients with a treatment plan for colorectal cancer. Methods: A prospective, multicentre, cohort study was conducted in five tertiary hospitals in India from December 2020 to March 2022. Consecutive patients with a new treatment plan for colorectal cancer were followed-up for six months. The total cost of treatment was reported, including out-of-pocket payments (OOPP, paid by patients at the time-of-service use) and covered by third parties (insurance, public funds). The primary outcome was catastrophic expenditure, defined as OOPPs greater than 25% of patient's annual household income and the secondary outcome was treatment attrition, defined as unplanned interruption of the treatment course not recommended by the clinical team. Findings: Of 226 patients included, 20 died within six months of being offered a treatment plan and four were lost to follow-up. The median total cost of colorectal cancer treatment was 407,508 Indian Rupees (INR/5340 USD), to which the biggest contributor was the patient's OOPP (median 330,277 INR/4328 USD). Surgery and anaesthesia costs (median 85,944 INR/1126 USD) were higher than radiotherapy (median 55,525 INR/728 USD) and chemotherapy (median 14,780 INR/194 USD). The overall catastrophic expenditure rate was 90.1% (182/202) and the treatment attrition rate was 9.4% (19/202). Patients with treatment attrition made lower OOPPs than those who completed treatment (median 205,926 vs 349,398 INR, p < 0.01) but had a similar risk of catastrophic expenditure (OR 0.23, 95%CI 0.03-2.28, p = 0.186). Interpretation: Most treatment costs for colorectal cancer were paid out-of-pocket by patients and catastrophic expenditure was common. Treatment attrition rates at tertiary centres were low, suggesting greater attrition at previous stages of care. Better financial protection may allow more patients to receive comprehensive cancer treatment while avoiding household financial catastrophe. Funding: This research was funded by the National Institute for Health Research (NIHR) (NIHR 16.136.79) using UK aid from the UK Government to support global health research, by the India Institute of the University of Birmingham and by the Global Challenges program of the University of Birmingham. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government. |
| first_indexed | 2024-04-13T22:55:17Z |
| format | Article |
| id | doaj.art-ca0236c63c71449793865a447ba897cb |
| institution | Directory Open Access Journal |
| issn | 2772-3682 |
| language | English |
| last_indexed | 2024-04-13T22:55:17Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health - Southeast Asia |
| spelling | doaj.art-ca0236c63c71449793865a447ba897cb2022-12-22T02:26:02ZengElsevierThe Lancet Regional Health - Southeast Asia2772-36822022-11-016100058Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre studyBodhisattva Bose0Joanne Clarke1James C. Glasbey2Parvez D. Haque3Kate Jolly4Pamela A. Kingsley5Rohin Mittal6Dion Morton7Raymond Oppong8Ashwin Phillips9Amrit Pipara10Jitendra Rohila11Avanish Saklani12Rajkumar Kottayasamy Seenivasagam13Joana F.F. Simoes14Atul Suroy15Sreejith K. Veetil16Aneel Bhangu17Dhruva Ghosh18Joana F.F. Simoes19Raymond Oppong20Omar Omar21Aneel Bhangu22Rajkumar Kottayasamy Seenivasagam23Bodhisattva Bose24Deepak Sundriyal25Deepa M. Joseph26Amoli Tandon27Sunil Kumar Singh28Raunak Verma29Dhruva Ghosh30Parvez D. Haque31Pamela A. Kingsley32Ashwin Phillips33Sreejith K. Veetil34Rohin Mittal35Thomas Samuel Ram36Harish Yezzaji37Mark Ranjan Jesudason38Ashish Singh39David John40Soosan Prasad41Pragnitha Chitteti42Esther Daniel43John Paul44Laura Arthy45Amrit Pipara46Robin Thambudorai47Mohandas Mallath48Manas Kumar Roy49Sonia Mathai50Jyotiska Chatterjee51Meenakshi Chakraborty52Avanish Saklani53Jitendra Rohila54Ashwin DeSouza55Jayesh Gori56Mufaddal Kazi57Anjali Daphal58All India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomNational Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United KingdomChristian Medical College and Hospital, Ludhiana, IndiaInstitute of Applied Health Research, University of Birmingham, Birmingham, United KingdomChristian Medical College and Hospital, Ludhiana, IndiaChristian Medical College and Hospital, Vellore, IndiaNational Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United KingdomHealth Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United KingdomChristian Medical College and Hospital, Ludhiana, IndiaTata Medical Center, Kolkata, IndiaTata Memorial Hospital, Mumbai, IndiaTata Memorial Hospital, Mumbai, IndiaAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaNational Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom; Corresponding author at: NIHR Global Health Research Unit on Global Surgery, University of Birmingham, UK.India Hub, NIHR Global Health Research Unit on Global Surgery, Christian Medical College & Hospital, Ludhiana, IndiaChristian Medical College and Hospital, Ludhiana, IndiaNational Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United KingdomChristian Medical College and Hospital, Ludhiana, India; India Hub, NIHR Global Health Research Unit on Global Surgery, Christian Medical College & Hospital, Ludhiana, IndiaNational Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United KingdomHealth Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United KingdomNational Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United KingdomNational Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United KingdomAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaAll India Institute of Medical Sciences Rishikesh, Rishikesh, IndiaChristian Medical College and Hospital, Ludhiana, IndiaChristian Medical College and Hospital, Ludhiana, IndiaChristian Medical College and Hospital, Ludhiana, IndiaChristian Medical College and Hospital, Ludhiana, IndiaChristian Medical College and Hospital, Ludhiana, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaChristian Medical College and Hospital, Vellore, IndiaTata Medical Center, Kolkata, IndiaTata Medical Center, Kolkata, IndiaTata Medical Center, Kolkata, IndiaTata Medical Center, Kolkata, IndiaTata Medical Center, Kolkata, IndiaTata Medical Center, Kolkata, IndiaTata Medical Center, Kolkata, IndiaTata Memorial Hospital, Mumbai, IndiaTata Memorial Hospital, Mumbai, IndiaTata Memorial Hospital, Mumbai, IndiaTata Memorial Hospital, Mumbai, IndiaTata Memorial Hospital, Mumbai, IndiaTata Memorial Hospital, Mumbai, IndiaSummary: Background: Although colorectal cancer is increasing in India, the cost of comprehensive treatment and its consequences for patients and households are unknown. This study aimed to describe catastrophic expenditure and treatment attrition in patients with a treatment plan for colorectal cancer. Methods: A prospective, multicentre, cohort study was conducted in five tertiary hospitals in India from December 2020 to March 2022. Consecutive patients with a new treatment plan for colorectal cancer were followed-up for six months. The total cost of treatment was reported, including out-of-pocket payments (OOPP, paid by patients at the time-of-service use) and covered by third parties (insurance, public funds). The primary outcome was catastrophic expenditure, defined as OOPPs greater than 25% of patient's annual household income and the secondary outcome was treatment attrition, defined as unplanned interruption of the treatment course not recommended by the clinical team. Findings: Of 226 patients included, 20 died within six months of being offered a treatment plan and four were lost to follow-up. The median total cost of colorectal cancer treatment was 407,508 Indian Rupees (INR/5340 USD), to which the biggest contributor was the patient's OOPP (median 330,277 INR/4328 USD). Surgery and anaesthesia costs (median 85,944 INR/1126 USD) were higher than radiotherapy (median 55,525 INR/728 USD) and chemotherapy (median 14,780 INR/194 USD). The overall catastrophic expenditure rate was 90.1% (182/202) and the treatment attrition rate was 9.4% (19/202). Patients with treatment attrition made lower OOPPs than those who completed treatment (median 205,926 vs 349,398 INR, p < 0.01) but had a similar risk of catastrophic expenditure (OR 0.23, 95%CI 0.03-2.28, p = 0.186). Interpretation: Most treatment costs for colorectal cancer were paid out-of-pocket by patients and catastrophic expenditure was common. Treatment attrition rates at tertiary centres were low, suggesting greater attrition at previous stages of care. Better financial protection may allow more patients to receive comprehensive cancer treatment while avoiding household financial catastrophe. Funding: This research was funded by the National Institute for Health Research (NIHR) (NIHR 16.136.79) using UK aid from the UK Government to support global health research, by the India Institute of the University of Birmingham and by the Global Challenges program of the University of Birmingham. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.http://www.sciencedirect.com/science/article/pii/S2772368222000749Catastrophic expenditureCancerColorectal cancerTreatment attritionIndia |
| spellingShingle | Bodhisattva Bose Joanne Clarke James C. Glasbey Parvez D. Haque Kate Jolly Pamela A. Kingsley Rohin Mittal Dion Morton Raymond Oppong Ashwin Phillips Amrit Pipara Jitendra Rohila Avanish Saklani Rajkumar Kottayasamy Seenivasagam Joana F.F. Simoes Atul Suroy Sreejith K. Veetil Aneel Bhangu Dhruva Ghosh Joana F.F. Simoes Raymond Oppong Omar Omar Aneel Bhangu Rajkumar Kottayasamy Seenivasagam Bodhisattva Bose Deepak Sundriyal Deepa M. Joseph Amoli Tandon Sunil Kumar Singh Raunak Verma Dhruva Ghosh Parvez D. Haque Pamela A. Kingsley Ashwin Phillips Sreejith K. Veetil Rohin Mittal Thomas Samuel Ram Harish Yezzaji Mark Ranjan Jesudason Ashish Singh David John Soosan Prasad Pragnitha Chitteti Esther Daniel John Paul Laura Arthy Amrit Pipara Robin Thambudorai Mohandas Mallath Manas Kumar Roy Sonia Mathai Jyotiska Chatterjee Meenakshi Chakraborty Avanish Saklani Jitendra Rohila Ashwin DeSouza Jayesh Gori Mufaddal Kazi Anjali Daphal Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study The Lancet Regional Health - Southeast Asia Catastrophic expenditure Cancer Colorectal cancer Treatment attrition India |
| title | Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study |
| title_full | Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study |
| title_fullStr | Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study |
| title_full_unstemmed | Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study |
| title_short | Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India: A prospective multicentre study |
| title_sort | catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in india a prospective multicentre study |
| topic | Catastrophic expenditure Cancer Colorectal cancer Treatment attrition India |
| url | http://www.sciencedirect.com/science/article/pii/S2772368222000749 |
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