Out-of-pocket payment and financial risk protection for breast cancer treatment: a prospective study from India

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dc.contributor.authorWadasadawala, Tabassumen
dc.contributor.authorMohanty, Sanjay K.en
dc.contributor.authorSen, Soumenduen
dc.contributor.authorKanala, Tejaswi S.en
dc.contributor.authorMaiti, Surajen
dc.contributor.authorPuchali, Namitaen
dc.contributor.authorGupta, Sudeepen
dc.contributor.authorSarin, Rajiven
dc.contributor.authorParmar, Vanien
dc.date.accessioned2025-02-20T20:21:08Zen
dc.date.available2025-02-20T20:21:08Zen
dc.date.issued2024-01-16en
dc.description.abstractBackground: Available data on cost of cancer treatment, out-of-pocket payment and reimbursement are limited in India. We estimated the treatment costs, out-of-pocket payment, and reimbursement in a cohort of breast cancer patients who sought treatment at a publicly funded tertiary cancer care hospital in India. Methods: A prospective longitudinal study was conducted from June 2019 to March 2022 at Tata Memorial Centre (TMC), Mumbai. Data on expenditure during each visit of treatment was collected by a team of trained medical social workers. The primary outcome variables were total cost (TC) of treatment, out-of-pocket payment (OOP), and reimbursement. TC included cost incurred by breast cancer patients during treatment at TMC. OOP was defined as the total cost incurred at TMC less of reimbursement. Reimbursement was any form of financial assistance (cashless or repayment), including social health insurance, private health insurance, employee health schemes, and assistance from charitable trusts, received by the patients for breast cancer treatment. Findings: Of the 500 patients included in the study, 45 discontinued treatment (due to financial or other reasons) and 26 died during treatment. The mean TC of breast cancer treatment was ₹258,095/US$3531 (95% CI: 238,225, 277,934). Direct medical cost (MC) accounted for 56.3% of the TC. Systemic therapy costs (₹50,869/US$696) were higher than radiotherapy (₹33,483/US$458) and surgery costs (₹25,075/US$343). About 74.4% patients availed some form of financial assistance at TMC; 8% patients received full reimbursement. The mean OOP for breast cancer treatment was ₹186,461/US$2551 (95% CI: 167,666, 205,257), accounting for 72.2% of the TC. Social health insurance (SHI) had a reasonable coverage (33.1%), followed by charitable trusts (29.6%), employee health insurance (5.1%), private health insurance (4.4%) and 25.6% had no reimbursement. But SHI covered only 40.1% of the TC of treatment compared to private health insurance that covered as much as 57.1% of it. Both TC and OOP were higher for patients who were younger, belonged to rural areas, had a comorbidity, were diagnosed at an advanced stage, and were from outside Maharashtra. Interpretation: In India, the cost and OOP for breast cancer treatment are high and reimbursement for the treatment flows from multiple sources. Though many of the patients receive some form of reimbursement, it is insufficient to prevent high OOP. Hence both wider insurance coverage as well as higher cap of the insurance packages in the health insurance schemes is suggested. Allowing for the automatic inclusion of cancer treatment in SHI can mitigate the financial burden of cancer patients in India. Funding: This work was funded by an extramural grant from the Women's Cancer Initiative and the Nag Foundation and an intramural grant from the International Institute of Population Sciences, Mumbai.en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier100346 (Article number)en
dc.identifier.doihttps://doi.org/10.1016/j.lansea.2023.100346en
dc.identifier.eissn2772-3682en
dc.identifier.issn2772-3682en
dc.identifier.orcidMaiti, Suraj [0000-0001-5441-1399]en
dc.identifier.otherPMC11096681en
dc.identifier.otherS2772-3682(23)00206-8 (PII)en
dc.identifier.pmid38756158en
dc.identifier.urihttps://hdl.handle.net/10919/124670en
dc.identifier.volume24en
dc.language.isoenen
dc.publisherElsevieren
dc.relation.urihttps://www.ncbi.nlm.nih.gov/pubmed/38756158en
dc.rightsCreative Commons Attribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectBreast canceren
dc.subjectCancer costsen
dc.subjectHealth care expenditureen
dc.subjectHealth economicsen
dc.subjectHealth insuranceen
dc.subjectHealth policyen
dc.subjectOOPen
dc.subjectOncologyen
dc.subjectReimbursementen
dc.titleOut-of-pocket payment and financial risk protection for breast cancer treatment: a prospective study from Indiaen
dc.title.serialThe Lancet Regional Health - Southeast Asiaen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherJournal Articleen
dcterms.dateAccepted2023-12-26en
pubs.organisational-groupVirginia Techen
pubs.organisational-groupVirginia Tech/Scienceen
pubs.organisational-groupVirginia Tech/Science/Economicsen
pubs.organisational-groupVirginia Tech/Graduate studentsen
pubs.organisational-groupVirginia Tech/Graduate students/Doctoral studentsen

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