New Delhi: Over 84 percent of breast cancer patients in India have to incur catastrophic healthcare expenditure and this form of cancer — the top malignancy in India now — leads to distress financing for more than 72 percent of patients.
Catastrophic healthcare expenditure is defined as household health spending exceeding 10 percent of household consumption expenditure by government think-tank NITI Aayog.
The findings have emerged in a crucial analysis by top cancer institute Tata Memorial Centre (TMC) and the International Institute for Population Sciences (IIPS), following examination of expenditure data in a total of 500 breast cancer patients who underwent treatment at TMC.
Importantly, the analysis report, published in the latest issue of the International Journal for Equity in Health on 23 July, notes that about 75 percent of the patients studied had some form of reimbursement or insurance but it reduced the incidence of catastrophic health expenditure by a mere 14 percent.
This is the largest study on breast cancer treatment financing in India so far.
A World Health Organization (WHO) report released this year showed that breast cancer was the leading form of cancer in India in 2022, followed by cancers of the lip and oral cavity.
In 2022, the country had registered 1,92,020 new breast cancer cases while 98,337 patients died of it.
“Our analysis has shown that out-of-pocket expenditure during breast cancer treatment is devastating for most patients and their families despite TMC being a top government institute where the treatment for the majority of them is highly subsidised,” said a researcher from IIPS associated with the project, who did not wish to be named.
Many patients included in the analysis, he added, were also beneficiaries of the government’s flagship health insurance scheme — Pradhan Mantri Jan Arogya Yojana — which provides hospitalisation benefits of up to Rs 5 lakh to the poor.
“Yet, they had catastrophic healthcare expenditure, as cancer treatment largely involves outpatient department (OPD) care and the cost of medicines, not covered under the insurance, is very high,” the researcher said.
Some independent specialists, too, agreed that the findings are stark and underline the need to develop policies that lead to early detection of cancers while also ensuring financial protection during treatment.
“This is a very important and credible study — it comes from one of India’s busiest and most reputed cancer hospitals. It is an unfortunate reality that most Indians are uninsured or underinsured. Therefore, a health emergency can wipe out lifelong family savings and cause catastrophic financial hardship,” Dr Kamal Saini, a medical oncologist and cancer researcher based in the UK, told ThePrint.
Breast cancer treatments include surgery, radiation, chemotherapy, and hormonal therapy — involving significant expenditure in the form of both money and time.
“More modern treatments such as targeted monoclonal antibodies, CDK4/6 inhibitors, antibody drug conjugates and immunotherapy are often cost-prohibitive and beyond the reach of most Indians,” Saini pointed out.
The researchers have suggested that making cancer treatment free for all irrespective of the type of cancer would help mitigate the burden of catastrophic healthcare spending among Indian households.
Also Read: Can mixing traditional & modern medicines help treat cancer? Govt wants to find out
What the analysis found
As part of the study, a total of 500 breast cancer patients were followed over a period of 34 months — between June 2019 and March 2022.
The cost of registration, admission, investigation, medicine, surgery, systemic therapy and radiotherapy was classified under direct medical costs. Similarly, expenditure on food, accommodation and travel was classified as direct non-medical costs.
Detailed information about coping mechanisms for cancer treatment from multiple sources such as income, savings, selling of assets, borrowing, loans and insurance was collected at the endline and used in estimating distress financing.
A patient was said to incur distress financing if the cancer treatment was met by any of the following means — selling assets, jewellery or property, or by taking loans.
The median and mean out-of-pocket expenditure payment were Rs 1,26,988 and Rs 1,86,461, respectively, show the results.
Treatment modalities included surgery, systemic therapy and radiotherapy, and about 83 percent patients had received all the three types of treatment modalities.
Though the majority of breast cancer patients had some type of reimbursement, it covered only 30.2 percent of the total treatment expenses, and the mean amount reimbursed was Rs 78,016.
The incidence of catastrophic healthcare expenditure was 98.1 percent before reimbursement and 84.6 percent after reimbursement.
“Thus, reimbursement reduced catastrophic healthcare expenditure only by 13.8 percent,” the researchers noted.
Also, higher prevalence of catastrophic health spending and distress financing was found among rural, poor, agriculture-dependent households and among patients from outside of Maharashtra, where TMC is located.
Among all the breast cancer patients, 44 percent had used two sources while 32.2 percent had used three or more sources for financing their treatment. Most of the patients — 78 percent — met their treatment costs by using multiple sources.
A mere 5.8 percent of patients used income as one of the sources for covering treatment cost, 48.6 percent used savings, 66.6 percent resorted to loans & borrowings and 72.4 percent either sold assets or borrowed to finance the cost of treatment.
The increased financial burden of catastrophic spending is also possibly due to non-reimbursement of indirect costs such as accommodation, travel and food of accompanying persons, according to the analysis.
(Edited by Nida Fatima Siddiqui)