Out-of-Pocket expenditure for diagnosis of lung cancer: A significant pretreatment financial burden – Study from a tertiary care cancer center in North India

Abstract

Background: The incidence of catastrophic expenditure due to health-care costs is growing and is estimated to be one of the major contributors to poverty. The need to pay out-of-pocket can also mean that households do not seek care when they need it. The total economic burden of cancer therapy amounts to the mean of 36,812 Indian National Rupee (INR). Out of this, 40% comprises expenditure incurred before coming to the hospital. Objectives: This study assessed the total out-of-pocket expenditure (OOPE) of lung cancer patients before they seek services for treatment at a tertiary care center. Materials and Methods: This was an institution-based cross-sectional survey in newly diagnosed and registered lung cancer patients > 18 years old. Self-designed, pretested, semi-structured questionnaire for sociodemographic details and direct costs incurred under various subsets was used. Data were analyzed using Epi Info version 7.2.0.1. Results: Out of 91 patients registered, 73 (80.2%) were male. The median OOPE was 19000 INR (range: 8000–40,000). We found that the total mean expenditure (19,516.48 ± 6488.22) was almost ten times their per capita income (2012.444 ± 1283.09). The total mean direct medical costs incurred were 8974.73 ± 5252 INR and direct nonmedical costs incurred were 10,574.73 ± 4414 INR. This study further showed that the direct nonmedical costs incurred were significantly higher (P = 0.02) than the direct medical costs. Similarly, the costs incurred on diagnostics were significantly higher (P < 0.001) as compared to the cost incurred on medicines. Conclusion: Lung cancer patients face the burden of OOPE at every stage, starting from the initial visit to a local health facility till the final diagnosis and treatment at a tertiary health-care facility. More measures are warranted to curtail preregistration and pretreatment expenses such as preventing people from traveling long distances just for imaging and diagnostic facilities and hence curtailing nonmedical cataclysmic expenditure.

Keywords

• Direct costs
• lung cancer patients
• out-of-pocket expenditure