Economics of Cancer Treatment in a Developing Country – Part 1
Cancer has become one of the leading causes of death among the human population worldwide.
It has become a growing threat in developing countries such as India where the “silent pandemic” of cancer is spreading at an alarming rate.
Initial studies in cancer prevalence indicated that developed nations had a higher incidence of cancers, but in recent years, the cancer incidence has increased substantially in developing countries as well. The estimates from Global Burden of Disease (GBD) suggest that about 70% of all cancer deaths are now concentrated among low- and middle-income countries.
A landmark study found that cancer had the greatest economic impact from premature death and disability of all causes of death worldwide. The total global economic impact of cancer diagnosis and treatment is over 900 billion dollars.
Health care costs include the direct costs of receiving medical care and the non-medical costs during treatment. Indirect costs include days lost from work for the patient or the caregiver. Intangible costs such as pain and suffering and loss of companionship are difficult to measure but very real to the patient and family.
In developing countries, after cancer is detected the burden on individuals and families is very profound, especially where the loss of income due to sickness or death by cancer can deplete family finances substantially. Hospital-based studies have estimated that on average, a household spends more than Rs.50,000.00 excluding non-medical costs, which is a significant component of total cancer care expenditure, for a cancer diagnosis. Non-medical expenditure also emerges as a significant proportion of total cancer care expenditure. In addition, cancer hospitalization and therapy cost about 2.5 times of overall average hospitalization expenditure.
It has been reported that 30-60% of households resort to borrowings and contributions from friends and relatives, respectively, for cancer hospitalization.
Private sector health care facilities are more accessed for cancer treatment in India. In particular, richer households rely more on private hospitals for cancer inpatient care, whereas poor households mainly depend on public healthcare facilities. The average expenditure in private facilities is almost two times higher than public facilities. Nearly one in every three patients’ household spends about half of per capita annual household expenditure on cancer hospitalization.
Targeted prevention, early cancer detection with screening and adequate treatment strategies aimed at preventable forms of cancer not only could save lives, but also improve economic prospects. Lack of awareness and effective interventions for some types of cancer still do not exist in developing nations. Despite the fact that some cancers can be prevented or treated effectively, mortality rates remain high.
The cancer mortality in India is projected to increase to over 900,000 deaths by the end of this decade. There is failure to deliver basic surgery and radiotherapy for cancer patients in developing countries, coupled to the lack of basic chemotherapy regimens.
Radiotherapy is one of the main components of modern cancer treatment and requires substantial capital investment, trained professionals in several disciplines, and high precision equipment. Access to such current state-of-the-art medical technology is necessary to lower the economic impact of cancer therapies in developing countries. A Linear accelerator has an average treatment delivery life of 15-20 years. Although the initial costs seem high as compared to other medical equipment that needs to be changed or upgraded after 5-7 years, the value for money is much higher for a Linear accelerator once the initial capital cost is mitigated against the number of patients treated per year for 15-20 years.