Economic burden of breast cancer to the households in Punjab, India

Abstract

Introduction: Breast cancer is on rise and cervix cancer is on declining mode according to the cancer registry data in India. The major mode of financing treatment is out-of-pocket (OOP) and this can push 25% of the cancer affected households below the poverty line. Materials and Methods: A cross-sectional descriptive study with a household perspective was done in the state of Punjab. By using probability proportional to the size method and systematic random sampling, the sample was drawn from every district of Punjab. A face-to-face semi-structured interview schedule was administered to 221 patients. Results: The direct cost contributed 79% toward the total cost-of-illness. The cost of drugs (36.23%) followed by cost of hospitalization (27.05%) and productivity loss (13.44%) were the main contributors toward the total cost of illness. The contribution of indirect cost is 21 per cent of the total cost. The cost of treatment depends upon type of facility used (more in private as compared to the public), stage of cancer (stage above first stage cost more than the first stage), and age at the time of diagnosis aged above sixty incurred more expenditure as compared to the aged below sixty. The 84% of the households had experienced the catastrophic health expenditure (CHE) and 51% of the households had faced distress financing (DF). The main financial coping strategies*(*multiple strategies) used were saving (74%), borrowing at low rate of interest (88%), social nets (55%), and selling financial assets (30%).

Catastrophic Healthcare Expenditure and Coping Strategies among Patients Attending Cancer Treatment Services in Addis Ababa, Ethiopia

“…In addition, although direct comparison seems infeasible because of the different threshold level of CHE used, our nding was higher as compared to other studies reported from Asian countries (47.8%-67.9%) [30][31][32]. But, it was lower compared to Indian breast cancer patients (84%) [33]. This high level of CHE might be due to the limited number of treatment/diagnostic centers available which can increase its side expenditures and frequent stock out of prescribed medicines.…”

Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

“…While most studies used the broad categories of strategies for coping with healthcare costs commonly covered in international household surveys (eg, using income/savings, borrowing money or selling assets) some drilled down to distinguish between types of borrowing and asset sales 19–28. For example, some studies examined who households borrowed from, noting that those forced to borrow from moneylenders faced higher interest rates than those borrowing from family or friends 25 26 28. The diversity of strategies was revealed in a study of households containing women with breast cancer.…”

“…Although almost 85% and 75%, respectively, were able to borrow at low interest rates or obtain support from families and friends, most also had to pawn personal items such as jewellery, borrow money at high interest rates or sell financial assets (shares, gold, etc) or economically productive assets, such as cattle. Most used a combination of strategies 25. A study of households with non-specific chronic conditions, also in India, found evidence that households may mortgage assets to pay for healthcare costs 29…”

“…Several studies provided evidence of other strategies to cope with healthcare costs that may have detrimental long-term impacts. These included: taking children out of school or sending them to work,13 21 25 27 30–32 reducing expenditure on food, education or social activities,13 28 32–37 institutionalising a child or adult patient,13 taking on extra work,13 32 38 39 quitting work to take on the role of caregiver,13 40 replacing labour (eg, a wife taking on ill husband’s work),41 taking a donation from a healthcare provider,41 or moving to cheaper or free accommodation 21. Coping strategies with more immediate potential impacts on health were also identified 21 28 34 42.…”

“…Patient exit interviews in South Africa found that patients with HIV or TB were more likely to borrow money or sell assets to pay for healthcare than were obstetric patients, and that borrowing money was more common among patients from rural versus urban areas 44. More severe disease was associated with an increased likelihood of distress financing generally among patients with cancer,25 and of cattle sale among patients with HIV 45. Those with CVD46 or angina7 were more likely to borrow or sell assets to pay for healthcare than those without these diseases.…”