Economic burden of breast cancer on households In Kerala

Abstract

Cancer is a disease in which the financial burden of treatment is a major source of stress for patients and their families. Cancer care requires expensive treatments and medications, and the out-of-pocket costs can consume a substantial part of a family's income and budget. Breast cancer is the most common type of cancer among females across the world. Hence, the study aimed to analyse the economic burden of breast cancer on households in Kerala. Specifically, the study examined the extent and dimensions of cancer in India, the direct and indirect costs associated with breast cancer, the medical services and health schemes provided by the government and other organisations, the financial coping mechanisms households use to fund breast cancer care and the determinants of the economic burden of breast cancer in Kerala. The research results will be valuable to individual patients, family caregivers, healthcare providers, and policymakers. The study is descriptive in nature. The data is collected from primary and secondary sources. Secondary data was collected from NSSO data, 75th (2017-18), NCRP reports (2012-16) and GLOBOCAN report (2020). Primary data was collected by interviewing 400 female patients who had invasive breast cancer. The study was conducted in Kerala. The cost-of-illness (COI) methodology was used to analyse the economic burden of cancer. Respondents who sought treatment in private hospitals incurred significantly higher medical costs during surgery and targeted therapy. Stage III breast cancer respondents incurred higher costs compared to stage I and stage II breast cancer respondents. On the basis of treatment protocol, the highest medical cost was observed for the treatment protocol- neoadjuvant chemotherapy followed by surgery, then adjuvant chemotherapy, then radiation and targeted therapy. The significant determinants of total medical cost for the treatment of breast cancer were the duration of radiation received, number of chemotherapy cycles received, choice of provider for surgery, choice of provider for chemotherapy and choice of provider for targeted therapy.Around 9.2 per cent of respondents availed of employee benefit schemes, 59 per cent of respondents availed government health schemes and 8 per cent availed private health insurance schemes. Around 23.7 per cent of respondents did not avail any health or insurance scheme. The out-of-pocket expenditures (OOPE) incurred by respondents who sought treatment in private hospitals were higher than the OOPE incurred by respondents who sought treatment in government hospitals. As the stage of breast cancer advances, the OOPE also increases. Around 40 per cent of respondents experienced CHE during breast cancer treatment. Using a multivariate regression analysis, the significant determinants of OOPE were TNM stage of breast cancer, duration of radiation received, number of chemotherapy cycles received, choice of provider for diagnosis, choice of provider for surgery, choice of provider for follow-up treatment, amount received from employee benefit scheme, government health schemes and health insurance scheme during treatment, total medical cost of treatment, and total non-medical cost of treatment. The goodness of fit of the model was 97 per cent. The common coping mechanisms among breast cancer patients were selling gold and borrowing from friends and family. Using a multinomial logistic regression model, the significant determinants of economic burden were the annual income of the household, TNM stage of breast cancer, whether gold was sold to fund treatment, and whether money was borrowed from a bank in order to fund treatment. The goodness of fit of the model was 68 per cent. The study focuses only on the economic burden of breast cancer. A comprehensive study that analyses the financial costs associated with all types of cancer is suggested for future research. The economic burden of cancer should be studied at a national level in order to formulate which reduces the burden of cancer on patients and their households.