Document Type: Research Articles
School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Background: The rising cost of cancer treatment has imposed a huge financial burden on the affected households,
leading to catastrophic outcomes and impoverishment. The present study was designed to estimate the economic
burden incurred by households for the treatment of head and neck cancer (HNC) in India. Methods: The present study
was undertaken in a large public sector tertiary care hospital of North India. A total of 159 patients were recruited
at time of their first registration in the department of Radiation Oncology, and were followed after completion of
their treatment. Another 288 were recruited within one month after completion of treatment. Economic burden was
assessed in terms of out of pocket (OOP) expenditure incurred, prevalence of catastrophic health expenditure and
distress financing (borrowing or selling of assets) related to different modalities of cancer treatment. Results: The
average OOP expenditure incurred by a patient of HNC patient was INR 37, 845 (USD 563), which varied from INR
32,379 (USD 482) when a patient undergoes radiotherapy alone to INR 67,480 (USD 1,004) for surgery along with
chemo-radiotherapy. Specifically, patients undergoing 2-DRT and IMRT alone had to spend INR 31,487 (USD 469) and
INR 42,405 (USD 631) respectively. The prevalence of catastrophic health expenditure (CHE) and distress financing
(DF) was 34% and 45% respectively. The odds of incurring both CHE and DF were found to be higher for patients in
the lowest income quartile and for those in the younger age groups. Conclusion: Cancer imposes significant economic
burden on households. The existing public health system should be strengthened to reduce OOP expenditure incurred
by patients. In addition, enhanced coverage of risk pooling mechanisms should be ensured.