Economic and non-economic burden of cancer: A propensity score matched analysis using household health survey data of India

Abstract

Background: Cancer affects the well-being not only of the patients but also of the other members of the household. Objectives: In this study, we assessed the nature and magnitude of the economic and non-economic burden on patients with cancer and their families due to the inpatient and outpatient cancer care. Materials and Methods: This study was conducted using the secondary data from the 75th round of the National Sample Survey Organization survey on health and morbidity, titled “Social Consumption: Health,” for the year 2017–2018. The burden of cancer on individuals was assessed in terms of the health-care expenditure and utilization of inpatient and outpatient cancer treatment. At the household level, cancer burden was assessed in terms of per person health-care expenditure, impact on the standard of living, strategies adopted for financing the health-care expenditure, and utilization of and expenditure on health-care by other members of the family. Propensity score matching was used to generate matched data separately for inpatient and outpatient cases and at individual and household levels to control for confounders. The difference in the burden between the matched cancer-affected and unaffected individuals/households was estimated using the average treatment effect. Results: For the year 2017–2018, data were available for a total of 113,823 households with 555,352 individuals across India. The mean out-of-pocket expenditure (OOPE) for a patient with cancer exceeded that of patients with other chronic diseases by ₹2895 for each outpatient visit and ₹52393 for each inpatient admission. The mean length of the hospital stay due to cancer was found to be 7 days longer than that due to any other chronic disease. The per person inpatient health-care expenditure for the other members of a cancer-affected household was ₹11,000 less than that of other members of the unaffected households. More than 50% of households with cancer patients had to borrow money to pay for inpatient care compared to control households. The share of OOPE for outpatient care in the monthly consumption expenditure of a cancer-affected household was twice as high as that of an unaffected household. Moreover, the number of outpatient visits for other ailing persons in a cancer-affected household was one-fourth that of an unaffected household. Conclusion: Cancer imposes an immense economic and non-economic burden on affected individuals and households. Therefore, there is a need to design appropriate health-care strategies for providing optimal financial support to patients with cancer.