High Costs of Management of Oral Cancer in Sri Lanaka Mandate Prevention as Priority

Abstract

Background: Lip plus Oral Cavity Cancers (ICD O C00-C06) (OCA) rank top among males in Sri Lanka, similar to the situation across the whole of South Asia. According to the Cancer Incidence Data Sri Lanka 2010, 1564 new cases of OCA were reported to the 9 cancer treatment centres in Sri Lanka. The Sri Lankan government spent 3.2% of its GDP on health from which 2.3% was spent on treatment for neoplasms, a significant a portion of the health budget. This study aimed to estimate the total costs of management of OCA in Sri Lanka over the first 12 months from diagnosis in the year 2016. Methods: This study was conducted in Sri Lankan tertiary care centres which provide treatment for OCA. A pre-tested questionnaire was used to collect all costs associated with OCA. Estimates were conducted from a societal (healthcare, household and indirect cost) perspective. Costs to the healthcare system included surgery, ICU care, chemotherapy and radiotherapy; capital costs including estimated value for land, buildings, equipment and furniture. Household costs consisted of out of pocket expenditure for healthcare and indirect costs for lost income due to absenteeism for the patient and any companion. Costs were estimated according to the stage of presentation for treatment at first visit to one year of follow-up. Findings: Of the 69 OCA patients, 60 were male. Twelve patients reported with recurrence. Mean cost to the health system for management of a single Stage 11 OCA patient was Rs 58979.42 (US$ 393.72 considering the midyear exchange rate in the year 2016). Mean household cost was Rs 121,516.33 ( US$ 811.19). The management of each Stage 111 or 1V OCA patient over one year cost the health system Rs 303619.7 (US$ 2026.83), with household costs of Rs 128,939.77 ( US$ 860.75) per patient. Interpretation: Owing to the high incidence of OCA in Sri Lanka, the economic costs associated with these diseases are enormous, resulting in negative impacts on both the healthcare system and individual families, thus impacting the country's economy. Policy makers should take note of this burden and take immediate steps for prevention and control of OCA. Funding: University of Peradeniya, Sri Lanka Grant No. 2013/22. Declaration of Interest: The authors declare no competing interests. Ethical Approval: Ethical approval was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Colombo and informed written consent was obtained from all patients before data collection.