Abstract
Objective:The aim of this systematic review is to determine pooled estimates of out-of-pocket (OOPE) and catastrophic health expenditure (CHE), correlates of CHE, and most common modes of distress financing on the treatment of selected non-communicable disease (cancer) among adults in India. Methods:PubMed, Scopus and Embase were searched for eligible studies using strict inclusion and exclusion criteria. Data was extracted and pooled estimates using random effects model of meta-analysis were determined for different types of costs. Forest plots were created and heterogeneity among studies was checked. Results:The pooled estimate of direct OOPE on inpatient and outpatient cancer care were 83396.07 INR (4405.96 USD) (95% CI = 44591.05-122202.0) and 2653.12 (140.17 USD) INR (95% CI = -251.28-5557.53), respectively, total direct OOPE was 47138.95 INR (2490.43 USD) (95% CI = 37589.43-56690.74), indirect OOPE was 11908.50 INR (629.15 USD) (95% CI=-5909.33-29726.31) and proportion of individuals facing CHE was 62.7%. However, high heterogeneity was observed among the studies. Savings, income, borrowing money and sale of assets were the most common modes of distress financing for cancer treatment. Conclusion:Income- and treatment-related cancer policies are needed to address the evidently high and unaffordable cancer treatment cost. Economic studies are needed for estimating all types of costs using standardised definitions and tools for precise estimates. Robust cancer database/registries and programs focusing on affordable cancer care can reduce the economic burden and prevent impoverishment.
Highlights
Non-communicable diseases (NCDs) are long duration diseases, which result from a combination of factors, such as physiology, genetics, lifestyle-related behaviour and environment (WHO, 2018)
The pooled estimate of direct OOPE on inpatient and outpatient cancer care were 83396.07 Indian currency (INR) (4405.96 US dollars (USD)) and 2653.12 (140.17 USD) INR, respectively, total direct OOPE was 47138.95 INR (2490.43 USD), indirect OOPE was 11908.50 INR (629.15 USD) and proportion of individuals facing catastrophic health expenditure (CHE) was 62.7%
The treatment cost often results in financial catastrophe and distress compelling a household to resort to alternative ways of financing, which pushes the household in a deeper financial debt (WHO, 2010)
Summary
Non-communicable diseases (NCDs) are long duration (chronic) diseases, which result from a combination of factors, such as physiology, genetics, lifestyle-related behaviour and environment (WHO, 2018). 71% (41 million) of all global deaths are attributed to them (WHO, 2018). Cancer has been reported to be the second leading cause of mortality globally, accounting for an estimated 9.6 million global deaths in the year 2018 (WHO, 2019). Cancer-related deaths range from 11.6% to 67.2% in India (Nethan et al, 2017). Owing to its chronic nature and expensive treatment, out-of-pocket expenditure (OOPE) is the highest for cancer. The treatment cost often results in financial catastrophe and distress compelling a household to resort to alternative ways of financing, which pushes the household in a deeper financial debt (WHO, 2010). Owing to lack of finances, knowledge and technological assistance, cancer patients and their caregivers, especially those who belong to the lower socioeconomic group, face significant financial and emotional struggle (Vashistha et al, 2019)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
