Out-of-pocket expenditure for the diagnosis of cervical, breast, and oral cavity cancer: A cross-sectional study from a tertiary care hospital in South India

Abstract

Background: Cancer as a disease has widespread financial impact on patients. Most public funded government schemes provide insurance only after the diagnosis is made. Patients incur a substantial out-of-pocket expenditure even before the diagnosis. Objectives: The study was done with the objective of determining the total cost (direct out-of-pocket expenditure and indirect cost) incurred from the symptom onset to diagnosis among patients diagnosed with cancer of the uterine cervix, oral cavity, and breast. Materials and Methods: In this hospital-based study conducted in the Regional Cancer Center of a tertiary hospital in South India, 100 patients were interviewed using a predesigned, pretested questionnaire. For cost calculation, the reference period was duration between the first contact to the health facility for the symptoms suggestive of cancer, and the histopathological diagnosis. The total direct (out-of-pocket expenses) and indirect (income lost) costs were determined by interviewing the participants. The Mann-Whitney and Kruskal-Wallis test were used to compare the out-of-pocket expenses across age, gender, and tumor type categories. Results: The median (first quartile [Q1] and third quartile [Q3]) cost incurred while diagnosing the three cancers was Indian rupees (INRs) 3660 (1280, 12,660); the median (Q1, Q3) direct cost was INR 1710 (350, 10,930) and the median (Q1, Q3) indirect cost was INR 250 (0, 2000). Those who visited a private health facility for their symptoms incurred a significantly higher direct cost (P < 0.05). Further, those aged 15–44 years, above the poverty line, male, who had completed more than primary education, or were diagnosed with cervical cancer incurred higher costs, although this was not statistically significant. Conclusion: Patients of common cancers incur a high out-of-pocket expenditure even before initiation of treatment. Measures such as providing all diagnostic modalities under a single roof and adopting a standardized protocol for various investigation procedures may help in reducing the costs incurred by patients.