Varanasi: The Tata Memorial Centre (TMC), which operates two cancer hospitals — Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH) — in Varanasi, has conducted first of its kind study on the cost of oral cancer treatment in India.
The study was published in the medical journal ‘ecancer’ on June 17.
TMC director Dr RA Badwe said, “According to the World Health Organization (WHO), cancer is the second leading cause of death globally, with approximately 70% cases being reported in low and middle income countries (LMIC).
India’s cancer scenario is burdened with oral cavity cancer being the most common among men.
In fact, India accounted for almost a third of the global incidence in 2020.” “As per the GLOBOCAN statistics, the rate of new cases being diagnosed has increased by a staggering 68% in the past two decades alone, making it a real public health crisis.
To add to this, accessibility to health services is low, which coupled with poor health literacy results in a majority of cases presenting with advanced stage disease that is often difficult to treat,” said Dr Badwe adding that approximately 10% of the patients have progressive disease that makes them untreatable and can only be offered supportive care for their symptoms.
Most of those who receive some forms of treatment are left unemployed and become an economic burden on their family and friends.
Even patients with health insurance and government aid, typically seen as immune to the cost of healthcare, face serious challenges as most of the schemes do not provide the actual amount needed for the treatment.
This eventually increases their out-of-pocket expenses, pushing a significant proportion of the patients themselves and their families into a never-ending cycle of debt.
To tackle these issues, the officer-in-charge of MPMMCC and HBCH Dr Pankaj Chaturvedi and his team at Tata Memorial Centre set out to conduct a cost of illness analysis that would provide invaluable information for policy makers that make appropriate allocation of resources towards cancer.
Dr Chaturvedi claimed that this is the first such study in India and among a handful globally, whose estimates were calculated utilizing a bottom-up approach where data was collected prospectively for each service as it was used.
“This ginormous data collection has resulted in determining the direct healthcare costs of treating oral cancer, i.e., the per patient cost borne by a healthcare provider that are directly attributable to treating oral cancer.” Research fellow at Tata Memorial Hospital and the lead author of the study, Dr Arjun Singh, said that the unit cost of treating advanced stages (Rs.
2,02,892) was found to be 42% greater than early stages (Rs.
1,17,135).
“At the same time, there was an average reduction of 11% in the unit costs as socio-economic status increased.
Medical equipment accounted for 97.8% of capital costs, with the highest contributor being the radiology services that included CT, MRI and PET scan.
Variable costs that included consumables for surgery in advanced stages were 1.4 times higher than early stages.
With the addition of additional chemo and radiotherapy to surgery, the average cost of treatment increased by 44.6%,” he added.
According to the study, about 60-80% of the cases of oral cancer visit their specialist oncologists at advanced stages.
Multiplying the cost per unit of early and advanced cancer as per the study’s results, India spent approximately Rs 2,386 crores in 2020 on oral cancer treatment, paid for by insurance schemes, government and private sector spending, out of pocket payments and charitable donations or a combination of these.
This is a significant portion of the healthcare budget allocation the government made in 2019-20, towards a single disease.
Without any inflation in costs, this will result in an economic burden on the country of Rs 23,724 crore over the next 10 years.
This straining economic impact of treating oral cancer treatment, strongly suggests that prevention must be one of the key mitigation strategies for addressing affordability.
Almost all oral cancers are caused by some form of tobacco and areca nut use, either direct or as a secondhand intake.
It is very important for our country to take adequate measures to curb this menace and mitigate the economic burden caused by just one of the hundreds of diseases caused by tobacco consumption.
Dr Chaturvedi said that early detection strategies leading to just 20% reduction in advanced stage disease could save almost 250 crores annually.
Physicians, dentists and all healthcare workers are the first line of detection where opportunistic screening of high-risk individuals such as tobacco and areca nut users can be performed.
Institutions also play a key role by following up screened patients, actioning tobacco de-addiction strategies and providing timely care and support.
He said that Tata Memorial Centre’s efforts can now provide in-depth information on the costs of treating oral cancer that can assist policy makers in planning treatment disbursements more effectively.