Lancet Reg Health Southeast Asia. 2022 Nov;6:None. doi: 10.1016/j.lansea.2022.100058.
Although colorectal cancer is increasing in India, the cost of comprehensive treatment and its consequences for patients and households are unknown. This study aimed to describe catastrophic expenditure and treatment attrition in patients with a treatment plan for colorectal cancer.
A prospective, multicentre, cohort study was conducted in five tertiary hospitals in India from December 2020 to March 2022. Consecutive patients with a new treatment plan for colorectal cancer were followed-up for six months. The total cost of treatment was reported, including out-of-pocket payments (OOPP, paid by patients at the time-of-service use) and covered by third parties (insurance, public funds). The primary outcome was catastrophic expenditure, defined as OOPPs greater than 25% of patient's annual household income and the secondary outcome was treatment attrition, defined as unplanned interruption of the treatment course not recommended by the clinical team.
Of 226 patients included, 20 died within six months of being offered a treatment plan and four were lost to follow-up. The median total cost of colorectal cancer treatment was 407,508 Indian Rupees (INR/5340 USD), to which the biggest contributor was the patient's OOPP (median 330,277 INR/4328 USD). Surgery and anaesthesia costs (median 85,944 INR/1126 USD) were higher than radiotherapy (median 55,525 INR/728 USD) and chemotherapy (median 14,780 INR/194 USD). The overall catastrophic expenditure rate was 90.1% (182/202) and the treatment attrition rate was 9.4% (19/202). Patients with treatment attrition made lower OOPPs than those who completed treatment (median 205,926 vs 349,398 INR, < 0.01) but had a similar risk of catastrophic expenditure (OR 0.23, 95%CI 0.03-2.28, = 0.186).
Most treatment costs for colorectal cancer were paid out-of-pocket by patients and catastrophic expenditure was common. Treatment attrition rates at tertiary centres were low, suggesting greater attrition at previous stages of care. Better financial protection may allow more patients to receive comprehensive cancer treatment while avoiding household financial catastrophe.
This research was funded by the National Institute for Health Research (NIHR) (NIHR 16.136.79) using UK aid from the UK Government to support global health research, by the India Institute of the University of Birmingham and by the Global Challenges program of the University of Birmingham. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.
尽管印度的结直肠癌发病率在上升，但综合治疗的费用及其对患者和家庭的影响尚不清楚。本研究旨在描述接受结直肠癌治疗计划的患者的灾难性支出和治疗中断情况。
2020年12月至2022年3月，在印度的五家三级医院进行了一项前瞻性、多中心队列研究。对连续的新接受结直肠癌治疗计划的患者进行了为期六个月的随访。报告了治疗的总费用，包括自付费用（患者在使用服务时支付）和第三方支付（保险、公共资金）。主要结局是灾难性支出，定义为自付费用超过患者家庭年收入的25%，次要结局是治疗中断，定义为临床团队未建议的治疗过程的意外中断。
纳入的226例患者中，20例在接受治疗计划后六个月内死亡，4例失访。结直肠癌治疗的中位总费用为407,508印度卢比（5340美元），其中最大的贡献者是患者的自付费用（中位330,277印度卢比/4328美元）。手术和麻醉费用（中位85,944印度卢比/1126美元）高于放疗（中位55,525印度卢比/728美元）和化疗（中位14,780印度卢比/194美元）。总体灾难性支出率为90.1%（182/202），治疗中断率为9.4%（19/202）。治疗中断的患者自付费用低于完成治疗的患者（中位205,926对349,398印度卢比，<0.01），但灾难性支出风险相似（OR 0.23，95%CI 0.03-2.28，P=0.186）。
结直肠癌的大多数治疗费用由患者自付，灾难性支出很常见。三级中心的治疗中断率较低，表明在护理的先前阶段中断率更高。更好的经济保护可能使更多患者能够接受全面的癌症治疗，同时避免家庭经济灾难。
本研究由英国国家卫生研究院（NIHR）（NIHR 16.136.79）资助，该研究院使用英国政府的援助资金支持全球卫生研究，由伯明翰大学印度研究所和伯明翰大学全球挑战计划资助。本出版物中表达的观点是作者的观点，不一定是NIHR或英国政府的观点。
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