Understanding the economic burden of cancer care and the utility of health insurance: An exploratory cross-sectional study in a tertiary care hospital in Karnataka, India.

Background: Families and caregivers of cancer patients experience significant financial challenges associated with out-of-pocket (OOP) expenditures. Objectives: This study aims to assess the OOP expenditure and its impact on the livelihood of patients and families, associated with receiving cancer care from a teaching hospital in Karnataka. Materials and Methods: It focuses on understanding health insurance use and its effects on OOP expenses for cancer care based on data obtained from 271 patients receiving treatment for more than 6 months. A structured questionnaire was developed and used for data collection and focused on obtaining direct costs such as consultation fees, surgery costs, and radiotherapy costs and indirect costs such as travel expenses, food costs, and patient income loss, as well as questions that measure the impact of the financial burden on patients and their associated livelihood. Results: In the present study, the median cost of OOP expense incurred for cancer treatment is estimated to be 3.10 lakh Indian rupees. It was also found that patients enrolled in public health insurance schemes, especially Ayushman Bharath-Arogya Karnataka have lesser OOP expenditure than those with either private health insurance or no health insurance. Conclusions: This indicates the need for effective implementation of various public health insurance schemes and their ability to protect patients from huge OOP expenses and related financial risks.

To CT or not to CT: Questioning the Cost-Effectiveness of CT Thorax in Head and Neck Cancers.

Computed tomography (CT) scan has been an integral part of the diagnostic workup for patients with head and neck squamous cell carcinoma. Our study was designed to find out the incidence of distant metastasis and second primary tumor and to correlate the cost-effectiveness of CT thorax in detecting the same. This study was conducted among 326 cancer patients who visited our center with curative intent in the year 2021, with lesions in various head and neck subsites. Data were collected based on their pathological TNM staging and the presence of distant metastasis as evident on their CT thorax imaging with various variables related to the disease. Incremental cost-effectiveness ratio (ICER) was calculated for detecting a single metastatic deposit and second primary tumor in terms of Indian currency and was correlated to each subsite and stage of disease at presentation. Out of these 326 patients, 281 patients were included in our study after considering the inclusion criteria, and among these 281 patients, 235 of them underwent CT thorax for metastatic workup. No patient was found to have a second primary. Metastases were found in 12 patients. The site of primary lesion and clinical tumor (cT) staging were found to be significantly influencing the incidence of metastasis on CT thorax. ICER was least for larynx, pharynx, and paranasal sinuses and was highest for oral cavity primaries and early-stage disease. As per our observations and results of ICER, CT thorax is indeed a valuable modality but should be used judiciously when it comes to initial diagnostic workup.

Utilisation of integrated counselling & testing centre (ICTC): a comparative study between a tertiary care teaching hospital and a government district hospital in Karnataka.

A study was undertaken during November 2005 to October 2006 to assess about utilization aspects of ICTC at a tertiary care teaching hospital and a government district hospital in Karnataka. The average monthly numbers of persons visiting ICTC per month at the tertiary care teaching hospital (509) were higher than that of Government district hospital (222). However, the average monthly number of direct walk-in persons and follow up, attending the centre at district hospital were higher than that of teaching hospital. Thus optimal use of information, education and communication (IEC) techniques needs to be strengthened to improve the utilization of ICTC services at the tertiary care teaching hospital.