Out-of-Pocket, Catastrophic Health Expenditure and Distress Financing on Non-Communicable Diseases in India: A Systematic Review with Meta-Analysis.

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.

Software version of Roland Morris Disability questionnaire for outcome assessment in low back pain.

BACKGROUND: Developing and using the software version of existing validated paper version of patient-related outcome can go a long way in saving cost, time and effort. However, the equivalence of paper version and software versions cannot be assumed. The aim of the study is to test the equivalence between paper version and software version of Roland Morris Disability Questionnaire and its acceptability among patients. METHODS: This is a within-subject cross over equivalence study. Fifty-five patients with back pain were asked to complete the paper and software version of RMDQ in random order. Patients were included from the Neuro Spinal surgery outpatient department of Lilavati Hospital and Research Center. RESULTS: Statistical analysis of 52 patients who completed the study showed high agreement between the paper and software version of the questionnaire (intraclass correlation coefficient 0.994, 95% confidence interval (0.989-0.996)). High sensitivity and specificity of 84 and 88% of the software version was noted. About 69.2% patients preferred software version over paper version. CONCLUSION: Our study shows that software version is comparable to the paper version. It may prove to be a useful tool for epidemiological studies and patient follow-up over longer period.