Abstract
Background
Cancer, a multifaceted and complex group of diseases, continues to be a significant global health challenge. In 2022, an estimated 20 million new cancer cases were diagnosed, and nearly 9.7 million deaths worldwide. Stomach and pancreatic cancers were the sixth and twelfth most common malignant tumours globally, with approximately 0.97 million and 0.51 million new cases, respectively. Stomach and pancreatic cancers impose a substantial economic burden on households, particularly where financial risk protection remains limited.
Objectives
The study estimates the financial burden experienced by patients undergoing treatment for stomach and pancreatic cancer from a public policy perspective.
Methods
The study was a prospective cohort study conducted at a tertiary cancer centre in India. A total of 244 adult patients newly diagnosed with stomach and pancreatic cancer were followed till treatment completion. Non-parametric (Shapiro-Wilk test, Mann-Whitney U test, Kruskal-Wallis test) tests were used for group comparisons, and generalized linear models were used to estimate adjusted OOP expenditure. Financial burden was assessed using the ratio of OOP expenditure to annual household income and Catastrophic Health Expenditure (CHE).
Results
Mean treatment expenditure was ?5,08,306 ($6,110), for pancreatic cancer ?5,33,914 ($6,427), and gastric cancer ?4,83,927 ($5,816). The share of medical expenses accounts for 84% of total expenditure, primarily driven by surgery (30.9%), chemotherapy (19.6%), medications (13.8%), and diagnostics (10.3%). Mean total OOP expenditure was ?3,49,718 (US$4,203), with households spending nearly 1.86 times their annual income on treatment. Despite lower absolute OOP expenditure, patients receiving subsidised public-sector care faced a higher OOP-to-income ratio (2.1) than private patients (1.6). Overall, only 31% of treatment expenditure was reimbursed. Mean medical OOP expenditure was ?2,61,285 ($3,140), the non-medical OOP expenditure was ?88,433 ($1,063).
Conclusions
Stomach and pancreatic cancer treatment in India results in a financial burden for households, mainly driven by high medical costs and inadequate insurance coverage. Poor households are more vulnerable to treatment expenditures. Existing health security mechanisms including publicly funded health insurance provide partial relief but fail to protect vulnerable households from substantial OOP expenditure. Strengthening financial risk protection through enhanced insurance coverage, revised reimbursement caps, and inclusion of non-medical costs is essential to mitigate the economic burden of cancer treatment.