Direct cost of cancer in Nepal

Burden of cancer is increasing. It is also going to cause financial burden. How much burden does it cause and how can we address it?

1. Direct Cost of Cancer in Nepal: A Cross-Sectional Study in a Tertiary Cancer Hospital Shiva Ram Khatiwoda 1 , Raja Ram Dhungana 1 , Vishnu Prasad Sapkota 2 , Sarswoti Singh 2 1 Nepal Family Development Foundation, Kathmandu, Nepal 2 Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal Correspondence : Shiva Ram Khatiwoda , [email protected] 1

2. Background Increasing burden of cancer in developing countries [1] Dominant OOP is causing more financial burden to people in developing countries [2]. 808 million people incurred catastrophic health spending in 2010 [3]. Over 75 % cancer patients experience death or financial catastrophe within one year in Southeast Asia [4]. Government of Nepal provides Rs 1 lakhs (about US $ 1000) to people with cancer for their medical care [5]. Since we lacked information on exact cost involved, we carried out this study . 2

3. Objective To estimate direct cost of cancer among people receiving treatment for cancers in a tertiary cancer hospital in Nepal 3

4. Methodology Research Method: Quantitative Types of study: Descriptive, Cross-sectional Study Site : Bhaktapur Cancer Hospital, November 2016 to February 2017 Sample size: 294, People , who were receiving cancer treatment after being diagnosed as having cancer 4

5. Methodology .... Cost of illness method : to calculate the direct cost [6]. Data collection Tool : S tructured questionnaire Technique : interview Data Entry in epi -data 3.1 and Analysis in IMB SPSS 21, and MS Excel 2013 Descriptive statistics : percentage, mean (standard deviation/SD), median (IQR) Mann-Whitney U Test and Kruskal -Wallis Test 5

6. Result Age : Median ( IQR) 54 (19) years Sex : F emale :169 (57.5 %), M ale : 125 (42.5 %) Diagnosis: L ung cancer : 57 (19.93 %) Breast cancer : 46 ( 15.65%) Cervical cancer: 42 (14.29 %) Other cancers : 149 (50.68 %) 6

7.   Mean (SD) % of Direct cost Median (IQR) Medical cost 313.54 (178.2) 80.91 263.65 (238.2) Non-medical cost 73.99 (19.09) 19.09 66 (14.8) Direct Cost 387.54 (196.8) 100 346.1 (260.5) n = 294 7 Table 1. Direct cost of cancer (NRs, ‘000) Cost varied significantly with age, types of cancer and treatment ( p < 0.05 ).

8. 8 313.54 + 73.99 = 387.54 Figure 1. Percentage of direct cost (NRs ‘000)

9. Figure 2 . Percentage of participants with different method of payment for service utilization (n=294) 9

10. Figure 3 : Percentage of participants with experiencing financial hardship and coping mechanism (n=294) 10

11. Mean medical cost NRs 313,544.76 GDP per capital income NRs 78,946 [7] (World Bank, 2016) 11 Figure 4. Distribution of medical cost (NRs ‘000) (n=294)

12. Conclusion The average direct cost was catastrophic (above 40% of non-subsistence needs of households) [8,9]. Government’s support of one lakh is appreciable, but it is far from adequate . Solutions to financial hardships? : Better preventive and curative services, Reducing OOP / better health financing mechanism, Avoiding low value therapy, Price regulation, Increasing income of the people, etc. Full article https://doi.org/10.3389/fpubh.2019.00160 12

13. Acknowledgement Department of Community Medicine and Public Helath , Maharajgunj Medical Campus, IOM, TU Bhaktapur Cancer Hospital Study Participants Frontiers in Public Health | Health Economics https://doi.org/10.3389/fpubh.2019.00160 13

14. References Stewart BW, Wild CP. World cancer report 2014 2014. Lyon CEDEX, France. 2014. Mills A. Health care systems in low-and middle-income countries. New Engl J Med. (2014) 370:552–7. 10.1056/NEJMra1110897 Wagstaff A, Flores G, Hsu J, Smitz M-F, Chepynoga K, Buisman LR, et al. Progress on catastrophic health spending in 133 countries: a retrospective observational study. Lancet Global Health. (2018) 6:e169–79. 10.1016/S2214-109X(17)30429-1 ACTION Study Group. Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC medicine. 2015 Dec 1;13(1):190 Annual Report 2071/2072 (2014/2015). Kathmandu: Department of Health Services ( DoHS ); 2016. 14

15. References ... Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams- Gessel S, Bloom LR, Fathima S, et al. The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum; (2011). Available online at:  https://www.world-heart-federation.org/wp-content/uploads/2017/05/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf World Bank. GDP per Capita 2016. World Bank (2016). Available online at:  https://data.worldbank.org/indicator/ny.gdp.pcap.cd  (accessed February 6, 2019). Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet. (2003) 362:111–7. 10.1016/S0140-6736(03)13861-5 Fifth Household Budget Survey 2014/15. Kathmandu: Nepal Rastra Bank; (2016 ). 15

16. Presented on NHRC 6 th summit Day II https :// www.youtube.com/watch?v=ESygIA2qv1w Our presentation starts at: https :// youtube.com/watch?v=ESygIA2qv1w&t=8507s QA https :// youtube.com/watch?v=ESygIA2qv1w&t=11009s 16

17. Lets talk Financial Hardship & Addressing It Popular media show with Consequence of Catastrophic Expenditure to Health due to Cancer in Nepal just in 1 minute and 30 seconds: Meri Bassai Episode- 546, 17-April--2018, By Media Hub Official Channel http:// www.youtube.com/watch?v=WpUDA7z-bww&t=26m28s Popular oncologist talks on how to solve financial toxicity? Financial toxicity in lung cancer patients-presentation at World Conference on Lung Cancer , 2018 http:// www.youtube.com/watch?v=jLBAyz50g1M&t=7m23s 17

18. Thank You 18