To study expenditure on major Gastro-intestinal cancer surgery in Tata Memorial Centre

Introduction:Health economics is increasingly being recognized as an important aspect of health care management. Unlike developed countries, India does not have comprehensive medical insurance coverage. Majority of our patients end up in paying from their own pocket. Nearly 75% of health spending in India is out of pocket expenditure (OOP) and this OOP pushes 39 million Indians to poverty every year. Increasing use of technology in investigation as well as surgery and medical expenses all add to the cost of treatment. India spends only 4% of its GDP on Total Healthcare Expenditure (THE), when compared to other Low to middle income countries (LMIC) in which they spend 5.7% of their GDP. According to an analysis, private expenditure on health in India is close to 78% compared to 14% in the Maldives, 29% in Bhutan, 53% in Sri Lanka, 31% in Thailand and 61% in China .Major Gastrointestinal (GI) and Hepato-Pancreato-Biliary (HPB) cancer surgeries are supra-major surgeries with their own set of complications which can result in significant morbidity. Whenever there is increased morbidity, cost of treatment also increases. A recent large series from TMH has shown that Pancreaticoduodenectomy (PD) was associated with morbidity of 20-30%; radical gastrectomy has morbidity of 12%6; low rectal cancer surgery 26.5% morbidity. While these results are comparable to other centers of excellence worldwide, the costs incurred for these complications must have added to these already expensive procedures. The median cost for PD in USA in 2012 is $30, 9372. This cost is on the background of GDP and total health expenditure (THE) of USA which is 17% of total GDP. If an average American national is to spend OOP for the costs of this surgery (in addition to the costs of treating pancreatic cancer as a whole), only 5 % of the population of USA would be able to afford this expense in one of the most affluent societies of the world. In contrast, there is no published data available from the Indian subcontinent for PD, a surgery that is both complex and uncommonly performed for a disease with a much lower incidence in this part of the world.  It is naturally expected that costs will be much lower given the GDP of 6% of India; thus there is an urgent need to generate data regarding this assumption that complex GI and HPB surgeries would be affordable to a large number of Indian patients.

This study attempts to analyze costs of major GI and HPB cancer surgeries in Tata Memorial Centre.

Primary Aim:To assess costs of following surgeries in general and private patients  pancreaticoduodenectomy, Radical gastrectomy with D2 Lymphadenectomy

Low anterior resection, Hepatectomy

Methodology

At the time of admission, patients and their relatives will be given a proforma to document the amount spent  (in INR) during each stage of their management including baseline and pre-operative blood tests, radiological imaging, endoscopies, surgical costs including consumables ,  ICU care and room charges till the day of discharge.Costs incurred by patients and their family members for the surgical treatment from the time of registration till post-operative recovery (till the day of discharge) will be assessed.