Cancer Treatment In India: Value-based cancer care in the era of precision medicine, Health News, ET HealthWorld
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When it comes to diseases like cancer, the usual conversations in India are fixated on the cost. The outcome is not given the importance it deserves. What good will low cost bring about if the outcome itself is ignored.
Historically, cancer treatment in India has always been assumed to be very expensive. Since India is predominantly a country of low and middle income people, and there have been many instances of patients and their families facing economic distress, the focus of treatment has been on bringing the cost down. But at what cost should we bring the cost down? Does the lopsided focus on bringing the cost down affect the outcome? In our view, it certainly does as there is a cost attached to low cost. To elaborate on this aspect, we must take a closer look at cancer care.
Today, cancer is fast becoming a chronic disease, and a sea change has occurred in the manner in which we stage cancer, how we adopt a multi-disciplinary approach to cancer care, and how we apply genomics and molecular diagnostics in this era of precision medicine to provide the right treatment the first time. Understanding the genomic correlates of response and resistance are helping us stratify patients and avoid the perils of under/over treatment.
Needless to say, the advancement in cancer care comes with a price tag. The expense is on three main counts One, towards recruiting the talent pool of competent resources including surgical oncologists, medical oncologists, radiation oncologists, organ-specific specialists, genomic experts, radiologists, pathologists, qualified nurses, and other support staff. Many of these resources can easily find better job prospects in the West and so the challenge is how to recruit and retain them, which has a significant cost attached to it.
Two, towards adopting best-of-breed technologies like digital PET scan, adoptive radiotherapy, and train people on these technologies, and, three, towards creating a certain margin to be used for reinvestments. In India, even after providing for all three components, we find that the cost of cancer care is 1/6th of that in the United States, not just in the case of peripheral centres but also in the case of Centers of Excellence.
What we have demonstrated through our focused factory approach and hub and spoke model of cancer care is that if patients are properly treated i.e. given the right treatment at the right time using good talent, knowledge, technology and infrastructure, it is possible to get the same outcome as that in a premier center like M D Anderson or Sloan Kettering.
Having said that, the key question before us is how we bridge the gap between the rich and poor in India. On one end, we have 350 million middle class people going up the ladder who can afford quality treatment and who can also buy insurance. This population is as big as that of the United States.
On the other end are 900 million people who are economically challenged. We have a few government schemes aimed at subsidizing treatment for this group but unfortunately they are half baked. This group is deprived of the right treatment at the right time, and worse, in the absence of genomics, almost 40 per cent of them are subjected to wrong or unnecessary treatments.
If we ensure proper treatment for this group, the cost savings would be phenomenal. Proper treatment would imply a) avoiding unnecessary treatment, and b) giving right treatment at the right time, such that cancer hopefully does not recur in their lifetime which automatically brings down the cost of cancer care. It is pertinent to note that better awareness and understanding of cancer is half the battle won as it helps make the right decisions at the right time.
How is it that a PET scan in India can be done at 250 dollars or less, whereas in the US the cost is 2500 dollars. Quite obviously, we are doing a good job of bringing the cost down. Having said that, we must study the examples of different countries as also Indian states like Orissa who have successfully adopted Universal Healthcare thereby ensuring a decent insurance coverage. We must study the economics of all models in vogue to ascertain the size of the healthcare fund to be created for India, which can help ensure uniformity of quality cancer care for the community at large, including the rich sections, middle class people, and the poor populace.
Today, poor patients are squarely denied the administration of pathbreaking immunotherapy drugs, which is sad and absurd. Any cancer patient has equal right to the right treatment at the right time. A universal healthcare model can ensure this uniformity though a prudent and purposeful cross subsidy approach, whereby affluent patients pay a premium for services they can easily afford, while poor and marginalized patients are treated at subsidized rates without compromising on the quality of care.
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Monday, March 13, 2023 at 11:40 am