The economics of cancer treatment: implications for quality-of-life assessment in India.

5which measure several domains of subjective health. The results of these trials are often used to counsel and treat Indian patients without heed to one crucial difference. The vast majority of Indian patients pay for healthcare (including the cost of chemotherapeutic drugs) out of their own pocket. Health insurance cover for the general population is abysmally low. Given the prohibitive cost of newer chemotherapy drugs, it is likely that expensive treatment for advanced cancers, while resulting in improvement in some health-related QOL indices, adversely impacts on the overall QOL for both patients and their families. Repeated visits to hospital often result in loss of wages for the earning member of the family. The average cost of a full course (4– 6 cycles) of gemcitabine-containing regimens is about US$ 4000, while the per capita annual income of an Indian in 2002 was US$ 480. Moreover, there is an adverse psychological impact in terms of guilt when patients cannot receive the recommended treatment for economic reasons. The effect of economic hardship resulting from cancer and its treatment is not measured by the standard instruments of QOL. We feel it is vital for such instruments to be developed and validated for use in a situation where the cost of cancer care is borne by economically disadvantaged patients and their families.