Tata Memorial Centre publishes study on the economic loss due to premature death from oral cancer in India

Despite strides in oral cancer diagnosis and treatment, escalating healthcare costs financial strain on both providers and patients.

According to the World Health Organization (WHO),India’s cancer scenario is burdened with oral cavity cancer being the most common among men. In fact, India accounts for almost a third of the global incidence and mortality related to oral cancer. 

Despite strides in oral cancer diagnosis and treatment, escalating healthcare costs strain both providers and patients financially. These expenses, along with the direct and indirect costs, not only impact individuals but also their families and supporters, pushing the economically disadvantaged further into a debt-cycle and poverty. Moreover, these cancers are becoming increasingly common among the younger age groups, in contrast to the western world, which can put a significant strain on the productivity of the economy.

To tackle these issues, Dr Pankaj Chaturvedi, Director, ACTREC, led a research to quantify the economic loss resulting from premature mortality   related to oral cancer in India based on a long follow up. This  study’s  estimates were calculated utilising real time patient data that was collected prospectively for up to 3 years. This data collection enabled determination of the total lost productivity due to premature mortality related to oral cancer, 

Dr Arjun Singh, Assistant Professor at Tata Memorial Hospital and the lead author of the study said that the 671 years were lost to early (29.8per cent) and advanced cancers (70.2per cent). Considering the retirement age in India being 62 years, 91 per cent of the deaths or incurable recurrence of cancers were in the premature age groups, with a median age of 41.5 years.

Both early (70 per cent ) and advanced (86 per cent) stage cancers were from a middle-class socioeconomic status, with 53 per cent requiring some form of insurance schemes or financial support in order to complete treatment. The productivity lost due to premature mortality was calculated using a method known as human capital approach, where individual patient data (including market and non-market contribution, socioeconomic status, education level, etc.) was gathered prospectively and over a long time period.  . 

Their results were in line with the national labour force participation (48 per cent) and unemployment rates (7 per cent) as reported by the National Sample Survey Office (NSSO), India. Productivity lost due to premature mortality among females and males was 57,22,803 rupees and 71,83,917 rupees, respectively per death.

The loss of productivity to society was 31,29,092 rupees per early-stage and 71,72,566 rupees per advanced-stage cancer. Based on the death rates in the population, these results show that the total cost of lost productivity due to premature oral cancer mortality in India in 2022 was $5.6 billion, representing 0.18 per cent of the combined gross domestic product. These results underestimate the impact of variability in treatments and its access that exists across the country. While population data has been derived from an internationally validated registry, the GLOBOCAN, the true burden might be much more as the population coverage in low and middle-income countries is estimated to represent less than ten percent of the actual population.

Due to the younger age of initiation of tobacco and areca nut usage in India, oral cancers tends to develop in younger individuals as well. This leads to devastating consequences for individuals, families, society and the economy. Tailored prevention policies that target this young age group need to be implemented. Screening and early detection strategies among high-risk groups need to be prioritised. Such programs have been difficult to implement in many countries due to a lack of infrastructure and resources, including the availability of treatment for those identified with any suspicious lesions. These differences in access to treatment result in productivity losses.

Dr Sudeep Gupta, Director, Tata Memorial Centre said  “ The gross lack of awareness, fear, and misconceptions surrounding oral cancer lead to a large number of cases being diagnosed at a late-stage, contributing to the high mortality rates. Even those who receive timely treatment in these advanced stages often face complex surgeries and reduced quality of life, impacting their ability to contribute to society.”

Dr R. A. Badwe, senior author and Ex-Director, Tata Memorial Centre, added that “Very few studies have focused on productivity losses of cancer in low resource settings and particularly in India to understand the broader economic impact. In order to inform policy- makers decisions around resource allocation we undertook a study and extrapolation to estimate the overall economic costs of oral cancer in India due to premature mortality.”

Tata memorial Centre’s efforts can now provide in-depth information on the productivity loss resulting from premature mortality of oral cancer that can assist policy makers in planning disbursements more effectively. In a country where the affordability gap is wide, these results are important to deliver a disease-driven, objective strategy for oral cancer care.