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The Changing Economics of Cancer Care in India: Can Innovation Coexist with Affordability?

Cancer care in India is at an interesting crossroads. On one side, we have never had more options for patients- from targeted therapies and immunotherapy to precision diagnostics and newer radiation and surgical techniques. On the other, the cost of accessing these advances remains a significant concern for many Indian families.

India recorded an estimated 14.6 lakh new cancer cases and more than 8 lakh cancer deaths in 2022, according to ICMR-NCRP estimates. As the number of patients grows, the question is no longer simply whether we can bring the latest innovation to India, but whether we can make meaningful innovation accessible to the people who need it.

The hidden cost of cancer

For a cancer patient, the treatment bill is only one part of the economic burden. Investigations, medicines, travel, accommodation, loss of income and the need for a caregiver can all add up. A large Indian study involving more than 12,000 cancer patients found that average annual direct out-of-pocket expenditure on cancer treatment was about ?3.31 lakh. Diagnostics and medicines were among the major contributors. Importantly, the study also found that publicly financed health insurance schemes were associated with lower financial hardship. At the same time, India's overall out-of-pocket health expenditure has been declining- from 48.8% of total health expenditure in 2017-18 to 39.4% in 2021-22. This is encouraging, but cancer remains an area where financial protection needs continued attention.

Innovation should mean better value, not simply newer technology

In oncology, innovation is often associated with expensive new drugs. But innovation can also mean using existing technology more intelligently. For example, molecular testing can help identify the patients who are most likely to benefit from a targeted treatment. Similarly, biosimilars and quality-assured generics can potentially reduce treatment costs without compromising evidence-based care.

Recent Indian research has highlighted substantial price differences between different brands of oral targeted cancer medicines, with some generic and Janaushadhi alternatives showing significant cost savings where available. The real question, therefore, should be: Does this innovation meaningfully improve the patient's outcome or quality of life, and can we deliver it responsibly?

A community cancer care model can change the economics

This is one of the principles behind the M|O|C model that we have been developing.

M|O|C Cancer Care was conceived as a network of community cancer centres where patients can access specialist oncology care closer to home, particularly for treatments that do not always require prolonged hospitalisation. The model combines medical oncology expertise with treatment, pharmacy, all the value-added wellness services required for rehabilitation of patients and survivorship and also links to surgical and radiation specialists whenever patients need these interventions at appropriate time in their cancer journey.

From my own experience as a clinician and part of the M|O|C leadership, I have seen that affordability is not achieved simply by reducing the price of a medicine. The entire care pathway has to become more efficient. If a patient can receive an appropriate infusion in a well-equipped treatment setting instead of requiring an unnecessary overnight admission, there can be savings in both time and cost. If specialist care is available closer to the patient's home, travel and indirect expenses can also reduce. The objective is not to compromise on infrastructure or expertise, but to use them more efficiently.

The way forward

India does not need to choose between innovation and affordability. It needs to become better at connecting the two.

Hospitals and cancer centres must increasingly think about value-based care- the outcome achieved for every rupee spent. Pharmaceutical companies can contribute through responsible pricing, wider access to generics and biosimilars, and innovative access programmes. Insurers and policymakers have an equally important role in expanding meaningful financial protection.

For doctors, the responsibility is perhaps the most immediate: prescribe what the patient actually needs, explain the expected benefit, discuss alternatives where appropriate, and remain conscious that every additional test or treatment has an economic consequence for the family.

The future of Indian oncology should not only be defined by how many new technologies we can offer. It should be defined by how intelligently we can make the right technologies accessible to the right patients, at the right time and at a cost they can sustain. That is where innovation becomes meaningful- not merely because it is new, but because it improves cancer care without putting good treatment beyond the patient's reach.

Dr. Pritam Kalaskar
M.D D.M
Consultant Cancer Physician
MOC Cancer Care & Research Centre, Thane .