Determinants of out-of-pocket expenditures amongst cancer patients undergoing modern radiotherapy modalities in public healthcare facilities of Tamil Nadu, South India

BACKGROUND: The advancement of medical technology has improved cancer treatment, yet financial disparities remain, particularly in low-income regions. Modern radiotherapy modalities, including LINAC, Cobalt Therapy, and Brachytherapy, impose significant Out-Of-Pocket Expenditure (OOPE) on patients despite public healthcare provisions. This study aims to assess OOPE and its determinants among patients undergoing advanced radiotherapy in public healthcare facilities in Tamil Nadu. METHODS: A cross-sectional study was conducted in secondary and tertiary hospitals across Tamil Nadu, enrolling 500 patients undergoing radiotherapy. Patient-level costing included direct medical costs (procedure, material), direct non-medical costs (travel, accommodation, food), and indirect costs (income loss for patients and caregivers). Log-linear regression models in STATA 17 identified key OOPE determinants, including socioeconomic status, insurance coverage, travel distance, and waiting time. RESULTS: While procedural costs were covered under insurance, non-medical and indirect costs significantly contributed to OOPE. The median total per-patient cost per radiotherapy procedure was ₹900 for LINAC, ₹840 for cobalt therapy, and ₹1,550 for brachytherapy. Higher socioeconomic status and greater travel distances increased expenditures. Patients who were insured but did not utilize insurance faced catastrophic expenses (₹55,900 median cost), highlighting gaps in awareness and accessibility. CONCLUSION: Despite insurance coverage, financial burdens persist, necessitating targeted interventions. Strengthening insurance utilization, decentralizing radiotherapy services, and integrating patient support systems can reduce OOPE. Future research should explore long-term financial interventions to improve equitable cancer care.