India has 1.24 billion people, or a population that is nearly 4 times greater than the USA. The USA has nearly 22,000 newly diagnosed patients with multiple myeloma, and the best information I could find is that each year 16,000 are newly diagnosed in India. This would indicate that the incidence rate in India is much lower than that in the US. I have not found a good explanation for this significant difference. Difference in diet, life expectancy, rural vs. urban population, industrialization, use of chemicals and pesticides, under-reporting, genetics, all could have an impact; however it would be great to know why people from India are 5 to 6 times less likely to be diagnosed with multiple myeloma.
Priya lives in India and provided the following outline of how their health care system provides services to myeloma patients in India:
Even though India is the largest generic medicine exporter, healthcare policies of India fall short of saving the needy. Recent years have seen some progress with regard to publicly funded care in India, but this is in its nascent stages. This could be the reason why spending for health is one of the leading causes of poverty in India with over 63 million individuals pushed to shell out their last earnings by healthcare expenditures. India’s urbane population has gradually begun to opt for health insurance which until now had existed only as part of basic life insurance policies or as part of overall benefit package of employees.
In order to understand the scope of myeloma treatment in India, I had connected up with a few hospitals and oncologists here. What I came to understand is that treatments offered for myeloma is good but there are drugs that are not yet available here and tests like FISH that are not available at all treatment centers. However, clinical trials are not very common and participation is less. Moreover, the money involved, from an Indian perspective, continue to be very high. You can read one of the conversations I had with Dr. Lalit Kumar from All India Institute of Medical Science (AIIMS) which is funded by the central government. Dr. Kumar provides an overview of myeloma treatment in India and the costs involved.
Quoting Dr. Kumar:
In a government hospital like AIIMS, (funding by central govt) the cost of transplant comes to less than 3 lacs rupees (approx. 6000 US $). Private hospital charges approx. 8 lacs (approx. 16000 US $). Thalidomide would cost 3000 INR per month; Lenalidomide is about 15000 INR per month and bortezomib 20,000 INR per month. Zoledronic acid (injections) costs about 1500 INR per month.
So, for a person on Lenalidomide + dexa and Zoledronic acid cost would come about 20,000.00 INR (approx. 370 US $) per month.
CLICK HERE to read Dr. Lalit Kumar’s interview. (http://trialx.com/curetalk/2013/03/myeloma-in-india-curetalk-in-conversation-with-dr-lalit-kumar-professor-of-medical-oncology-all-india-institute-of-medical-sciences-aiims-delhi-india/)
Given below is a list of hospitals which offer some of the best treatments for myeloma patients in India:
- Post Graduate Institute of Medical Research, Chandigarh
- AII India Institute of Medical Sciences, New Delhi
- Tata Memorial, Mumbai
- CMC, Vellore
- Manipal Hospital, Mangalore
- Tata Medical Center, Kolkata
- Apollo Hospital, Chennai
And for transplants, you can find a list of CIMBCR approved centers in India at the link: http://www.cibmtr.org/About/WhoWeAre/Centers/Pages/index.aspx?country=India
So it would seem that if you can get into a state subsidized hospital you can get the standard of care for low risk multiple myeloma of Rd, transplant, and one year of Rd maintenance for approximately $10,400 US. However the average family in India earns just $6100/year, and this is usually without insurance and in a pay for service system. This is care at a state subsided facility, and the cost in the private sector is greater. For a US citizen to understand what this would mean, it would be equivalent to spending $86,000 of your own money out of pocket. However the true cost in the USA for a US citizen without insurance would be much closer to $500,000. So even though the cost of care is far less in India, it is just as painful financially to the average citizen of India.
For all of the international myeloma patients, we hope that the last few posts have provided some help with your myeloma journey. We will continue to look for ideas that will benefit all of the multiple myeloma patient population.
By Priya Menon and Gary Petersen
For more information on multiple myeloma go to the web site www.myelomasurvival.com or you can follow me on twitter at: https://twitter.com/grpetersen1