Indirect economic burden of cancer in populations in China, 2021: A measurement based on a human capital approach.

[OBJECTIVES] Cancer imposes an enormous burden. In China, research on cancer economic burden has primarily focused on the direct economic burden while the indirect economic burden of cancer (IEBC) has been overlooked. Therefore, we aimed to conduct a systematic quantification of IEBC in populations in China.

[METHODS] A human capital approach was used to estimate the IEBC. The loss of productivity time was approximated based on disability-adjusted life years (DALYs) from the GBD 2021. The labour force participation rate and per capita economic parameters were sourced from various datasets, and subgroup and sensitivity analyses were conducted. The indirect-to-direct economic burden ratio was estimated partially based on results from a literature review.

[RESULTS] The overall IEBC in populations in China was estimated to be CNY1014.4 billion in 2021, representing 0.89 % of the gross domestic product (GDP). Among this total, CNY990.3 billion (97.6 %) was attributed to premature death and CNY24.1 billion to disability; CNY822.3 billion (81.1 %) to males and CNY853.8 billion (84.2 %) to populations under the age of 60 years. Region heterogeneity was observed to be CNY26.5 billion for the Northwest and CNY263.7 billion for the East. Of the overall IEBC, 58.8 % (CNY596.9 billion) could be attributed to a range of modifiable risk factors (tobacco was the leading one at CNY304.6 billion); 76.0 % (CNY770.8 billion) was attributed to screening-targeted cancers, mainly gastrointestinal cancers (CNY458.2 billion), lung cancer (CNY232.9 billion), breast and cervical cancer (CNY57.2 billion). The by-cancer median value of the indirect-to-direct economic burden ratio was 2.56 (range 0.83-4.76).

[CONCLUSIONS] The previously underestimated IEBC was roughly 3 times the reported direct economic burden in populations in China. Systematic quantification of the IEBC from "preventable" and "screenable" cancer types suggests there to be a potential extent of future economic benefit of implementing more effective and scaled-up population-based primary and secondary interventions.