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Feasibility of the International Wealth Index and the Gapminder tool as instruments to assess household income and estimate catastrophic expenditure: A prospective patient-level cohort study in India

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  • CROCODILE study group

Abstract

Background: Patient income assessment is required to assess healthcare catastrophic expenditure (Sustainable Development Goal) but self-reported income has several biases. This study aimed to assess the feasibility of the International Wealth Index (IWI) and the Gapminder tool as indirect instruments to assess household income. Methods: Prospective cohort study of colorectal cancer patients in five tertiary care hospitals in India (Dec 2020-August 2021). Patient self-reported household income was compared to income estimated from the IWI (twelve questions about household goods) and the Gapminder tool (five pictures of household assets). Agreement between instruments was explored with Bland-Altman methods. Cancer care expenditure from the same cohort was used to illustrate the impact of these tools in catastrophic expenditure rates. Results: From the 226 patients included, 99.5% completed the IWI and the Gapminder tool. Overall, self-reported incomes were lower than the estimated from the IWI and Gapminder tools (median incomes: 17350₹ for self-reported, 37491₹ for IWI and 51520₹ for Gapminder). The IWI showed better agreement with the self-reported income than the Gapminder tool. For both instruments, the agreement was better for low income earning households. Illustrative catastrophic expenditure rates range from 71% to 56% to 43% when using self-reported, IWI and Gapminder incomes respectively. Discussion: It is feasible to use the IWI and the Gapminder tools to estimate household income although they might overestimate income, with an impact on catastrophic expenditure rates. Further refinement of these tools could enable global monitoring and modelling of catastrophic expenditure from real-world data, at low burden for patients.

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  • CROCODILE study group, 2023. "Feasibility of the International Wealth Index and the Gapminder tool as instruments to assess household income and estimate catastrophic expenditure: A prospective patient-level cohort study in India," PLOS ONE, Public Library of Science, vol. 18(5), pages 1-12, May.
    • Handle: RePEc:plo:pone00:0276339
    DOI: 10.1371/journal.pone.0276339
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    References listed on IDEAS

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    1. Leila Doshmangir & Edris Hasanpoor & Gerard Joseph Abou Jaoude & Behzad Eshtiagh & Hassan Haghparast-Bidgoli, 2021. "Correction to: Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta‑analysis," Applied Health Economics and Health Policy, Springer, vol. 19(6), pages 953-953, November.
    2. Mathieu J. P. Poirier & Karen A. Grépin & Michel Grignon, 2020. "Approaches and Alternatives to the Wealth Index to Measure Socioeconomic Status Using Survey Data: A Critical Interpretive Synthesis," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 148(1), pages 1-46, February.
    3. Leila Doshmangir & Edris Hasanpoor & Gerard Joseph Abou Jaoude & Behzad Eshtiagh & Hassan Haghparast-Bidgoli, 2021. "Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis," Applied Health Economics and Health Policy, Springer, vol. 19(6), pages 839-855, November.
    4. Jeroen Smits & Roel Steendijk, 2015. "The International Wealth Index (IWI)," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 122(1), pages 65-85, May.
    5. David McKenzie, 2005. "Measuring inequality with asset indicators," Journal of Population Economics, Springer;European Society for Population Economics, vol. 18(2), pages 229-260, June.
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