Economics ETDs

Publication Date

Summer 5-4-2018


This dissertation investigates the socio-economic burden of cancer patients using a primary survey in Nepal. Given the low uptake rate of cancer screening facilities in developing countries, my study covers three important issues: the need of information dissemination on cancer prevention among asymptomatic individuals, the emotional stress of cancer patients in relation to a control group of patients, and the severity of economic burden due to premature cancer related deaths measured at the national and individual levels. In developing countries with low level of information and awareness, it is difficult to communicate the importance of cancer preventative measures to the healthy population. It is only those who have a deeper understanding of the state of world and of the extent of disease adversities can truly value a cancer preventative program. With this background, Chapter 2 studies the retrospective preference of cancer patients in valuing an annual comprehensive cancer screening program. Conventional contingent valuation models and a structural equation modeling framework under mediation analysis not only determines how current health status affect preferences, but also unravel mediating linkages between different psychosocial factors of patients. For example, patients' perceived chances of cancer re-occurrence may lead them to prefer screening services, but it can also leave an opposing effect on screening preferences through higher pessimism among patients. The second chapter is a case-control comparison of mental burden. I extended the mental health literature by studying the differential impact of gender and cancer sites on patients' experience of emotional stress. Using propensity score matching methods, binary, and multivalued treatment effect weighting strategies, I found that cervical cancer is not only the most prevalent cancer in Nepal, but they also face the highest mental burden pointing to dysfunctional familial relationships. The objective of my third chapter is to highlight the magnitude of economic burden that low resource-setting countries face due to cancer. Mortality cost measured in the number of life years lost and the amount of productivity loss constitute the highest proportion of economic burden. Understanding the severity is important to provide insight into the need of a cancer control policy in the country.

Degree Name


Level of Degree


Department Name

Department of Economics

First Committee Member (Chair)

Alok K. Bohara

Second Committee Member

Jennifer A. Thacher

Third Committee Member

Kira Villa

Fourth Committee Member

Shiraz I Mishra




Cancer, Structural Equation Models, Economic Burden, Mental Burden, Contingent valuation, Nepal

Document Type