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Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review

STUDY QUESTION: What are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries (LMICS)? SUMMARY ANSWER: Direct medical costs paid by patients for infertility treatment are significantly higher than annual average income...

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Autores principales: Njagi, Purity, Groot, Wim, Arsenijevic, Jelena, Dyer, Silke, Mburu, Gitau, Kiarie, James
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10029849/
https://www.ncbi.nlm.nih.gov/pubmed/36959890
http://dx.doi.org/10.1093/hropen/hoad007
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author Njagi, Purity
Groot, Wim
Arsenijevic, Jelena
Dyer, Silke
Mburu, Gitau
Kiarie, James
author_facet Njagi, Purity
Groot, Wim
Arsenijevic, Jelena
Dyer, Silke
Mburu, Gitau
Kiarie, James
author_sort Njagi, Purity
collection PubMed
description STUDY QUESTION: What are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries (LMICS)? SUMMARY ANSWER: Direct medical costs paid by patients for infertility treatment are significantly higher than annual average income and GDP per capita, pointing to unaffordability and the risk of catastrophic expenditure for those in need. WHAT IS KNOWN ALREADY: Infertility treatment is largely inaccessible to many people in LMICs. Our analysis shows that no study in LMICs has previously compared ART medical costs across countries in international dollar terms (US$PPP) or correlated the medical costs with economic indicators, financing mechanisms, and policy regulations. Previous systematic reviews on costs have been limited to high-income countries while those in LMICs have only focussed on descriptive analyses of these costs. STUDY DESIGN, SIZE, DURATION: Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA), we searched PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, EconLit, PsycINFO, Latin American & Caribbean Health Sciences Literature, and grey literature for studies published in all languages from LMICs between 2001 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: The primary outcome of interest was direct medical costs paid by patients for one ART cycle. To gauge ART affordability, direct medical costs were correlated with the GDP per capita or average income of respective countries. ART regulations and public financing mechanisms were analyzed to provide information on the healthcare contexts in the countries. The quality of included studies was assessed using the Integrated Quality Criteria for Review of Multiple Study designs. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 4062 studies identified, 26 studies from 17 countries met the inclusion criteria. There were wide disparities across countries in the direct medical costs paid by patients for ART ranging from USD2109 to USD18 592. Relative ART costs and GDP per capita showed a negative correlation, with the costs in Africa and South-East Asia being on average up to 200% of the GDP per capita. Lower relative costs in the Americas and the Eastern Mediterranean regions were associated with the presence of ART regulations and government financing mechanisms. LIMITATIONS, REASONS FOR CAUTION: Several included studies were not primarily designed to examine the cost of ART and thus lacked comprehensive details of the costs. However, a sensitivity analysis showed that exclusion of studies with below the minimum quality score did not change the conclusions on the outcome of interest. WIDER IMPLICATIONS OF THE FINDINGS: Governments in LMICs should devise appropriate ART regulatory policies and implement effective mechanisms for public financing of fertility care to improve equity in access. The findings of this review should inform advocacy for ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage. STUDY FUNDING/COMPETING INTEREST(S): This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors declare no competing interests. TRIAL REGISTRATION NUMBER: This review is registered with PROSPERO, CRD42020199312.
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spelling pubmed-100298492023-03-22 Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review Njagi, Purity Groot, Wim Arsenijevic, Jelena Dyer, Silke Mburu, Gitau Kiarie, James Hum Reprod Open Original Article STUDY QUESTION: What are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries (LMICS)? SUMMARY ANSWER: Direct medical costs paid by patients for infertility treatment are significantly higher than annual average income and GDP per capita, pointing to unaffordability and the risk of catastrophic expenditure for those in need. WHAT IS KNOWN ALREADY: Infertility treatment is largely inaccessible to many people in LMICs. Our analysis shows that no study in LMICs has previously compared ART medical costs across countries in international dollar terms (US$PPP) or correlated the medical costs with economic indicators, financing mechanisms, and policy regulations. Previous systematic reviews on costs have been limited to high-income countries while those in LMICs have only focussed on descriptive analyses of these costs. STUDY DESIGN, SIZE, DURATION: Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA), we searched PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, EconLit, PsycINFO, Latin American & Caribbean Health Sciences Literature, and grey literature for studies published in all languages from LMICs between 2001 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: The primary outcome of interest was direct medical costs paid by patients for one ART cycle. To gauge ART affordability, direct medical costs were correlated with the GDP per capita or average income of respective countries. ART regulations and public financing mechanisms were analyzed to provide information on the healthcare contexts in the countries. The quality of included studies was assessed using the Integrated Quality Criteria for Review of Multiple Study designs. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 4062 studies identified, 26 studies from 17 countries met the inclusion criteria. There were wide disparities across countries in the direct medical costs paid by patients for ART ranging from USD2109 to USD18 592. Relative ART costs and GDP per capita showed a negative correlation, with the costs in Africa and South-East Asia being on average up to 200% of the GDP per capita. Lower relative costs in the Americas and the Eastern Mediterranean regions were associated with the presence of ART regulations and government financing mechanisms. LIMITATIONS, REASONS FOR CAUTION: Several included studies were not primarily designed to examine the cost of ART and thus lacked comprehensive details of the costs. However, a sensitivity analysis showed that exclusion of studies with below the minimum quality score did not change the conclusions on the outcome of interest. WIDER IMPLICATIONS OF THE FINDINGS: Governments in LMICs should devise appropriate ART regulatory policies and implement effective mechanisms for public financing of fertility care to improve equity in access. The findings of this review should inform advocacy for ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage. STUDY FUNDING/COMPETING INTEREST(S): This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors declare no competing interests. TRIAL REGISTRATION NUMBER: This review is registered with PROSPERO, CRD42020199312. Oxford University Press 2023-03-01 /pmc/articles/PMC10029849/ /pubmed/36959890 http://dx.doi.org/10.1093/hropen/hoad007 Text en © World Health Organization, [2023]. All rights reserved. The World Health Organization has granted the Publisher permission for the reproduction of this article. https://creativecommons.org/licenses/by/3.0/igo/This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 IGO License (https://creativecommons.org/licenses/by/3.0/igo/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Njagi, Purity
Groot, Wim
Arsenijevic, Jelena
Dyer, Silke
Mburu, Gitau
Kiarie, James
Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
title Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
title_full Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
title_fullStr Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
title_full_unstemmed Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
title_short Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
title_sort financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10029849/
https://www.ncbi.nlm.nih.gov/pubmed/36959890
http://dx.doi.org/10.1093/hropen/hoad007
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