Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle- Income Countries and Reduction Interventions in the Last 30 Years: A Systematic Review

Klazura, Greg and Wong, Lye-Yeng and Ribeiro, Lucas Loiola Ponte Albuquerque and Anyomih, Theophilus Teddy Kojo and Ooi, Reuben Yih Khai and Fissha, Aemon Berhane and Alam, Syeda Fatema and Daudu, Davina and Nyalundja, Arsene Daniel and Beltrano, Joana and Patil, Poorvaprabha P. and Wafford, Q. Eileen and Rapolti, Diana Ioana and Sullivan, Gwyneth A. and Graf, Akua and Veras, Perry and Nico, Elsa and Sheth, Monica and Shing, Samuel R. and Mathur, Priyanka and Langer, Monica (2024) Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle- Income Countries and Reduction Interventions in the Last 30 Years: A Systematic Review. Journal of Surgical Research, 299. pp. 163-171. ISSN 0022-4804, DOI https://doi.org/10.1016/j.jss.2024.04.021.

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Official URL: https://doi.org/10.1016/j.jss.2024.04.021

Abstract

Introduction: Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). Methods: We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. Results: 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. Conclusions: CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE. (c) 2024 Elsevier Inc. All rights reserved.

Item Type: Article
Funders: Fulbright Fogarty Fellowship, GHES NIH FIC (D43 TW010540)
Uncontrolled Keywords: Catastrophic expenditures; Surgical expenditures; Low- and middle-income countries
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 14 Jan 2025 04:54
Last Modified: 14 Jan 2025 04:54
URI: http://eprints.um.edu.my/id/eprint/46938

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