wow-inequalities/02-data/intermediate/wos_sample/dc421ba3410ad20cbedf63fd59b99ec2-njagi-purity-and-gr/info.yaml

abstract: '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.'
affiliation: 'Njagi, P (Corresponding Author), Maastricht Univ, United Nations Univ
  MERIT, Maastricht Grad Sch Governance, NL-6211 Maastricht, Netherlands.

  Njagi, Purity; Groot, Wim, Maastricht Univ, United Nations Univ MERIT, Maastricht
  Grad Sch Governance, Maastricht, Netherlands.

  Groot, Wim, Maastricht Univ, Fac Hlth Med \& Life Sci, Dept Hlth Serv Res, Maastricht,
  Netherlands.

  Arsenijevic, Jelena, Univ Utrecht, Fac Law Econ \& Governance, Sch Governance, Utrecht,
  Netherlands.

  Dyer, Silke, Univ Cape Town, Dept Obstet \& Gynaecol, Cape Town, South Africa.

  Mburu, Gitau, WHO, Dept Sexualand Reprod Hlth \& Res SRH, UNDP UNFPA UNICEF WHO
  World Bank Special Programme, Dev \& Res Training Human Reprod HRP, Geneva, Switzerland.

  Njagi, Purity, Maastricht Univ, United Nations Univ MERIT, Maastricht Grad Sch Governance,
  NL-6211 Maastricht, Netherlands.'
article-number: hoad007
author: Njagi, Purity and Groot, Wim and Arsenijevic, Jelena and Dyer, Silke and Mburu,
  Gitau and Kiarie, James
author-email: njagi@merit.unu.edu
author_list:
- family: Njagi
  given: Purity
- family: Groot
  given: Wim
- family: Arsenijevic
  given: Jelena
- family: Dyer
  given: Silke
- family: Mburu
  given: Gitau
- family: Kiarie
  given: James
da: '2023-09-28'
doi: 10.1093/hropen/hoad007
eissn: 2399-3529
files: []
journal: HUMAN REPRODUCTION OPEN
keywords: 'assisted reproductive technology; in vitro fertilization; infertility;

  medical costs; out of pocket; systematic review; low- and middle-income

  countries'
keywords-plus: 'PUBLIC-HEALTH SECTOR; SOUTH-AFRICA; INFERTILITY CARE; ECONOMIC-IMPACT;

  EMBRYO-TRANSFER; ACCESS; IVF; CONSEQUENCES; SERVICES; WOMEN'
language: English
month: MAR 7
number: '2'
number-of-cited-references: '73'
orcid-numbers: kiarie, james/0000-0003-4180-7858
papis_id: 1cf9da867f6cb2104337956c643570dc
ref: Njagi2023financialcosts
tags:
- review
times-cited: '5'
title: 'Financial costs of assisted reproductive technology for patients in low- and
  middle-income countries: a systematic review'
type: article
unique-id: WOS:000954279300001
usage-count-last-180-days: '4'
usage-count-since-2013: '4'
volume: '2023'
web-of-science-categories: Obstetrics \& Gynecology; Reproductive Biology
year: '2023'