167 lines
5.7 KiB
YAML
167 lines
5.7 KiB
YAML
abstract: 'STUDY QUESTION What are the direct costs of assisted reproductive
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technology (ART), and how affordable is it for patients in low- and
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middle-income countries (LMICS)? SUMMARY ANSWER Direct medical costs
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paid by patients for infertility treatment are significantly higher than
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annual average income and GDP per capita, pointing to unaffordability
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and the risk of catastrophic expenditure for those in need. WHAT IS
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KNOWN ALREADY Infertility treatment is largely inaccessible to many
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people in LMICs. Our analysis shows that no study in LMICs has
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previously compared ART medical costs across countries in international
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dollar terms (US\$PPP) or correlated the medical costs with economic
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indicators, financing mechanisms, and policy regulations. Previous
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systematic reviews on costs have been limited to high-income countries
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while those in LMICs have only focussed on descriptive analyses of these
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costs. STUDY DESIGN, SIZE, DURATION Guided by the preferred reporting
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items for systematic reviews and meta-analyses (PRISMA), we searched
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PubMed, Web of Science, Cumulative Index of Nursing and Allied Health
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Literature, EconLit, PsycINFO, Latin American \& Caribbean Health
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Sciences Literature, and grey literature for studies published in all
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languages from LMICs between 2001 and 2020. PARTICIPANTS/MATERIALS,
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SETTING, METHODS The primary outcome of interest was direct medical
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costs paid by patients for one ART cycle. To gauge ART affordability,
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direct medical costs were correlated with the GDP per capita or average
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income of respective countries. ART regulations and public financing
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mechanisms were analyzed to provide information on the healthcare
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contexts in the countries. The quality of included studies was assessed
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using the Integrated Quality Criteria for Review of Multiple Study
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designs. MAIN RESULTS AND THE ROLE OF CHANCE Of the 4062 studies
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identified, 26 studies from 17 countries met the inclusion criteria.
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There were wide disparities across countries in the direct medical costs
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paid by patients for ART ranging from USD2109 to USD18 592. Relative ART
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costs and GDP per capita showed a negative correlation, with the costs
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in Africa and South-East Asia being on average up to 200\% of the GDP
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per capita. Lower relative costs in the Americas and the Eastern
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Mediterranean regions were associated with the presence of ART
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regulations and government financing mechanisms. LIMITATIONS, REASONS
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FOR CAUTION Several included studies were not primarily designed to
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examine the cost of ART and thus lacked comprehensive details of the
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costs. However, a sensitivity analysis showed that exclusion of studies
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with below the minimum quality score did not change the conclusions on
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the outcome of interest. WIDER IMPLICATIONS OF THE FINDINGS Governments
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in LMICs should devise appropriate ART regulatory policies and implement
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effective mechanisms for public financing of fertility care to improve
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equity in access. The findings of this review should inform advocacy for
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ART regulatory frameworks in LMICs and the integration of infertility
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treatment as an essential service under universal health coverage. STUDY
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FUNDING/COMPETING INTEREST(S) This work received funding from the
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UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research,
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Development and Research Training in Human Reproduction (HRP), a
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cosponsored programme executed by the World Health Organization (WHO).
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The authors declare no competing interests.'
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affiliation: 'Njagi, P (Corresponding Author), Maastricht Univ, United Nations Univ
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MERIT, Maastricht Grad Sch Governance, NL-6211 Maastricht, Netherlands.
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Njagi, Purity; Groot, Wim, Maastricht Univ, United Nations Univ MERIT, Maastricht
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Grad Sch Governance, Maastricht, Netherlands.
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Groot, Wim, Maastricht Univ, Fac Hlth Med \& Life Sci, Dept Hlth Serv Res, Maastricht,
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Netherlands.
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Arsenijevic, Jelena, Univ Utrecht, Fac Law Econ \& Governance, Sch Governance, Utrecht,
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Netherlands.
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Dyer, Silke, Univ Cape Town, Dept Obstet \& Gynaecol, Cape Town, South Africa.
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Mburu, Gitau, WHO, Dept Sexualand Reprod Hlth \& Res SRH, UNDP UNFPA UNICEF WHO
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World Bank Special Programme, Dev \& Res Training Human Reprod HRP, Geneva, Switzerland.
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Njagi, Purity, Maastricht Univ, United Nations Univ MERIT, Maastricht Grad Sch Governance,
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NL-6211 Maastricht, Netherlands.'
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article-number: hoad007
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author: Njagi, Purity and Groot, Wim and Arsenijevic, Jelena and Dyer, Silke and Mburu,
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Gitau and Kiarie, James
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author-email: njagi@merit.unu.edu
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author_list:
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- family: Njagi
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given: Purity
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- family: Groot
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given: Wim
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- family: Arsenijevic
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given: Jelena
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- family: Dyer
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given: Silke
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- family: Mburu
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given: Gitau
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- family: Kiarie
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given: James
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da: '2023-09-28'
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doi: 10.1093/hropen/hoad007
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eissn: 2399-3529
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files: []
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journal: HUMAN REPRODUCTION OPEN
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keywords: 'assisted reproductive technology; in vitro fertilization; infertility;
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medical costs; out of pocket; systematic review; low- and middle-income
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countries'
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keywords-plus: 'PUBLIC-HEALTH SECTOR; SOUTH-AFRICA; INFERTILITY CARE; ECONOMIC-IMPACT;
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EMBRYO-TRANSFER; ACCESS; IVF; CONSEQUENCES; SERVICES; WOMEN'
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language: English
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month: MAR 7
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number: '2'
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number-of-cited-references: '73'
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orcid-numbers: kiarie, james/0000-0003-4180-7858
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papis_id: 1cf9da867f6cb2104337956c643570dc
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ref: Njagi2023financialcosts
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tags:
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- review
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times-cited: '5'
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title: 'Financial costs of assisted reproductive technology for patients in low- and
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middle-income countries: a systematic review'
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type: article
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unique-id: WOS:000954279300001
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usage-count-last-180-days: '4'
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usage-count-since-2013: '4'
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volume: '2023'
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web-of-science-categories: Obstetrics \& Gynecology; Reproductive Biology
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year: '2023'
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