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

Greg Klazura, Lye Yeng Wong, Lucas Loiola Ponte Albuquerque Ribiero, Theophilus Teddy Kojo Anyomih, Reuben Yih Khai Ooi, Aemon Berhane Fissha, Syeda Fatema Alam, Davina Daudu, Arsene Daniel Nyalundja, Joana Beltrano, Poorvaprabha P. Patil, Q. Eileen Wafford, Diana Ioana Rapolti, Gwyneth A. Sullivan, Akua Graf, Perry Veras, Elsa Nico, Monica Sheth, Samuel R. Shing, Priyanka MathurMonica Langer

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish
Pages (from-to)163-171
Number of pages9
JournalJournal of Surgical Research
Volume299
Early online date16 May 2024
DOIs
Publication statusPublished - Jul 2024

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