Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America.
Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
PLoS Negl Trop Dis. 2024 May 13;18(5):e0012086. doi: 10.1371/journal.pntd.0012086. eCollection 2024 May.
Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs.
We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I2 statistic.
Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0-11.0%), dengue (12.5%), and lymphatic filariasis (0.0-23.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9-99.3%) and visceral leishmaniasis (24.6-91.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65-80%, n = 2, I2 = 0.00%). Costs of visceral leishmaniasis impoverished 20-26% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare.
NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.
被忽视的热带病（NTDs）主要影响贫困人群，可能导致灾难性的医疗支出（CHS）和自付费用（OOP）导致的贫困。本系统评价旨在总结 NTDs 造成的经济困难。
我们检索了 PubMed、EMBASE、EconLit、OpenGrey 和 EBSCO Open Dissertations，以获取自数据库成立至 2023 年 1 月 1 日报告 NTDs 造成经济困难的文章。我们总结了研究结果和方法特征。进行荟萃分析以汇总 CHS 的患病率。使用 I2 统计量评估异质性。
在纳入的 10 项研究中，有 10 项研究评估了 6 种 NTD（布鲁里溃疡、基孔肯雅热、登革热、内脏利什曼病、麻风病和淋巴丝虫病）的 2761 名患者的 CHS（n=10）和贫困（n=1）。CHS 在研究中的定义不同。麻风病（0.0-11.0%）、登革热（12.5%）和淋巴丝虫病（0.0-23.0%）患者的 OOP 成本导致 CHS 的患病率相对较低，而布鲁里溃疡（45.6%）患者的 CHS 患病率相对较高。基孔肯雅热（11.9-99.3%）和内脏利什曼病（24.6-91.8%）患者的 CHS 患病率差异很大。荟萃分析显示，内脏利什曼病 OOP 成本导致 CHS 的患病率为 73%（95%CI；65-80%，n=2，I2=0.00%）。对调查的 61 户家庭中的 20-26%进行了调查，具体取决于所捕获的成本。报告的成本没有捕获隐藏在放弃寻求医疗保健的经济负担。
NTDs 导致大量家庭面临经济困难。然而，文献中并未全面评估 NTDs 造成的经济困难。为了制定循证策略来最大程度地减少 NTDs 造成的经济困难，研究应评估家庭特征、疾病阶段和寻求治疗行为等方面导致经济困难的因素。
