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The global impact of non-communicable diseases on households and impoverishment: a systematic review

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Abstract

The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case–control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75 % of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158 % across the different NCDs and countries. Financial catastrophe due to the selected NCDs was seen in all countries and at all income levels, and occurred in 6–84 % of the households depending on the chosen catastrophe threshold. In 16 low- and middle-income countries (LMIC), 6–11 % of the total population would be impoverished at a 1.25 US dollar/day poverty line if they would have to purchase lowest price generic diabetes medication. NCDs impose a large and growing global impact on households and impoverishment, in all continents and levels of income. The true extent, however, remains difficult to determine due to the heterogeneity across existing studies in terms of populations studied, outcomes reported and measures employed. The impact that NCDs exert on households and impoverishment is likely to be underestimated since important economic domains, such as coping strategies and the inclusion of marginalized and vulnerable people who do not seek health care due to financial reasons, are overlooked in literature. Given the scarcity of information on specific regions, further research to estimate impact of NCDs on households and impoverishment in LMIC, especially the Middle Eastern, African and Latin American regions is required.

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References

  1. Alwan A. World Health Organization (WHO). Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2010

  2. Allotey P, Reidpath DD, Yasin S, Chan CK, de Graft Aikins A. Rethinking health-care systems: a focus on chronicity. Lancet. 2011;376:450–1.

    Article  Google Scholar 

  3. Bloom DE, Cafiero ET, Jané-Llopis E, et al. The global economic burden of noncommunicable diseases. Geneva: World Economic Forum; 2011.

    Google Scholar 

  4. Boutayeb A, Boutayeb S. The burden of non communicable diseases in developing countries. Int J Equity Health. 2005;4(1):2.

    Article  PubMed Central  PubMed  Google Scholar 

  5. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2012 revision, highlights and advance tables. Working Paper No. ESA/P/WP.228. 2013.

  6. Bloom D, Cafiero E, McGovern M, et al. The economic impact of non-communicable disease in China and India: estimates, projections, and comparisons. PDGA Working Paper No. 107. 2013.

  7. WHO guide to identifying the economic consequences of disease and injury. Department of Health Systems Financing. Health systems and services. Geneva: World Health Organization; 2009.

  8. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff. 2007;26(4):972–83. doi:10.1377/hlthaff.26.4.972.

    Article  Google Scholar 

  9. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362:111–7. doi:10.1016/s0140-6736(03)13861-5.

    Article  PubMed  Google Scholar 

  10. Engelgau M, Rosenhouse S, El-Saharty S, Mahal A. The economic effect of noncommunicable diseases on households and nations: a review of existing evidence. J Health Commun: Int Perspect. 2011;16(sup2):78–81.

    Article  Google Scholar 

  11. de Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global. Glob Health. 2010;6(1):5.

    Article  Google Scholar 

  12. Maher D, Sekajugo J, Harries AD, Grosskurth H. Research needs for an improved primary care response to chronic non-communicable diseases in Africa. (1365-3156 (Electronic)).

  13. Abe S. Japan’s strategy for global health diplomacy: why it matters. Lancet. 2013;382(9896):915–6.

    Article  PubMed  Google Scholar 

  14. McIntyre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Soc Sci Med. 2006;62(4):858–65. doi:10.1016/j.socscimed.2005.07.001.

    Article  PubMed  Google Scholar 

  15. Consumer Price Index (CPI) conversion factors for years 1774 to estimated 2024 to convert to dollars of 2013. http://oregonstate.edu/cla/polisci/sites/default/files/faculty-research/sahr/inflation-conversion/pdf/cv2013.pdf. Accessed 23-04-2014.

  16. Wells G, Shea B, O’Connel D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 13 Feb 2014.

  17. Zhou B, Yang L, Sun Q, Gu H, Wang B. Social health insurance and drug spending among cancer inpatients in China. Health Aff (Proj Hope). 2008;27(4):1020–7.

    Article  Google Scholar 

  18. Zaidi AA, Ansari TZ, Khan A. The financial burden of cancer: estimates from patients undergoing cancer care in a tertiary care hospital. Int J Equity Health. 2012;11(1):60. doi:10.1186/1475-9276-11-60.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Yabroff KR, Lamont EB, Mariotto A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst. 2008;100(9):630–41.

    Article  PubMed  Google Scholar 

  20. van Houtven CH, Ramsey SD, Hornbrook MC, Atienza AA, van Ryn M. Economic burden for informal caregivers of lung and colorectal cancer patients. Oncologist. 2010;15(8):883–93. doi:10.1634/theoncologist.2010-0005.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Thuan NBT, Lofgren C, Chuc NKT, Janlert U, Lindholm L. Household out-of-pocket payments for illness: evidence from Vietnam. BMC Public Health. 2006;6:283. doi:10.1186/1471-2458-6-283.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Syse A, Tonnessen M. Cancer’s unequal impact on incomes in Norway. Acta Oncol. 2012;51(4):480–9. doi:10.3109/0284186x.2011.640710.

    Article  PubMed  Google Scholar 

  23. Sun Q, Liu X, Meng Q, Tang S, Yu B, Tolhurst R. Evaluating the financial protection of patients with chronic disease by health insurance in rural China. Int J Equity Health. 2009;8:42. doi:10.1186/1475-9276-8-42.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Su TT, Kouyate B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull World Health Organ. 2006;84(1):21–7.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Shugarman LR, Bird CE, Schuster CR, Lynn J. Age and gender differences in Medicare expenditures at the end of life for colorectal cancer decedents. J Women’s Health. 2007;16(2):214–27. doi:10.1089/jwh.2006.0012.

    Article  Google Scholar 

  26. Shobhana R, Rama Rao P, Lavanya A, Williams R, Vijay V, Ramachandran A. Expenditure on health care incurred by diabetic subjects in a developing country—a study from southern India. Diabetes Res Clin Pract. 2000;48(1):37–42.

    Article  CAS  PubMed  Google Scholar 

  27. Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol. 2012;30(14):1608–14.

    Article  PubMed  Google Scholar 

  28. Rodbard HW, Green AJ, Fox KM, Grandy S. Impact of type 2 diabetes mellitus on prescription medication burden and out-of-pocket healthcare expenses. Diabetes Res Clin Pract. 2010;87(3):360–5. doi:10.1016/j.diabres.2009.11.021.

    Article  PubMed  Google Scholar 

  29. Rayappa PH, Raju KNM, Kapur A, Bjork S, Sylvest C, Dilip Kumar KM. Economic cost of diabetes care: the Bangalore urban district diabetes study. Int J Diabetes Dev Ctries. 1999;9:87–97.

    Google Scholar 

  30. Rao KD, Bhatnagar A, Murphy A. Socio-economic inequalities in the financing of cardiovascular & diabetes inpatient treatment in India. Indian J Med Res. 2011;133:57–63.

    PubMed Central  PubMed  Google Scholar 

  31. Ramachandran A, Ramachandran S, Snehalatha C, et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India. Diabetes Care. 2007;30(2):252–6.

    Article  PubMed  Google Scholar 

  32. Pisu M, Azuero A, Meneses K, Burkhardt J, McNees P. Out of pocket cost comparison between Caucasian and minority breast cancer survivors in the Breast Cancer Education Intervention (BCEI). Breast Cancer Res Treat. 2011;127(2):521–9. doi:10.1007/s10549-010-1225-0.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Okumura Y, Ito H. Out-of-pocket expenditure burdens in patients with cardiovascular conditions and psychological distress: a nationwide cross-sectional study. Gen Hosp Psychiatry. 2013;35(3):233–8. doi:10.1016/j.genhosppsych.2012.12.013.

    Article  PubMed  Google Scholar 

  34. Obi SN, Ozumba BC. Cervical cancer: socioeconomic implications of management in a developing nation. J Obstet Gynaecol. 2008;28(5):526–8.

    Article  CAS  PubMed  Google Scholar 

  35. Niens LM, Cameron A, Van de Poel E, Ewen M, Brouwer WBF, Laing R. Quantifying the impoverishing effects of purchasing medicines: a cross-country comparison of the affordability of medicines in the developing world. PLoS Med. 2010;. doi:10.1371/journal.pmed.1000333.

    PubMed Central  PubMed  Google Scholar 

  36. Moore KA. Breast cancer patients’ out-of-pocket expenses. Cancer Nurs. 1999;22(5):389–96.

    Article  CAS  PubMed  Google Scholar 

  37. McKevitt C, Fudge N, Redfern J, et al. Self-reported long-term needs after stroke. Stroke. 2011;42(5):1398–403.

    Article  PubMed  Google Scholar 

  38. Markman M, Luce R. Impact of the cost of cancer treatment: an internet-based survey. J Oncol Pract. 2010;6(2):69–73.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Longo CJ, Bereza BG. A comparative analysis of monthly out-of-pocket costs for patients with breast cancer as compared with other common cancers in Ontario, Canada. Curr Oncol. 2011;18(1):e1–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Lauzier S, Maunsell E, Drolet M, et al. Wage losses in the year after breast cancer: extent and determinants among Canadian women. J Natl Cancer Inst. 2008;100(5):321–32. doi:10.1093/jnci/djn028.

    Article  PubMed  Google Scholar 

  41. Lauzier S, Levesque P, Mondor M, et al. Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses. J Natl Cancer Inst. 2013;105(4):280–92. doi:10.1093/jnci/djs512.

    Article  PubMed  Google Scholar 

  42. Lauzier S, Levesque P, Drolet M, et al. Out-of-pocket costs for accessing adjuvant radiotherapy among Canadian women with breast cancer. J Clin Oncol. 2011;29(30):4007–13.

    Article  PubMed  Google Scholar 

  43. Khowaja LA, Khuwaja AK, Cosgrove P. Cost of diabetes care in out-patient clinics of Karachi, Pakistan. BMC Health Serv Res. 2007;7:189.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Kang HY, Lim SJ, Suh HS, Liew D. Estimating the lifetime economic burden of stroke according to the age of onset in South Korea: a cost of illness study. BMC Public Health. 2011;11:646.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Joshi A, Mohan K, Grin G, Perin DMP. Burden of healthcare utilization and out-of-pocket costs among individuals with NCDs in an Indian setting. J Commun Health. 2013;38(2):320–7.

    Article  Google Scholar 

  46. Jeon YH, Essue B, Jan S, Wells R, Whitworth JA. Economic hardship associated with managing chronic illness: a qualitative inquiry. BMC Health Serv Res. 2009;9:182.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Huffman MD, Rao KD, Pichon-Riviere A, et al. A cross-sectional study of the microeconomic impact of cardiovascular disease hospitalization in four low- and middle-income countries. PLoS ONE. 2011;. doi:10.1371/journal.pone.0020821.

    Google Scholar 

  48. Higashiyama A, Okamura T, Watanabe M, et al. Effect of chronic kidney disease on individual and population medical expenditures in the Japanese population. Hypertens Res. 2009;32(6):450–4. doi:10.1038/hr.2009.51.

    Article  PubMed  Google Scholar 

  49. Heeley E, Anderson CS, Huang Y, et al. Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke. 2009;40(6):2149–56. doi:10.1161/strokeaha.108.540054.

    Article  PubMed  Google Scholar 

  50. Grover S, Avasthi A, Bhansali A, Chakrabarti S, Kulhara P. Cost of ambulatory care of diabetes mellitus: a study from north India. Postgrad Med J. 2005;81(956):391–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Gordon LG, Ferguson M, Chambers SK, Dunn J. Fuel, beds, meals and meds: out-of-pocket expenses for patients with cancer in rural Queensland. Cancer Forum. 2009;33(3):204.

    Google Scholar 

  52. Gordon L, Scuffham P, Hayes S, Newman B. Exploring the economic impact of breast cancers during the 18 months following diagnosis. Psycho-Oncology. 2007;16(12):1130–9. doi:10.1002/pon.1182.

    Article  PubMed  Google Scholar 

  53. Goldhaber-Fiebert JD, Li H, Ratanawijitrasin S, et al. Inpatient treatment of diabetic patients in Asia: evidence from India, China, Thailand and Malaysia. Diabet Med. 2010;27(1):101–8.

    Article  CAS  PubMed  Google Scholar 

  54. Gerzeli S, Tarricone R, Zolo P, Colangelo I, Busca MR, Gandolfo C. The economic burden of stroke in Italy. The EcLIPSE Study: economic longitudinal incidence-based project for stroke evaluation. Neurol Sci. 2005;26(2):72–80. doi:10.1007/s10072-005-0439-0.

    Article  CAS  PubMed  Google Scholar 

  55. Falconer DG, Buckley A, Colagiuri R. Counting the cost of type 2 diabetes in Vanuatu. Diabetes Res Clin Pract. 2010;87(1):92–7.

    Article  PubMed  Google Scholar 

  56. Essue BM, Wong G, Chapman J, Li Q, Jan S. How are patients managing with the costs of care for chronic kidney disease in Australia? A cross-sectional study. BMC Nephrol. 2013;. doi:10.1186/1471-2369-14-5.

    PubMed Central  PubMed  Google Scholar 

  57. Essue BM, Hackett ML, Li Q, Glozier N, Lindley R, Jan S. How are household economic circumstances affected after a stroke? The psychosocial outcomes in stroke (POISE) study. Stroke. 2012;43(11):3110–3. doi:10.1161/strokeaha.112.666453.

    Article  PubMed  Google Scholar 

  58. Essue B, Kelly P, Roberts M, Leeder S, Jan S. We can’t afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia. J Health Serv Res Policy. 2011;16(4):226–31. doi:10.1258/jhsrp.2011.010159.

    Article  PubMed  Google Scholar 

  59. Engelgau MM, Karan A, Mahal A. The economic impact of non-communicable diseases on households in India. Glob Health. 2012;8:9. doi:10.1186/1744-8603-8-9.

    Article  Google Scholar 

  60. Eaker S, Wigertz A, Lambert PC, Bergkvist L, Ahlgren J, Lambe M. Breast cancer, sickness absence, income and marital status. A study on life situation 1 year prior diagnosis compared to 3 and 5 years after diagnosis. PLoS ONE. 2011;. doi:10.1371/journal.pone.0018040.

    PubMed Central  PubMed  Google Scholar 

  61. Dewey HM, Thrift AG, Mihalopoulos C, et al. Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2003;34(10):2502–7. doi:10.1161/01.str.0000091395.85357.09.

    Article  PubMed  Google Scholar 

  62. Davidoff AJ, Erten M, Shaffer T, et al. Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer. 2013;119(6):1257–65. doi:10.1002/cncr.27848.

    Article  PubMed  Google Scholar 

  63. Chirikos TN, Russell-Jacobs A, Jacobsen PB. Functional impairment and the economic consequences of female breast cancer. Women Health. 2002;36(1):1–20.

    Article  PubMed  Google Scholar 

  64. Chirikos TN, Russell-Jacobs A, Cantor AB. Indirect economic effects of long-term breast cancer survival. Cancer Pract. 2002;10(5):248–55.

    Article  PubMed  Google Scholar 

  65. Chatterjee S, Riewpaiboon A, Piyauthakit P, Riewpaiboon W. Cost of informal care for diabetic patients in Thailand. Prim Care Diabetes. 2011;5(2):109–15.

    Article  PubMed  Google Scholar 

  66. Chang K. Comorbidities, quality of life and patients’ willingness to pay for a cure for type 2 diabetes in Taiwan. Public Health. 2010;124(5):284–94. doi:10.1016/j.puhe.2010.02.019.

    Article  CAS  PubMed  Google Scholar 

  67. Campbell RS, Patel V, Gleeson M, Calimlim BM, Zagari MJ, Curkendall SM. Out-of-pocket healthcare expenditures and caps in patients with chronic conditions. Am J Pharm Benefits. 2011;3(2):98–105.

    Google Scholar 

  68. Bennett JA, Brown P, Cameron L, Whitehead LC, Porter D, McPherson KM. Changes in employment and household income during the 24 months following a cancer diagnosis. Support Care Cancer. 2009;17(8):1057–64.

    Article  PubMed  Google Scholar 

  69. Banthin JS, Bernard DM. Changes in financial burdens for health care: national estimates for the population younger than 65 years, 1996 to 2003. JAMA. 2006;296(22):2712–9. doi:10.1001/jama.296.22.2712.

    Article  CAS  PubMed  Google Scholar 

  70. Baanders AN, Heijmans MJ. The impact of chronic diseases: the partner’s perspective. Fam Community Health. 2007;30(4):305–17.

    Article  PubMed  Google Scholar 

  71. Arrossi S, Matos E, Zengarini N, Roth B, Sankaranayananan R, Parkin M. The socio-economic impact of cervical cancer on patients and their families in Argentina, and its influence on radiotherapy compliance. Results from a cross-sectional study. Gynecol Oncol. 2007;105(2):335–40. doi:10.1016/j.ygyno.2006.12.010.

    Article  PubMed  Google Scholar 

  72. Arozullah AM, Calhoun EA, Wolf M, et al. The financial burden of cancer estimates from a study of insured women with breast cancer. J Support Oncol. 2004;2(3):271–8.

    PubMed  Google Scholar 

  73. Bernard DM, Banthin JS, Encinosa WE. Health care expenditure burdens among adults with diabetes in 2001. Med Care. 2006;44(3):210–5. doi:10.1097/01.mlr.0000199729.25503.60.

    Article  PubMed  Google Scholar 

  74. Chang S, Long SR, Kutikova L, et al. Estimating the cost of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol. 2004;22(17):3524–30. doi:10.1200/JCO.2004.10.170.

    Article  PubMed  Google Scholar 

  75. Dewey HM, Thrift AG, Mihalopoulos C, et al. ‘Out of pocket’ costs to stroke patients during the first year after stroke—results from the North East Melbourne Stroke Incidence Study. J Clin Neurosci. 2004;11(2):134–7.

    Article  PubMed  Google Scholar 

  76. Grunfeld E, Coyle D, Whelan T, et al. Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. Can Med Assoc J. 2004;170(12):1795–801.

    Article  Google Scholar 

  77. Jagsi R, Pottow JAE, Griffith KA, et al. Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol. 2014;32(12):1269–76. doi:10.1200/jco.2013.53.0956.

    Article  PubMed  Google Scholar 

  78. Karan A, Engelgau M, Mahal A. The household-level economic burden of heart disease in India. Trop Med Int Health. 2014;19(5):581–91. doi:10.1111/tmi.12281.

    Article  PubMed  Google Scholar 

  79. Kelley AS, McGarry K, Fahle S, Marshall SM, Du Q, Skinner JS. Out-of-pocket spending in the last five years of life. J Gen Intern Med. 2013;28(2):304–9. doi:10.1007/s11606-012-2199-x.

    Article  PubMed Central  PubMed  Google Scholar 

  80. Riewpaiboon A, Riewpaiboon W, Ponsoongnern K, Van den Berg B. Economic valuation of informal care in Asia: a case study of care for disabled stroke survivors in Thailand. Soc Sci Med. 2009;69(4):648–53. doi:10.1016/j.socscimed.2009.05.033.

    Article  PubMed  Google Scholar 

  81. World Health Organization (WHO). Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization; 2013.

  82. Van Doorslaer E, O’Donnell O, Rannan-Eliya R, et al. Paying out-of-pocket for health care in Asia: catastrophic and poverty impact. EQUITAP Project: working paper #2, Erasmus University, Rotterdam and IPS, Colombo. 2005.

  83. Mendis S, Fukino K, Cameron A, et al. The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Organ. 2007;85:279–88. doi:10.2471/BLT.06.033647.

    Article  PubMed Central  PubMed  Google Scholar 

  84. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373:240–9. doi:10.1016/S01406736(08)61762-6.

    Article  CAS  PubMed  Google Scholar 

  85. Wagstaff A. Poverty and health sector inequalities. Bull World Health Organ. 2002;80(2):97–105.

    PubMed Central  PubMed  Google Scholar 

  86. WHO Regional Office for the Western Pacific. Noncommunicable disease and poverty: the need for pro-poor strategies in the Western Pacific region: a review. World Health Organization; 2006.

  87. Brooks J, Wilson K, Amir Z. Additional financial costs borne by cancer patients: a narrative review. Eur J Oncol Nurs. 2011;15(4):302–10. doi:10.1016/j.ejon.2010.10.005.

    Article  PubMed  Google Scholar 

  88. Girgis A, Lambert S, Johnson C, Waller A, Currow D. Physical, psychosocial, relationship, and economic burden of caring for people with cancer: a review. J Oncol Pract. 2013;9(4):197–202. doi:10.1200/jop.2012.000690.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Goryakin Y, Suhrcke M. The prevalence and determinants of catastrophic health expenditures attributable to non-communicable diseases in low- and middle-income countries: a review-based commentary on the methodological challenges involved. Int J Equity Health. 2014;13(1):107. doi:10.1186/s12939-014-0107-1.

    Article  PubMed Central  PubMed  Google Scholar 

  90. Haley WE. The costs of family caregiving: implications for geriatric oncology. Crit Rev Oncol Hematol. 2003;48(2):151–8.

    Article  PubMed  Google Scholar 

  91. Kankeu HT, Saksena P, Xu K, Evans DB. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst. 2013;11:31.

    Article  PubMed Central  PubMed  Google Scholar 

  92. Kim P. Cost of cancer care: the patient perspective. J Clin Oncol. 2007;25(2):228–32. doi:10.1200/jco.2006.07.9111.

    Article  PubMed  Google Scholar 

  93. Leive A, Xu K. Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bull World Health Organ. 2008;86(11):849–56.

    Article  PubMed Central  PubMed  Google Scholar 

  94. Mahal A, Karan A, Engelgau M. The economic implications of non-communicable disease for India. Health, Nutrition and Population (HNP) Discussion Paper. The World Bank. 2010.

  95. Pearce S, Kelly D, Stevens W. ‘More than just money’—widening the understanding of the costs involved in cancer care. J Adv Nurs. 2001;33(3):371–9.

    Article  CAS  PubMed  Google Scholar 

  96. Pisu M, Azuero A, McNees P, Burkhardt J, Benz R, Meneses K. The out of pocket cost of breast cancer survivors: a review. J Cancer Surviv. 2010;4(3):202–9. doi:10.1007/s11764-010-0125-y.

    Article  PubMed Central  PubMed  Google Scholar 

  97. Tong A, Cheung KL, Nair SS, Kurella Tamura M, Craig JC, Winkelmayer WC. Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD. Am J Kidney Dis. 2014;63(6):913–27. doi:10.1053/j.ajkd.2013.11.017.

    Article  PubMed  Google Scholar 

  98. Valtorta NK, Hanratty B. Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: a systematic review. Maturitas. 2013;74(4):313–33.

    Article  PubMed  Google Scholar 

  99. Wagner L, Lacey MD. The hidden costs of cancer care: an overview with implications and referral resources for oncology nurses. Clin J Oncol Nurs. 2004;8(3):279–87. doi:10.1188/04.cjon.279-287.

    Article  PubMed  Google Scholar 

  100. Yabroff KR, Borowski L, Lipscomb J. Economic studies in colorectal cancer: challenges in measuring and comparing costs. J Natl Cancer Inst Monogr. 2013;2013(46):62–78. doi:10.1093/jncimonographs/lgt001.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

Completion of this manuscript was supported by a Grant from the WHO. O.H. Franco and L. Jaspers work in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd.); Metagenics Inc.; and AXA. Nestlé Nutrition (Nestec Ltd.); Metagenics Inc.; and AXA had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript. V. Colpani is a visiting researcher supported by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), in Brazil. Dr. Shanthi Mendis from the WHO and co-author on this manuscript participated in the interpretation and preparation of this manuscript. The manuscript was approved by the WHO for submission.

Conflict of interest

With regard to potential conflicts of interest, there is nothing to disclose. Drs. Jaspers, Colpani and Franco had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA 29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    Loes Jaspers, Veronica Colpani, Layal Chaker, Sven J. van der Lee, Taulant Muka, David Imo, Raha Pazoki & Oscar H. Franco

  2. Department of Endocrinology, Erasmus MC, Rotterdam, The Netherlands

    Layal Chaker

  3. Chronic Diseases Prevention and Management, Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva, Switzerland

    Shanthi Mendis

  4. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

    Rajiv Chowdhury

  5. Medical Library, Erasmus MC, Rotterdam, The Netherlands

    Wichor M. Bramer

  6. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

    Abby Falla

  7. Division of Infectious Disease Control, Municipal Public Health Service (GGD) Rotterdam-Rijnmond, Rotterdam, The Netherlands

    Abby Falla

Authors
  1. Loes Jaspers
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  2. Veronica Colpani
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  3. Layal Chaker
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  4. Sven J. van der Lee
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  5. Taulant Muka
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  6. David Imo
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  7. Shanthi Mendis
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  8. Rajiv Chowdhury
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  9. Wichor M. Bramer
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  10. Abby Falla
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  11. Raha Pazoki
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  12. Oscar H. Franco
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Corresponding author

Correspondence to Oscar H. Franco.

Additional information

Loes Jaspers and Veronica Colpani have contributed equally to this work.

Electronic supplementary material

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Supplementary material 1 (DOC 97 kb)

Appendices

Appendix 1: Search strategy 6 November 2014

(‘non communicable disease’/de OR ‘ischemic heart disease’/exp OR ‘cerebrovascular accident’/exp OR ‘chronic obstructive lung disease’/de OR ‘lung cancer’/exp OR ‘colon cancer’/exp OR ‘breast cancer’/exp OR ‘chronic kidney disease’/de OR ‘non insulin dependent diabetes mellitus’/de OR ‘uterine cervix cancer’/exp OR (‘non communicable’ OR noncommunicable OR ((heart OR cardiac OR cardial OR cardiopath* OR cardiomyopath* OR coronar* OR myocard*) NEAR/3 (ischem* OR ischaem* OR anoxia OR hypoxia)) OR (coronary NEAR/3 (insufficien* OR occlus* OR disease* OR acute OR atherosclero* OR arteriosclero* OR sclero* OR cardiosclero* OR constrict* OR vasoconstrict* OR obstruct* OR stenosis* OR thrombo*)) OR angina* OR ((heart OR myocard* OR cardiac OR cardial) NEAR/3 infarct*) OR ((cerebrovascul* OR brain OR ‘cerebral vascular’ OR ‘cerebro vascular’) NEAR/3 (accident* OR lesion* OR attack OR ischem* OR ischaem* OR insult* OR insuffucien* OR arrest* OR apoplex*)) OR cva OR stroke OR (chronic AND (obstruct* NEAR/3 (lung* OR pulmonar* OR airway* OR bronch* OR respirat*))) OR ((lung* OR pulmonar* OR colon* OR colorect* OR breast* OR mamma*) NEAR/3 (neoplas* OR cancer* OR carcino* OR adenocarcino* OR metasta* OR sarcom*)) OR (chronic NEAR/3 (kidney* OR nephropathy* OR renal)) OR ((‘adult onset’ OR ‘type 2’ OR ‘type ii’ OR ‘non-insulin dependent’ OR ‘noninsulin dependent’ OR ‘insulin independent’) NEAR/3 diabet*) OR ((cervix OR cervical) NEAR/3 (cancer* OR neoplas* OR tumo* OR carcinom* OR malign*))):ab,ti) AND (adult/exp) AND (‘randomized controlled trial’/exp OR ‘cohort analysis’/de OR ‘case control study’/exp OR ‘cross-sectional study’/de OR ‘systematic review’/de OR ‘meta analysis’/de OR ecology/exp OR ‘ecosystem health’/exp OR ‘ecosystem monitoring’/exp OR model/exp OR ((random* NEAR/3 (trial* OR control*)) OR rct* OR cohort* OR ‘case control’ OR ‘cross-sectional’ OR (systematic* NEAR/3 review*) OR metaanaly* OR (meta NEXT/1 analy*) OR ecolog* OR ecosystem* OR model*):ab,ti) NOT ([animals]/lim NOT [humans]/lim) NOT ([Conference Abstract]/lim OR [Conference Paper]/lim OR [Letter]/lim OR [Note]/lim OR [Conference Review]/lim OR [Editorial]/lim OR [Erratum]/lim).

AND (((‘cost of living’/de OR budget/de OR ‘financial deficit’/exp OR income/de OR ‘health care cost’/de OR ‘hospitalization cost’/de OR insurance/exp OR ‘cost of illness’/de OR socioeconomics/exp OR (((cost* OR econom* OR expen*) NEAR/6 (living OR individu* OR famil* OR personal* OR patient* OR illness* OR direct* OR indirect*)) OR budget* OR deficit* OR debt* OR income OR insurance* OR socioeconom* OR pover* OR impover* OR poor OR wealth):ab,ti) AND (family/exp OR home/de OR household/de OR (famil* OR home OR household* OR personal):ab,ti)) OR ‘caregiver burden’/de OR (microeconom* OR (micro NEXT/1 econom*) OR ‘Out of pocket’ OR ‘Willingness to pay’ OR (catastroph* NEAR/3 (spend* OR expend*)) OR ‘Poverty line’ OR (Value* NEXT/2 ‘statistical life’)):ab,ti).

Appendix 2: Newcastle Ottawa Quality Assessment Scale, cross-sectional and descriptive studies

Note: A study can be awarded a maximum of one star for each numbered item within the Selection and Exposure categories. A maximum of two stars can be given for Comparability.

Selection

  1. 1.

    Is definition of NCDs adequate?

    1. (a)

      Yes, according to a clear and widely used definition*

    2. (b)

      Yes, e.g. record linkage or based on self-reports

    3. (c)

      No description

  2. 2.

    Representativeness of the cases

    1. (a)

      Consecutive or obviously representative series of cases*

    2. (b)

      Excluded cases are random*

    3. (c)

      No description of the excluded cases or potential for selection biases or not stated

  3. 3.

    Comparison with a reference group

    1. (a)

      The results are compared with a reference from community or with the status of the cases prior to the disease*

    2. (b)

      The results are compared with the results from other patients

    3. (c)

      No description/no comparison available

  4. 4.

    Definition of reference

    1. (a)

      Individuals with no NCD or sample from general population or the same individuals before NCD suffering*

    2. (b)

      Non community comparator is described

    3. (c)

      No description of source

Comparability

  1. 1.

    Comparability of the results on the basis of the design or analysis

    1. (a)

      The results are described in age and sex sub groups (sex is not applicable for female diseases)*

    2. (b)

      The results are additionally adjusted for/described in different socioeconomic factors or disease related confounders*

Exposure (costs, productivity, households)

  1. 1.

    Ascertainment of exposure

    1. (a)

      Secure record (e.g. surgical records, hospital records, and administrative records, national…)*

    2. (b)

      Structured interview where blind to case/control status*

    3. (c)

      Interview not blinded to case/control status

    4. (d)

      Written self-report or medical record only

    5. (e)

      No description

  2. 2.

    Same method of ascertainment for NCDs and comparators

    1. (a)

      Yes*

    2. (b)

      No

    3. (c)

      No comparator group exist

  3. 3.

    Non-Response rate

    1. (a)

      All participants included or same rate for both groups or respondents and non-respondents have the same characteristics*

    2. (b)

      Non respondents described

    3. (c)

      Rate different and no designation

    4. (d)

      Response rate not described

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Jaspers, L., Colpani, V., Chaker, L. et al. The global impact of non-communicable diseases on households and impoverishment: a systematic review. Eur J Epidemiol 30, 163–188 (2015). https://doi.org/10.1007/s10654-014-9983-3

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  • DOI: https://doi.org/10.1007/s10654-014-9983-3

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