ArticlePLOS global public health2022
Out-of-pocket costs near end of life in low- and middle-income countries: A systematic review.
Article in PLOS global public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Core outcome sets for trials of interventions to prevent and to treat multimorbidity in adults in low and middle-income countries: the COSMOS study.BMJ global health · 2024Pooled it
- Economic Burden of Human Immunodeficiency Virus and Hypertension Care Among MOPHADHIV Trial Participants: Patient Costs and Determinants of Out-of-Pocket Expenditure in South Africa.International journal of environmental research and public health · 2025Trial
- A High-Resolution Microendoscope Improves Esophageal Cancer Screening and Surveillance: Implications for Underserved Global Settings Based on an International Randomized Controlled Trial.Gastroenterology · 2025Trial
- Common sense oncology values to action: a patient-led framework for randomized clinical trial design.Journal of the National Cancer Institute · 2026Article
- Precision medicine in low-income settings and small island developing states.Nature reviews. Endocrinology · 2026Review
- The impact of social determinants of health on acute kidney injury.Nature reviews. Nephrology · 2026Review
- Healthcare burden and impoverishment among older adults with palliative care needs in India: findings from a nationally representative study.BMC palliative care · 2026Article
- What factors predict severity of palliative care symptoms and concerns in COPD in South Africa? A cross-sectional study.Palliative care and social practice · 2026Article
- Dementia care gaps in Sub-Saharan Africa: A scoping review of technology, environmental, community perspectives, and financial constraints.PLOS global public health · 2026Article
- Identifying Strategies for Implementing Woman-Centered Care in Iranian Maternity Services: A Modified Delphi Study.International journal of women's health · 2026Article
- Place of death for people with dementia: A scoping review.PloS one · 2026Article
- Article
- Catastrophic health payments in Ghana post-National Health Insurance Scheme implementation: an analysis of service-specific health expenditures.BMJ global health · 2025Article
- Factors affecting out-of-pocket expenditures for chronic and acute illnesses in Bangladesh.PloS one · 2025Article
- Core outcome sets for trials of interventions to prevent and to treat multimorbidity in low- and middle-income countries: the COSMOS study.medRxiv : the preprint server for health sciences · 2024Article
- Palliative care needs and barriers in an urban Ugandan Emergency Department: A mixed-methods survey of emergency healthcare workers and patients.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2023Article
- Cross-national differences in wealth inequality in health services and caregiving used near the end of life.EClinicalMedicine · 2023Article
- Advanced HIV disease and health-related suffering-exploring the unmet need of palliative care.The lancet. HIV · 2023Review
- Improving palliative care outcomes in remote and rural areas of LMICs through family caregivers: lessons from Kazakhstan.Frontiers in public health · 2023Article
- Advance directives completion and hospital out-of-pocket expenditures.Journal of hospital medicine · 2022Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGlobally, there is a rise in chronic disease, including cancer, major organ failure and dementias. Patients and their families in low- and middle-income countries (LMICs) pay a high proportion of medical costs out of pocket (OOP), and a diagnosis of serious illness often has catastrophic financial consequences. We therefore conducted a review of the literature to establish what is known about OOP costs near end of life in LMICs.
aimsTo identify, organise and report the evidence on out-of-pocket costs in adult end-of-life populations in LMIC.
methodsA systematic search of 8 databases and a hand search of relevant systematic reviews and grey literature was performed. Two independent reviewers screened titles and abstracts, assessed papers for eligibility and extracted data. The review was registered with PROSPERO and adhered to the Preferred Reporting items for Systematic Reviews and Meta Analyses. The Mixed Methods Appraisal Tool was used to assess quality. The Wagstaff taxonomy was used to describe OOP.
resultsAfter deduplication, 9,343 studies were screened, of which 51 were read and rejected as full texts, and 12 were included in the final review. OOP costs increased with advanced illness and disease severity. The main drivers of OOP were medications and hospitalizations, with high but variable percentages of the affected populations reporting financial catastrophe, lost income, foregone education and other pressures.
conclusionDespite a small number of included studies and heterogeneity in methodology and reporting, it is clear that OOP costs for care near end of life in LMIC represent an important source of catastrophic health expenditures and impoverishment. This suggests a role for widespread, targeted efforts to avoid poverty traps. Financial protection policies for those suffering from incurable disease and future research on the macro- and micro- economics of palliative care delivery in LMIC are greatly needed.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.