SynthesisFrontiers in medicine2026
Out-of-pocket expenditure on medicine for chronic patients and its economic impact on Indian households: a systematic review and meta-analysis.
Synthesis in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Out-of-pocket expenditure (OOPE) on medicines constitutes a substantial component of healthcare spending in India, particularly among patients with chronic diseases requiring continuous treatment. This systematic review and meta-analysis aimed to synthesise evidence on medicine-related OOPE in India and assess its magnitude and variation across disease categories, healthcare settings, and provider sectors. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines, with the protocol registered in PROSPERO (CRD420251018386). PubMed, Scopus, and Web of Science were searched for peer-reviewed studies published from 1 January 2008 to 31 March 2025. Two reviewers independently screened studies, extracted data, and assessed methodological quality using Joanna Briggs Institute Critical Appraisal tools. Monetary estimates were standardised to constant 2024 Indian Rupees (INR) using the Consumer Price Index. Random-effects meta-analyses were performed for compatible outcomes, while disease-specific estimates derived from the same study population were synthesised descriptively to avoid treating correlated observations as independent. Findings: Thirty studies were included in the systematic review, of which 11 contributed to the quantitative meta-analysis. Among patients with chronic diseases, the pooled mean annual medicine-related OOPE was ₹9,550.58 per patient (95% CI: ₹3,642.60-₹15,458.57), with substantial between-study heterogeneity ( Interpretation: Medicine-related OOPE represents a substantial financial burden in India, particularly for patients requiring long-term treatment for chronic diseases. However, considerable heterogeneity and limited evidence within several subgroup analyses warrant cautious interpretation of pooled estimates. Strengthening public-sector medicine supply, improving access to affordable essential and generic medicines, and extending financial protection to outpatient medicines may help reduce household financial burden and advance Universal Health Coverage in India. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251018386, PROSPERO registration: CRD420251018386.
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