The prevalence and determinants of catastrophic health expenditures attributable to non-communicable diseases in low- and middle-income countries: a methodological commentary.
BACKGROUND
Non-communicable diseases (NCDs), while traditionally considered a "rich world"-problem, have been spreading fast in low and middle income countries and by now account for a large share of mortality and ill-health in these countries, too. In addition to the disease burden, NCDs may also impose a substantial economic cost. One way in which NCDs might impact people's economic well-being may be via the out-of-pocket expenditures required to cover treatment and other costs associated with suffering from an NCD.


METHODS
In this commentary, we identify and discuss the methodological challenges related to cross-country comparison of-out-of-pocket and catastrophic out-of-pocket health care expenditures, attributable to NCDs, focussing on low and middle income countries.


RESULTS
There is significant evidence of substantial cost burden placed by NCDs on patients living in low and middle income countries, with most of it being heavily concentrated among low socioeconomic status groups. However, a large variation in definition of COOPE between studies prevents cross-country comparison. In addition, as most studies tend to be observational, causal inferences are often not possible. This is further complicated by the cross-sectional nature of studies, small sample sizes, and/or limited duration of follow-up of patients. Most evidence for certain conditions (e.g., cancer) tends to be collected in high-income countries only.


CONCLUSIONS
The definitions for COOPEs should be standardized as much as possible, to enable comparison of COOPE prevalence between countries. Prospective study design using larger samples representative of broader sections of local population, collecting better data on both direct and indirect treatment costs is also needed.
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK. y.goryakin@uea.ac.uk.|UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, UK. y.goryakin@uea.ac.uk.
Yevgeniy
Y
Goryakin
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK. m.suhrcke@uea.ac.uk.|UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, UK. m.suhrcke@uea.ac.uk.|Centre for Health Economics, University of York, York, UK. m.suhrcke@uea.ac.uk.
Marc
M
Suhrcke
D002908:Chronic Disease / Q000191:economics*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005382:Financing, Personal / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D015995:Prevalence; D011446:Prospective Studies; D012959:Socioeconomic Factors