Economic burden and economic impact associated with non-communicable diseases among countries of the World Health Organization South-East Asia Region: A systematic review protocol

Objective: The objective of this systematic review is to synthesize studies on the economic burden and economic impact of non-communicable diseases in the World Health Organization South-East Asia Region (WHO SEAR) countries. Introduction: WHO SEAR countries represent 8.6% of the world's population, and 75% of all deaths in this region are attributable to non-communicable diseases. In addition, there is a pattern of low government spending on health in SEAR countries, leading to a high proportion of health financing by patients, risking impoverishment for households. Inclusion criteria: We will consider observational (cross-sectional, cohort, and case-control) and interventional (either single arm or comparative) studies that report the economic burden (direct and indirect costs, out-of-pocket expenditure) and economic impact (catastrophic health expenditure, hardship financing, impoverishment, and gross domestic product impact) at the individual, household, and/or country levels. This includes government surveys, surveillance, and secondary data analyses for one or more non-communicable diseases prevalent in the WHO SEAR. Methods: We will conduct a comprehensive search for relevant studies in databases, including MEDLINE (PubMed), Embase (Ovid), Scopus, Web of Science, Google Scholar, and gray literature, with no date limits. Two reviewers will independently screen titles and abstracts, followed by full-text screening. Included studies will be critically appraised for quality. Data will be extracted accordingly and, if possible, random effects meta-analyses will be conducted on the pooled data for resource utilization and costs (including burden and impact), presenting the degree of variation between studies. The characteristics and results of the included studies will be narratively summarized with accompanying tables. Review registration: PROSPERO CRD42023421302.