{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T10:59:37Z","timestamp":1768906777692,"version":"3.49.0"},"reference-count":34,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Amrita Seed Grant","award":["ASG2022016"],"award-info":[{"award-number":["ASG2022016"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,28]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Oral diseases are a major contributor to global disability but remain largely neglected in health policy, especially in low- and middle-income countries. India carries a disproportionately high burden of dental caries and periodontal disease, with limited access to oral healthcare and high reliance on out-of-pocket expenditure (OOPE). Despite this, there is a lack of synthesised economic evidence specific to India, which limits informed policymaking and resource allocation. This systematic review aims to assess the economic burden and financial impact of oral diseases in India\u2014at individual, household, health system and societal levels\u2014focusing on direct and indirect costs, including OOPE and catastrophic health expenditure (CHE).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>This review will follow the JBI methodology for economic evaluation evidence and adhere to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A three-step search strategy will be used to identify relevant studies from databases, including MEDLINE (Ovid), Embase, Scopus, CINAHL (Ovid), Dentistry and Oral Sciences Source (EBSCO) and Cochrane CENTRAL, as well as grey literature sources.<\/jats:p>\n                  <jats:p>We will include studies conducted in India that report on the economic burden or financial impact of oral diseases at the individual, household or population level. Eligible designs include cost-of-illness studies, cost analysis, cost-outcome analysis and health expenditure analysis using cross-sectional (including repeated cross-sectional) or cohort designs, as well as analyses based on secondary datasets. Studies using econometric, statistical or modelling methods, with or without comparators, will be included. Mixed-methods studies will be eligible if they provide extractable quantitative data.<\/jats:p>\n                  <jats:p>Two reviewers will independently screen and appraise studies using JBI critical appraisal tools suited to each study design. Data extraction will focus on direct and indirect costs, including OOPE and financial impacts, such as CHE, hardship financing and poverty effects. Findings will be presented narratively and, where feasible, pooled in a meta-analysis using MetaXL V.5 software.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>This review does not involve the collection or analysis of individual patient data. Instead, it will use data from publicly available economic research studies. All data sources will be appropriately cited. Extracted data will be systematically curated and managed using version-controlled spreadsheets and reference software. As this is a secondary analysis of published literature, ethical approval is not required. Findings will be disseminated through peer-reviewed publications and scientific presentations, as well as shared with policymakers and community health organisations via policy briefs and stakeholder outreach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD420251030651.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105664","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T16:30:19Z","timestamp":1756744219000},"page":"e105664","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Economic burden and economic impact of oral diseases in India: a protocol for a systematic review"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5358-4391","authenticated-orcid":false,"given":"Vineetha","family":"Karuveettil","sequence":"first","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"},{"name":"Amrita Centre for Evidence Based Oral Health: A JBI Centre of Excellence, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1907-8708","authenticated-orcid":false,"given":"Chandrashekar","family":"Janakiram","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"},{"name":"Amrita Centre for Evidence Based Oral Health: A JBI Centre of Excellence, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shewta","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6574-4487","authenticated-orcid":false,"given":"Aparna","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4486-632X","authenticated-orcid":false,"given":"Denny","family":"John","sequence":"additional","affiliation":[{"name":"Faculty of Life and Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India"},{"name":"Evidence Synthesis and Implementation for Indigenous Health: a JBI Affiliate Centre, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"2025100512101024000_15.9.e105664.1","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/S0140-6736(18)31707-0","article-title":"Strengthening oral health for universal health coverage","volume":"392","author":"Fisher","year":"2018","journal-title":"Lancet"},{"key":"2025100512101024000_15.9.e105664.2","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1002\/JPER.21-0469","article-title":"Global, regional, and national burden of periodontitis from 1990 to 2019: Results from the Global Burden of Disease study 2019","volume":"93","author":"Wu","year":"2022","journal-title":"J Periodontol"},{"key":"2025100512101024000_15.9.e105664.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-023-02056-5","article-title":"A scoping review exploring oral health inequalities in India: a call for 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