{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:00:28Z","timestamp":1785214828025,"version":"3.55.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:00:00Z","timestamp":1715558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I<jats:sup>2<\/jats:sup> statistic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0\u201311.0%), dengue (12.5%), and lymphatic filariasis (0.0\u201323.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9\u201399.3%) and visceral leishmaniasis (24.6\u201391.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65\u201380%, n = 2, I<jats:sup>2<\/jats:sup> = 0.00%). Costs of visceral leishmaniasis impoverished 20\u201326% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0012086","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T17:37:17Z","timestamp":1715621837000},"page":"e0012086","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Financial hardship among patients suffering from neglected tropical diseases: A systematic review and meta-analysis of global literature"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3502-4718","authenticated-orcid":true,"given":"Chanthawat","family":"Patikorn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1351-5006","authenticated-orcid":true,"given":"Jeong-Yeon","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Higashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0089-2462","authenticated-orcid":true,"given":"Xiao Xian","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4572-8794","authenticated-orcid":true,"given":"Nathorn","family":"Chaiyakunapruk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,13]]},"reference":[{"key":"pntd.0012086.ref001","volume-title":"Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021\u20132030.","author":"World Health Organization","year":"2020"},{"key":"pntd.0012086.ref002","volume-title":"Neglected tropical diseases, hidden successes, emerging opportunities. 2009","author":"World Health Organization","year":"2014"},{"issue":"1","key":"pntd.0012086.ref003","first-page":"303","article-title":"Neglected tropical diseases: equity and social determinants.","volume":"135","author":"J Aagaard-Hansen","year":"2010","journal-title":"Equity, social determinants and public health programmes."},{"key":"pntd.0012086.ref004","volume-title":"Distribution of health payments and catastrophic expenditures methodology","author":"World Health Organization","year":"2005"},{"key":"pntd.0012086.ref005","doi-asserted-by":"crossref","DOI":"10.1596\/1813-9450-4554","author":"A. Wagstaff","year":"2008","journal-title":"Measuring financial protection in health: World Bank Publications"},{"issue":"1","key":"pntd.0012086.ref006","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12962-023-00457-5","article-title":"Overview of the main methods used for estimating catastrophic health expenditure.","volume":"21","author":"HA Nguyen","year":"2023","journal-title":"Cost Effectiveness and Resource Allocation"},{"issue":"4","key":"pntd.0012086.ref007","doi-asserted-by":"crossref","first-page":"e0152866","DOI":"10.1371\/journal.pone.0152866","article-title":"Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses.","volume":"11","author":"A Asante","year":"2016","journal-title":"PLoS One."},{"issue":"2","key":"pntd.0012086.ref008","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1093\/heapol\/czn052","article-title":"Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences.","volume":"24","author":"SR Adhikari","year":"2009","journal-title":"Health Policy Plan"},{"key":"pntd.0012086.ref009","doi-asserted-by":"crossref","first-page":"689809","DOI":"10.3389\/fpubh.2021.689809","article-title":"Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups.","volume":"9","author":"J Wang","year":"2021","journal-title":"Front Public Health."},{"key":"pntd.0012086.ref010","unstructured":"Chaiyakunapruk N, Patikorn C, Cho J-Y, Oh SH, Huang XX. 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