Economic costs of infertility care for patients in low-income and middle-income countries: a systematic review protocol

Njagi, Purity; Groot, Wim; Arsenijevic, Jelena; Dyer, Silke; Mburu, Gitau; Kiarie, James

doi:10.1136/bmjopen-2020-042951

Cited by 18 publications

(8 citation statements)

References 34 publications

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“…In low-income nations like The Gambia, where public resources committed to health are already stretched, expenditures (partial or entire) for fertility care may negatively impact the long-term sustainability of services. This is much more evident in African countries where costs associated with infertility treatment and the Gross Domestic Product (GDP) is negatively linked, with fertility care costs reaching up to 200% of GDP per capita [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study

Afferri,

Dierickx,

Bittaye

et al. 2024

PLoS ONE

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Introduction In the Global South, (in)fertility care is scarcely recognized as a priority, yet the government of The Gambia has recently included it as one of the key priorities in its reproductive health strategic plan. This inclusion appears to be the result of years of engagement between policy actors, academic researchers, and activists in the field of reproductive health and specifically of infertility. However, the operationalization of the strategic plan may be hampered by multiple factors. The research aims to identify and analyze challenges that may impede the effective implementation of the strategic plan, thereby providing policy action points and practical guidance into the operationalization of (in)fertility care in the context of The Gambia’s health system. Methods This is a mixed-methods study with data from a survey and semi-structured interviews collected between 2020 and 2021 in The Gambia that were separately published. In this paper, we present the triangulation of quantitative and qualitative data using a convergence coding matrix to identify relevant policy action points. Results Six fertility care policy action points, driven by data, arose from the triangulation and interpretation process, specifically: (i) establishing and maintaining political commitment and national priority for fertility care; (ii) creating awareness and increasing the involvement of men in SRH and fertility; (iii) ensuring data-driven health policymaking; (iv) offering and regulating affordable IVF alternatives; (v) improving knowledge of and means for fertility care provision; and (vi) enhancing the collaboration among stakeholders and building links with the private healthcare sector. Conclusion This study found the implementation of the fertility care-related activities in the reproductive health strategic plan may face challenges that require careful mitigation through a holistic approach. Such an approach conceptualizes infertility not just as a biomedical issue but as a broader one that incorporates educational and socio-emotional aspects, including male and (not only) female involvement in sexual and reproductive health. Moreover, it is supported by a comprehensive health management information system that includes capturing data on the demand for, and access to, infertility services in The Gambia health system.

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Section: Discussionmentioning

confidence: 99%

Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study

Afferri,

Dierickx,

Bittaye

et al. 2024

PLoS ONE

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“…Infertility in developing countries was estimated to affect 3.5-16.7% of population 16 , reaching 30% in some developing regions 17 , male infertility, contributes to more than half of all cases of childlessness, in the Middle East region 60-70% of couples male factor is included as one of multiple factors of infertility 18 , this is particularly problematic in this area where fatherhood is equivalent to manhood 19 . This may lead to stigma of the affected male resulting in higher rates of depression 20 .…”

Section: Discussionmentioning

confidence: 99%

In Silico Design and Validation of a Novel PCR-RFLP Assay for Gprc6a Rs2247911 Polymorphism Involved in Male Infertility

Jawich

Alhalabi²,

Fahoum³

2022

Bulletin of Pharmaceutical Sciences. Assiut

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Male infertility is a prevalent disorder affecting approximately 7% of the male population, at least 2,000 genes are involved in spermatogenesis, availability of genetic investigations is a challenge in developing countries, GPRC6A, G-protein coupled receptor, activated by Osteocalcin (OCN)an osteoblast secreted hormone, is a master regulator of a complex metabolic and reproductive networks. rs2247911 in GPRC6A plays a role in male fertility and glucose metabolism, Although DNA sequencing is regarded the golden standard tool for genotyping, it is less affordable in developing world laboratories, polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) assay is an inexpensive and highly valuable tool for genotyping, this study aimed to develop (PCR-RFLP) method for assessment of rs2247911 polymorphism.10% of male subjects genotyped previously by sequencing were genotyped the by PCR-RFLP method based on Geneious® bioinformatics tool suggested restriction enzyme (ScrFI), PCR-RFLP 100% correctly identified genotypes. we present for the first time an accurate and inexpensive method for genotyping rs2247911.

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“…In keeping with the study protocol published in the PROSPERO database (CRD42020199312) and elsewhere ( Njagi et al , 2020 ), this study was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement ( Moher et al , 2009 ).…”

Section: Methodsmentioning

confidence: 99%

Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review

Njagi

Groot

Arsenijevic

et al. 2023

Human Reproduction Open

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STUDY QUESTION What are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries? SUMMARY ANSWER Direct medical costs paid by patients for infertility treatment are significantly higher than annual average income and GDP per capita, pointing to unaffordability and the risk of catastrophic expenditure for those in need. WHAT IS KNOWN ALREADY Infertility treatment is largely inaccessible to many people in low-and middle-income countries (LMICs). Our analysis shows that no study in LMICs has previously compared ART medical costs across countries in international dollar terms (US$PPP) or correlated the medical costs with economic indicators, financing mechanisms and policy regulations. Previous systematic reviews on costs have been limited to high-income countries while those in LMICs have only focussed on descriptive analyses of these costs. STUDY DESIGN, SIZE, DURATION Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA), we searched PubMed, Web of Science, CINAHL, EconLit, PsycINFO, LILACS and grey literature for studies published in all languages from LMICs between 2001 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS The primary outcome of interest was direct medical costs paid by patients for one ART cycle. To gauge ART affordability, direct medical costs were correlated with the Gross Domestic Product (GDP) per capita or average income of respective countries. ART regulations and public financing mechanisms were analysed to provide information on the healthcare contexts in the countries. The quality of included studies was assessed using the integrated quality criteria for review of multiple study designs (ICROMS). MAIN RESULTS AND THE ROLE OF CHANCE Of the 4,062 studies identified, 26 studies from 17 countries met the inclusion criteria. There were wide disparities across countries in the direct medical costs paid by patients for ART ranging from USD2,109 to USD18,592. Relative ART costs and GDP per capita showed a negative correlation, with the costs in Africa and South-East Asia being on average up to 200% of the GDP per capita. Lower relative costs in the Americas and the Eastern Mediterranean regions were associated with the presence of ART regulations and government financing mechanisms. LIMITATIONS, REASONS FOR CAUTION Several included studies were not primarily designed to examine the cost of ART, and thus lacked comprehensive details of the costs. However, a sensitivity analysis showed that exclusion of studies with below the minimum quality score did not change the conclusions on the outcome of interest. WIDER IMPLICATIONS OF THE FINDINGS Governments in LMICs should devise appropriate ART regulatory policies and implement effective mechanisms for public financing of fertility care to improve equity in access. The findings of this review should inform advocacy for ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage (UHC). STUDY FUNDING/COMPETING INTEREST(S) This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors declare no competing interests. TRIAL REGISTRATION NUMBER This review is registered with PROSPERO, CRD42020199312. WHAT DOES THIS MEAN FOR PATIENTS? This review appraises the literature on the costs of assisted reproductive technology (ART) borne by individuals, its affordability, and the association with government financing and ART regulations, between 2001 and 2020. To assess affordability, we examined the correlation of the direct medical costs paid by patients for one ART cycle with the respective countries' Gross Domestic Product (GDP) per capita or average income. Based on the findings, it is concluded that there were significant inequities in access to ART, and many patients in LMICs are still unable to afford it due to prohibitive costs. Better policies and government financial mechanisms are needed to improve affordability for patients in LMICs.

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Economic costs of infertility care for patients in low-income and middle-income countries: a systematic review protocol

Cited by 18 publications

References 34 publications

Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study

Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study

In Silico Design and Validation of a Novel PCR-RFLP Assay for Gprc6a Rs2247911 Polymorphism Involved in Male Infertility

Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review

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