Primary outcomes
| Ref | Study design, data, population, settings | Primary outcomes | Quality assessment | ||
| Annual absolute amounts of OOPE on medicines (Ratios of OOPE) | OOPE on medicines as a proportion of (i) Annual national average wages (ii) Mean annual household net adjusted disposable income per capita | OOPE on medicines as a proportion of total healthcare/medical services expenditure | |||
| Crystal et al
22 USA | Cross-sectional. Data: 1995 Medicare Current Beneficiary Survey (MCBS). No. of subjects: 7886 Age:≥65 | 0 NCDs: $103 (reference) 1 NCD: $254 (2.5) 2 NCDs: $379 (3.7) 3–5 NCDs: $581 (5.6) >5 NCDs: $791 (7.7) |
(i) 0 NCDs: 0.18% 1 NCD: 0.43% 2 NCDs: 0.65% 3–5 NCDs: 0.99% >5 NCDs: 1.35% (ii) 0 NCDs: 0.25% 1 NCD: 0.62% 2 NCDs: 0.92% 3–5 NCDs: 1.41% >5 NCDs: 1.93% | 0 NCDs: 17.1% 1 NCD: 27.3% 2 NCDs: 33.2% 3–5 NCDs: 36.6% >5 NCDs: 35.6% | High |
| Hwang et al
23 USA | Cross-sectional. Data: 1996 Medical Expenditure Panel Survey (MEPS). No. of subjects: 22 326 individuals and 8605 families. Age: All |
Aged<65
0 NCDs: $62 (reference) 1 NCD: $166 (2.7) 2 NCDs: $345 (5.6) ≥3 NCDs: $669 (10.8) Aged≥65 0 NCDs: $171 (reference) 1 NCD: $354 (2.1) 2 NCDs: $661 (3.9) ≥3 NCDs: $1006 (5.9) |
(i) Aged<65 0 NCDs: 0.12% 1 NCD: 0.28% 2 NCDs: 0.59% ≥3 NCDs: 1.14% Aged≥65 0 NCDs: 0.29% 1 NCD: 0.60% 2 NCDs: 1.13% ≥3 NCDs: 1.71% (ii) Aged<65 0 NCDs: 0.15% 1 NCD: 0.40% 2 NCDs: 0.84% ≥3 NCDs: 1.63% Aged≥65 0 NCDs: 0.42% 1 NCD: 0.86% 2 NCDs: 1.61% ≥3 NCDs: 2.45% |
Aged<65
0 NCDs: 17.1% 1 NCD: 27.0%, 2 NCDs: 33.8% ≥3 NCDs: 46.3% Aged≥65 0 NCDs: 24.9%, 1 NCD: 39.4%, 2 NCDs: 50.6% ≥3 NCDs: 50.5% | High |
| Sambamoorthi et al
24 USA | Cross-sectional. Data: Medicare beneficiaries from 1997 Medicare Current Beneficiary Survey (MCBS) Cost and Use files. No. of subjects: 8, 814 individuals. Age:≥65 | 0 NCDs: $147 (reference) 1 NCD: $284 (1.9) 2–3 NCDs: $516 (3.5) 4–6 NCDs: $833 (5.7) >6 NCDs: $1316 (9.0) |
(i) 0 NCDs: 0.25% 1 NCD: 0.48% 2–3 NCDs: 0.88% 4–6 NCDs: 1.42% >6 NCDs: 2.24% (ii) 0 NCDs: 0.36% 1 NCD: 0.69% 2–3 NCDs: 1.26% 4–6 NCDs: 2.03% >6 NCDs: 3.20% | NIL | High |
| Gellad et al
25 USA | Cross-sectional. Data: 1996–2000 Medical Expenditure Panel Survey Household Component (MEPS-HC). No. of subjects: 5996 individuals Age:≥65 | 0 NCDs: $407 (reference) 1 NCD: $898 (2.2) 2 NCDs: $1377 (3.4) ≥3 NCDs: $2083 (5.1) |
(i) 0 NCDs: 0.69% 1 NCD: 1.53% 2 NCDs: 2.34% ≥3 NCDs: 3.55% (ii) 0 NCDs: 0.99% 1 NCD: 2.19% 2 NCDs: 3.35% ≥3 NCDs: 5.07% | NIL | Moderate |
| Ruger et al
26 Korea | Cross-sectional. Data: 1998 Korean National Health and Nutrition Survey (KHNS). No. of subjects: 13 523 households and 39 060 household members. Age: All |
OOPE on medicines burden ratio
(Income quintile 0%–20%) 0 NCDs: 6 1 NCD: 22.6 2 NCDs: 27.4 ≥3 NCDs: 37.7 OOPE on medicines burden ratio (Income quintile 80%–100%) 0 NCDs: 1.4 1 NCD: 3.3 2 NCDs: 4.9 ≥3 NCDs: 3.9 | NIL | NIL | High |
| Paez et al
27 USA | Pooled cross-sectional Cross-sectional Data: 2005 Medical Expenditure Panel Survey (MEPS). Longitudinal Data: 1996 and 2005 MEPS. No. of subjects: Unspecified, weighted to represent 292 million civilian non-institutionalised US population. Age: All. |
Aged<65
0 NCDs: $54 (reference) 1 NCD: $255 (4.7) 2 NCDs: $557 (10.3) ≥3 NCDs: $1153 (21.4) Aged≥65 0 NCDs: $210 (reference) 1 NCD: $547 (2.6) 2 NCDs: $958 (4.6) ≥3 NCDs: $1566 (7.4) |
(i)
Aged<65 0 NCDs: 0.092% 1 NCD: 0.43% 2 NCDs: 0.95% ≥3 NCDs: 2.0% Aged≥65 0 NCDs: 0.36% 1 NCD: 0.93% 2 NCDs: 1.63% ≥3 NCDs: 2.67% (ii) Aged<65 0 NCDs: 0.13% 1 NCD: 0.62% 2 NCDs: 1.36% ≥3 NCDs: 2.81% Aged≥65 0 NCDs: 0.51% 1 NCD: 1.33% 2 NCDs: 2.33% ≥3 NCDs: 3.81% |
Aged<65
0 NCDs: 13.8% 1 NCD: 34.8% 2 NCDs: 48.3% ≥3 NCDs: 59.5% Aged≥65 0 NCDs: 31.5% 1 NCD: 50.5% 2 NCDs: 63.5% ≥3 NCDs: 63.0% | High |
| Kemp et al
28 Australia | Cross-sectional. Data: 2 Australian Bureau of Statistics' (ABS) surveys: the Household Expenditure Survey and Survey of Income and Expenditure 2009–2010. No. of subjects: 9774 households and 17 995 individuals. Age:≥15 | 1 NCD: Diabetes = $513 (reference) 3 NCDs: Diabetes+gastro-oesophageal reflux disease+depression = $1536 (3.0) 1 NCD: Acute coronary syndrome = $2290 (reference) 3 NCDs: Acute coronary syndrome+asthma + osteoarthritis =$3151 (1.4) |
(i) 1 NCD: Diabetes =1.02% 3 NCDs: Diabetes+gastro-oesophageal reflux disease+depression =3.06% 1 NCD: Acute coronary syndrome =4.57% 3 NCDs: Acute coronary syndrome+asthma + osteoarthritis =6.28% (ii)1 NCD: Diabetes=1.55% 3 NCDs: Diabetes+gastro-oesophageal reflux disease+depression =4.64% 1 NCD: Acute coronary syndrome =6.91% 3 NCDs: Acute coronary syndrome+asthma + osteoarthritis =9.51% | NIL | Satisfactory |
| Campbell et al
29 Canada | Cross-sectional. Data: Survey designed by the interdisciplinary Chronic Disease Collaboration- Barriers to Care for People with Chronic Health Conditions (BCPCHC), Feb 1-March 31, 2012. No. of subjects: 1849 individuals. Age:≥40 |
Aged<65
1 NCD: $418 (reference) ≥2 NCDs: $624 (1.5) Aged≥65 1 NCD: $549 (reference) ≥2 NCDs: $806 (1.5) |
(i) Aged<65 1 NCD: 0.87% ≥2 NCDs: 1.30% Aged≥65 1 NCD: 1.15% ≥2 NCDs: 1.68% (ii) Aged<65 1 NCD: 1.37% ≥2 NCDs: 2.05% Aged≥65 1 NCD: 1.80% ≥2 NCDs: 2.64% | NIL | Satisfactory |
| Park et al
30 Korea | Cross-sectional. Data: 2008 Korea Health Panel Survey (KHPS). No. of subjects: 2342 individuals. Age:≥65 |
OOPE on medicines cost ratio
0 NCDs: 1.00 1 NCD: 2.11 ≥2 NCDs: 4.18 | NIL | NIL | High |
| Pati et al
31 India | Cross-sectional. Data: WHO study on Global Ageing and Adult Health (SAGE) wave 1 survey of India, 2007. Subjects: 12 198 individuals. Age:≥18 | (Not annual OOPE, OOPE in last outpatient visit) 0 NCDs: $6 1 NCD: $7 ≥2 NCDs: $8 | NIL | 0 NCDs: 73.55% 1 NCD: 66.23% ≥2 NCDs: 61.05% | High |
| Park et al
32 Korea | Cross-sectional (from three waves) Data: 2008 first-wave survey, 2008 second-wave survey, 2009 third-wave survey from Korea Health Panel Survey. No. of subjects: 5640 individuals Age:≥20 |
OOPE on medicines OR for financial burden
1 NCD: 1.00 2 NCDs: 3.49 ≥3 NCDs: 8.61 | NIL | NIL | Moderate |
| Thorpe et al
33 USA | Cross-sectional. Data: Medical Expenditure Panel Survey (MEPS) 2012, and Health Insurance Exchange Compare dataset 2014. No. of subjects: Unspecified Age: 18–64 years | 1 NCD: $396 (reference) 2 NCDs: $595 (1.5) 3 NCDs: $795 (2.0) ≥4 NCDs: $1145 (2.9) |
(i) 1 NCD: 0.67% 2 NCDs: 1.01% 3 NCDs: 1.35% ≥4 NCDs: 1.95% (ii) 1 NCD: 0.96% 2 NCDs: 1.45% 3 NCDs: 1.94% ≥4 NCDs: 2.79% | NIL | Moderate |
| Hennessy et al
34 Canada | Cross-sectional. Data: Survey designed by the interdisciplinary chronic disease Collaboration- Barriers to Care for People with Chronic Health Conditions (BCPCHC), Feb 1-March 31, 2012. No. of subjects: 1849 individuals Age:≥40 | 1 NCD: $474 (reference) ≥2 NCDs: $736 (1.6) |
(i) 1 NCD: 1.00% ≥2 NCDs: 1.54% (ii) 1 NCD: 1.56% ≥2 NCDs: 2.42% | NIL | Satisfactory |
| Jung et al
35 Korea | Cross-sectional. Data: 2008 Korea Health Panel Survey (KHPS). No. of subjects: 8103 individuals. Age:≥20 | 1 NCD: $82 (reference) 2 NCDs: $156 (1.9) ≥3 NCDs: $260 (3.2) |
(i) 1 NCD: 0.25% 2 NCDs: 0.45% ≥3 NCDs: 0.79% (ii) 1 NCD: 0.42% 2 NCDs: 0.81% ≥3 NCDs: 1.34% | Moderate | |
NCD, non-communicable disease ; OOPE, out-of-pocket expenditure.