The Prevalence and Determinants of Catastrophic Health Expenditures in Iran: A Systematic Review and Meta-Analysis

Abstract

Objective: In this systematic review, we aimed at estimating the pooled prevalence of catastrophic health expenditures (CHE) in Iran and identifying and summarizing the determinants of CHE among Iranian households. Methods: We comprehensively searched the literature on November 2016 in PubMed, Scopus, Web of Science, the Cochrane Library, and 3 Persian databases. We also obtained the literature through colleague communications. Two review authors independently selected studies, extracted data, and evaluated them. We performed meta-analysis of prevalence of CHE and subgroup meta-analyses to assess the influence of data source and scope of research. Moreover, we categorized the determinants of CHE in Ian. Results: In this review, 16 studies met the inclusion criteria, and of them, 2 presented the results of multiple surveys. Results of 27 cross-sectional studies were used to estimate the pooled prevalence of CHE in Iran during 1995 and 2015, which was found to be 3.91% (95% confidence interval, CI: -3.26- 11.07). Subgroup meta-analyses based on data source revealed that the highest prevalence estimate of facing CHE was associated with author-made questionnaires, and the lowest to the statistical Centre of Iran (SCI) questionnaire. Also, meta-regression showed that the difference in sample size and year of study did not have any significant effect on the prevalence of CHE. Some of the variables such as use of inpatient, outpatient, and dentistry services, education, place of residence, and household income, which were considered as determinants of CHE in Iran, increased the possibility of facing CHE. Conclusions: Decrease in CHE to less than 1%, which was the objective of the 2 of Iran’s five-year development plans in 2007 and 2015, was not met. This percentage may need to be reconsidered according to the pooled estimate of CHE. Also, the factors revealed to be the determinants of an increase in the probability of facing CHE could indicate the need for health care services and socioeconomic variables that lower one’s capacity to pay for health services.