Magnitude of catastrophic health expenditure and its determinants among cancer patients in low and middle-income countries: a systematic review and meta-analysis

Abstract

Background: The World Health Organization promotes Universal Health Coverage, which emphasizes providing healthcare services without a financial burden. However, the majority of cancer patients in resource-constrained countries were exposed to catastrophic healthcare Expenditure (CHE) due to costly cancer care. Even though there are many primary studies in low and middle-income countries (LMICs), there is a need for aggregated information on the magnitude of CHE among cancer patients. Therefore, this study aimed to estimate the pooled magnitude of CHE and its determinants among cancer patients in low and middle-income countries. Methods: A comprehensive search was conducted on electronic databases such as PubMed/Medline, Web of Science, Scopus, Science Direct, African Journals Online, and Google Scholar for articles published from 2010 to June 30, 2025. Data were extracted using Microsoft Excel and exported to STATA version 17 software for analysis. The study quality appraisal was performed using the Joanna Briggs Institute critical appraisal tool. The potential heterogeneity of included studies was checked using Cochrane’s Q test and I-squared statistic. The publication bias of the study was checked using visual inspection of the funnel plot. In addition, subgroup and sensitivity analyses were also conducted. To determine the pooled magnitude of CHE and its determinants among cancer patients in LMICs, a random-effect model was used. Result: In this review, a total of 38 articles, with 50,968 participants, were included. The pooled magnitude of CHE among cancer patients in LMICs was 58.42% (95%CI: 52.29%, 64.55%). Older age (AOR = 1.44, [95% CI: 1.17, 1.76]), larger family size (AOR = 2.43, [95% CI: 1.01, 5.91]), low educational level (AOR = 4.18, [95% CI: 2.10, 8.30]), female (AOR = 2.64, [95% CI: 1.28, 5.45]), rural residence (AOR:3.56, [95% CI:2.87, 4.40]), unemployed cancer patients (AOR = 2.19, [95% CI: 1.26, 3.82]), poor wealth index (AOR = 5.18, [95%CI: 3.61, 7.44]), visiting private health facilities (AOR = 8.97, 95% CI: 1.65, 48.85]), distance to health facilities (AOR = 2.56, [95% CI: 1.07, 6.11]), advanced cancer stage (AOR = 3.10, [95% CI: 1.31, 7.30]), longer disease duration (AOR = 2.93, [95% CI: 1.55, 5.56]), having multiple cancer treatments (AOR = 4.25, [95% CI: 2.46, 7.33]), multiple cycles of chemotherapy (AOR = 3.88, [95% CI:2.00, 7.54]), and uninsured patients (AOR = 2.54, 95% CI: 1.71, 3.79]) were significantly associated with CHE among cancer patients in LMICs. Conclusion: The review indicated that nearly three-fifths of cancer patients in LMICs faced catastrophic health expenditure during service delivery. The government should decentralize cancer care to improve accessibility and affordable of care, which has the potential to reduce financial burden. In addition, healthcare providers should provide awareness of the importance of early screening and insurance enrollment to reduce CHE.