Economic burden and economic impact of oral diseases in India: A systematic review and meta-analysis

Objective: To quantify the economic burden and financial impact of oral diseases in India-on individuals, households, the health system, and society-focusing on direct and indirect costs and out-of-pocket expenditure (OOPE). Methods: Following JBI methodology and PRISMA 2020, we conducted a three-step search of MEDLINE, Embase, Scopus, CINAHL, DOSS, Cochrane CENTRAL, and grey literature. We included India-based studies reporting economic burden/financial impact at individual, household, or population levels. Eligible designs were cost-of-illness, cost/expenditure analyses, and cohort or cross-sectional studies; mixed-methods with extractable quantitative data were included. Two reviewers independently screened, appraised (JBI tools), and extracted data on direct/indirect costs, OOPE, catastrophic expenditure (CHE), and hardship financing. Findings were narratively synthesized; meta-analysis was undertaken in JBI SUMARI where appropriate. Results: Of 1684 records, 15 met inclusion criteria, mostly cross-sectional across states. OOPE varied widely; oral-cancer treatment often ranged from INR 80,000 to over INR 2,30,000. Direct costs were higher in private settings; indirect productivity losses were reported. CHE ranged from 0.6 % to 96 % across definitions; pooling studies using the ≥20 % income threshold yielded a CHE prevalence of 18.8 %. Insurance coverage was low (