Economic Studies on Non-Communicable Diseases and Injuries in India: A Systematic Review
The burden from non-communicable diseases and injuries (NCDI) in India is increasing rapidly. With low public sector investment in the health sector generally, and a high financial burden on households for treatment, it is important that economic evidence is used to set priorities in the context of NCDI.
Our objective was to understand the extent to which economic analysis has been used in India to (1) analyze the impact of NCDI and (2) evaluate prevention and treatment interventions. Specifically, this analysis focused on the type of economic analysis used, disease categories, funding patterns, authorship, and author characteristics.
We conducted a systematic review based on economic keywords to identify studies on NCDI in India published in English between January 2006 and November 2016. In all, 96 studies were included in the review. The analysis used descriptive statistics, including frequencies and percentages.
A majority of the studies were economic impact studies, followed by economic evaluation studies, especially cost-effectiveness analysis. In the costing/partial economic evaluation category, most were cost-description and cost-analysis studies. Under the economic impact/economic burden category, most studies investigated out-of-pocket spending. The studies were mostly on cardiovascular disease, diabetes, and neoplasms. Slightly over half of the studies were funded, with funding coming mainly from outside of India. Half of the studies were led by domestic authors. In most of the studies, the lead author was a clinician or a public health professional; however, most of the economist-led studies were by authors from outside India.
The results indicate the lack of engagement of economists generally and health economists in particular in research on NCDI in India. Demand from health policy makers for evidence-based decision making appears to be lacking, which in turn solidifies the divergence between economics and health policy, and highlights the need to prioritize scarce resources based on evidence regarding what works. Capacity building in health economics needs focus, and the government’s support in this is recommended.
The authors are grateful to Doctors for You for providing a platform to present early results. We acknowledge Nobhojit Roy, Siddarth David, and Kapil Dev Soni for their support and suggestions. We are indebted to Avantika Ranjan for helping us finalize some of the editorial aspects of the manuscript.
Data availability statement
The data that support the findings of this review were generated after examining full-text articles obtained through PubMed. In a few cases, PubMed did not provide full text articles but only a title and an abstract. In such cases, the articles were located using Sciencedirect, Google Scholar, Karolinska Institute Library (https://kib.ki.se/en), and individual requests to authors. These data are available from the corresponding author, Indrani Gupta, upon reasonable request. Copyright restrictions mean we are unable to provide the full text of any of the articles included in the review.
IG identified research questions, defined exclusion and inclusion criteria, and selected studies based on the criteria. AR searched for and selected studies based on selection criteria, extracted data from the studies, and drew up relevant tables. Both authors analyzed the data and wrote the manuscript.
Compliance with Ethical Standards
No funding was received for this research.
Conflicts of interest
The authors Indrani Gupta and Arjun Roy have no conflicts of interest to declare.
- 1.World Health Organization. Noncommunicable diseases country profiles 2014. http://apps.who.int/iris/bitstream/10665/128038/1/9789241507509_eng.pdf. Accessed 2 May 2017.
- 2.World Health Organization. India NCD Country Profile 2014. http://www.who.int/nmh/countries/ind_en.pdf. Accessed 2 May 2017.
- 4.Selvaraj S, Abrol D, Gopakumar K. Access to medicines in India. New Delhi: Academic Foundation; 2014.Google Scholar
- 5.World Health Organization. General government expenditure on health (GGHE) as % of THE. Global Health Expenditure Database 2012. http://apps.who.int/nha/ database/Select/Indicators/en. Accessed 2 May 2017.
- 6.Government of India. Ministry of Health and Family Welfare. National Health Accounts Estimates for India, 2014–15. https://mohfw.gov.in/sites/default/files/National%20Health%20Accounts%20Estimates%20Report%202014-15.pdf. Accessed 7 Mar 2018.
- 7.Jamison DT, Breman JG, Measham AR, et al., editors. Disease control priorities in developing countries. 2nd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006 (Co-published by Oxford University Press, New York). Available from: https://www.ncbi.nlm.nih.gov/books/NBK11728/.
- 9.Downey LE, Mehndiratta A, Grover A, Gauba V, Sheikh K, Prinja S, Singh R, Cluzeau FA, Dabak S, Teerawattananon Y, Kumar S, Swaminathan S. Institutionalising health technology assessment: establishing the Medical Technology Assessment Board in India. BMJ Glob Health. 2017;2(2):e000259. https://doi.org/10.1136/bmjgh-2016-000259.PubMedPubMedCentralCrossRefGoogle Scholar
- 10.Centers for Disease Control and Prevention. Public health economics and tools. 2017. https://www.cdc.gov/stltpublichealth/pheconomics/. Accessed 4 Nov 2017.
- 12.Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2015.Google Scholar
- 17.Anchala R, et al. Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial. J Am Heart Assoc. 2015;4(1):e001213.PubMedPubMedCentralCrossRefGoogle Scholar
- 21.Basu S, Yudkin JS, Sussman JB, Millett C, Hayward RA. Alternative strategies to achieve cardiovascular mortality goals in China and India: a microsimulation of target- versus risk-based blood pressure treatment. Circulation. 2016;133(9):840–8.Google Scholar
- 51.Kesavadev J, et al. Cost-effective use of telemedicine and self-monitoring of blood glucose via Diabetes Tele Management System (DTMS) to achieve target glycosylated hemoglobin values without serious symptomatic hypoglycemia in 1,000 subjects with type 2 diabetes mellitus—a retrospective study. Diabetes Technol Ther. 2012;14(9):772–6.PubMedCrossRefGoogle Scholar
- 57.Kumpatla S, et al. The costs of treating long term diabetic complications in a developing country: a study from India. JAPI. 2013;61:17.Google Scholar
- 112.UK and India to work together on evidence-informed healthcare policy and practice. 2013. https://www.gov.uk/government/world-location-news/uk-and-india-to-work-together-on-evidence-informed-healthcare-policy-and-practice. Accessed 4 Nov 2017.
- 115.Bloom DE, Cafiero ET, McGovern ME, Prettner K, Stanciole A, Weiss J, Bakkila S, Rosenberg L. The economic impact of non-communicable disease in China and India: estimates, projections, and comparisons. NBER Working Paper No. 19335. http://www.nber.org/papers/w19335.
- 116.Garg CC, Evans D. What is the impact of non-communicable diseases on national health expenditures: a synthesis of available data. Geneva: World Health Organization; 2011.Google Scholar
- 117.Gupta I, Kandamuthan S, Upadhyaya D. Economic impact of cardiovascular diseases in India. New Delhi: Institute of Economic Growth University of Delhi; 2006.Google Scholar
- 118.Mahal AS, Karan A, Engelgau M. Economic implications of non-communicable disease for India. Washington, DC: World Bank; 2010.Google Scholar