Publication

Abstract : 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 (<15 %) with limited protection. Up to one-third of patients relied on hardship financing (borrowing or asset sales). Conclusion Oral diseases impose a substantial economic burden in India, characterised by high OOPE, elevated CHE risk (pooled 18.8 %), and frequent distress financing. Priorities include stronger national data, standardised costing/reporting (price year, components, variance), and expanded financial protection to reduce household hardship and advance universal oral health coverage. Systematic review registration number The protocol is prospectively registered in the International Prospective Register of Systematic Reviews database (PROSPERO ID: CRD420251030651).