The economic burden of lung cancer in low- and lower-middle-income countries: a systematic review

Lung Cancer is one of the four most frequent malignant neoplasms in the world, and first in mortality. In 2020, lung cancer resulted in roughly 1.8 million deaths globally. Lung cancer is a major public health problem in low and lower-middle income countries, where high rates of tobacco smoking, environmental pollution, and limited access to healthcare resources contribute to a significant burden of the disease. The objective of our review was to compare costs among available countries and identify major cost drivers.

A systematic database search was performed according to PRISMA guidelines on Web of Science, PubMed, Cochrane, EBSCO, ISPOR, and Google Scholar using a pre-defined search string. Studies were screened for eligibility and included if they provided information about the direct and indirect costs of lung cancer in low- and lower-middle-income countries. Search cut off was on August 4, 2025. The data from included studies were extracted, quantitatively synthesized, and compared.

Of 2,383 articles, 15 met the inclusion criteria. All studies were conducted in low- and lower-middle-income countries, with a time frame ranging from 2003 to 2025. Most studies estimated costs based on prevalence. Most studies reported total healthcare costs as direct costs related to lung cancer; seven studies reported on indirect costs. Total average direct costs ranged from USD 2,540.66 per patient in Nepal to USD 10,179.98 per patient in the first year of treatment in Bolivia. Indirect costs varied from USD 140,995,744.13 in Bangladesh to USD 320,427,043.97 in Vietnam for their given respective sample sizes. Cost estimates varied substantially even for the same country depending on study's analytical focus, timeframe, and other methodological considerations.

In conclusion, the costs of lung cancer are substantial and increase with disease progression, encompassing both direct and indirect components. High out-of-pocket expenditures further intensify the economic burden on patients and may lead to an underestimation of the true societal costs. The lack of standardized methodologies and robust data highlights the need for further research to guide effective policy and resource allocation in LMICs.

Registration: PROSPERO, ID CRD42020160370.