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Background Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures and deterioration of bone tissue. It is also associated with an increased risk of fracture that is the most important complication of osteoporosis. Osteoporosis and consequent fractures not only have a major impact on the health and quality of life, but also impose a significant economic burden on the health system of countries. Objective Since the population of many countries around the world is aging, the incidence of fractures due to osteoporosis is increasing too. The knowledge about costs and economic aspects of osteoporosis plays an important role in making policies and planning measures for the prevention and management of this disease, hence, this study systematically investigated the available evidence on the costs associated with osteoporosis worldwide. Methods Considering language, year of publication, and the research question, electronic searches were conducted in multiple databases and different sources. After selecting articles based on inclusion and exclusion criteria, the data were extracted and the results were summarized. To prevent bias, the whole procedure was performed by three researchers. Results Of a total of 1989 papers, 28 papers were included in the study on the basis of inclusion criteria. Among the selected studies, 13 papers reported direct and indirect costs. Based on the data extracted from the mentioned studies, the mean age of people with osteoporotic fractures was 50 years, with the highest costs associated with hip fractures. Conclusion There is a paucity of studies investigating the burden of osteoporosis in the world. The available studies indicate a lack of standardization in the methodological approach of assessing the economic burden of this disease. It is necessary to highlight the importance of studies on osteoporosis to inform policymakers and enhance health care planning.

Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve the quality of life for both the patient and the family.

Background: Financial ability to pay has a unique role in the accessibility of health care services, which indicates the necessity of raising enough funds by governments. However, how much households are willing to pay (WTP) for receiving a particular service? And what factors influence their WTP? The current systematic review aimed to, firstly, review studies on the WTP for Down syndrome (DS) screening, and, secondly, to identify factors that affect WTP for DS screening. Methods: We systematically searched the Scopus, PubMed, Web of Sciences (ISI), and Embase databases to identify relevant studies from their inception to June 2020; the search strategy was updated on December 2021. Initially, 157 articles were identified, and 5 were found eligible for full-text review. In event of any disagreement, a third reviewer was used. Extracted WTPs were converted to US dollars in 2018 using exchange rate parity and the present value formula to make a comparison. The quality assessment of the selected studies was done using the "Lancsar and Louvier" and Smith checklist; also, vote counting was used to assess the influence of factors. Results: Five eligible studies, published from 2005 to 2020, were fully reviewed. All final studies were scored as good quality. The extracted WTPs varied from $169 to $1118 in UK and Canada, respectively. Income and information/knowledge about screening tests were the most frequently investigated factors. Education level, detection rate, women's age, cost, and family history were significantly associated with higher levels of WTP for DS screening. Conclusion: This study demonstrated a significant gap in WTP for DS screening in various countries. Women are WTP higher costs for tests with higher screenings. Also, a unique role was identified for income, occupation, information, and family history of DS in WTP for DS screening. In addition, a positive association was found for the variable of age.

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