The costs of limited health literacy: a systematic review

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Abstract
Objectives To summarize evidence about (1) the costs of limited health literacy (HL) and (2) the cost-effectiveness of interventions to improve limited HL. Methods We performed a systematic review searching electronic databases and additional information resources. We included observational studies and interventional studies with HL-outcomes. We included populations at high risk for low HL and patients with (1) diabetes mellitus or (2) hyperlipidemia. Results We retrieved 2,340 papers and included 10 studies for analysis. The prevalence of limited HL is considerable (range 34–59%). On the health system level, the additional costs of limited HL range from 3 to 5% of the total health care cost per year. On the patient level, the additional expenditures per year per person with limited HL compared to persons with adequate HL range from US $143 to 7,798. Data on the cost-effectiveness of interventions to improve limited HL are scarce. Conclusion The costs of limited HL may be substantial, but few studies were retrieved and the results are heterogeneous.