PONE-D-24-40151Financial cost of assisted reproductive technology for patients in high-income countries: A systematic review protocolPLOS ONE

Dear Dr. Njagi,

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PLOS ONE

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2. Thank you for stating the following financial disclosure:

“This work has received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). Grant Number: APW-PO 203363893.”

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors present a protocol for a systematic review to evaluate the financial cost of assisted reproductive technology for patients in HIC. The protocol is well organized and written clearly. It is a highly relevant subject. I present below some minor comments to help strengthen the manuscript:

The objective of the abstract could be clearer. Is there a way for the author to be more specific, particularly regarding the concept of healthcare system characteristics: “to examine the ART costs paid by patients in HICs and the correlation with economic and healthcare system characteristics”

Spell out “ICROMS” in the abstract

I would invite the authors to provide an explanation of the choice of the timeframe and provide some reflections around the potential challenges of having such a large timeframe, particularly regarding different tendencies around ART access that may change with time.

For the screening procedure, will the authors use a software like Covidence?

For the inclusion and exclusion criteria section, I would invite the authors to divide that section into two parts – inclusion and exclusion criteria – and details to the exclusion criteria, such as Exclude studies that present the same dataset or results as another included study to avoid redundancy, and exclude studies with substantial ethical concerns.

In that same section, it will be important list which ART are included and excluded. For example: in vitro fertilization, intracytoplasmic sperm infection, artificial insemination, egg donation, sperm donation, surrogacy, fertility preservation (i.e., egg, sperm freezing), etc.

Provide a more thorough plan for data synthesis. Clearly explain how findings will be categorized, summarized, and compared. If a meta-analysis is not possible, discuss alternative approaches to synthesizing qualitative and quantitative data.

Consider conducting a pilot search to ensure that the proposed search strategy yields relevant and sufficient studies. This step would demonstrate feasibility and help fine-tune the process before full implementation.

Reviewer #2: Good greeting

I would like to thank the researchers for this idea of ​​research because it studies an important problem in society, the language is clear ,correct and unambiguous

The search is excellent and deserves to be published

my regards

Reviewer #3: Financial cost of assisted reproductive technology for patients in high-income countries: A systematic review protocol

This study protocol provides the plan of the authors to write a review on the above topic. The authors aware the difference of the public and private IVF systems in some high-income countries (HIC), also payment Out of Pocket (OOP) as the consequences for the patients.

Currently the protocol indicates that the authors pay more attention on In Vitro Fertilisation. However, there are many other issues that can be included in this proposed review such as:

1. Cross Border Reproductive Care, because patients from HIC may go to LMIC to obtain ART treatment especially surrogation. The authors should be able to look at financial or cost distribution in each part such as legal cost, treatment for the couple and surrogate etc.

2. Gamete or embryo donation this may occur in both HIC and LMIC.

3. Social fertility preservation.

4. Consider the role of children in family that motivates people in HIC to have their own child.

It is suggested that authors discusss those issue since this will reveal the main reason of couple in HIC to have their own child.

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Reviewer #1: No

Reviewer #2: Yes: Sawsan S. Hamzah

Reviewer #3: Yes: Mulyoto Pangestu

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Financial cost of assisted reproductive technology for patients in high-income countries: A systematic review protocol

PONE-D-24-40151R1

Dear Dr. Njagi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Patrick Goymer

Staff Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for your revisions, the protocol is now much more robust and clearer. Good luck with the actual review.

Reviewer #2: I would like to thank the researchers for this research idea because it studies an important problem in society, and the language is clear, correct and unambiguous ,The research is excellent and Especially after the author made the corrections required by the reviewers deserves to be published

My Regards

Reviewer #3: I would like to thanks to the authors who already made all the correction and adding further information as requested by reviewers.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Sawsan S. Hamzah

Reviewer #3: Yes: Mulyoto Pangestu

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