Challenges of the epidemiological and economic burdens associated with hypertension in middle income countries: evidence from Mexico

Abstract

BackgroundIn order to identify the challenges resulting from hypertension in a middle income country, this study has developed probabilistic models to determine the epidemiological and economic burden of hypertension in Mexico.MethodsConsidering a population base of 654,701 reported cases of adults with hypertension, we conducted a longitudinal analyses in order to identify the challenges of epidemiological changes and health care costs for hypertension in the Mexican health system. The cost-evaluation method used was based on the instrumentation technique. To estimate the epidemiological changes for 2015–2017, probabilistic models were constructed according to the Box-Jenkins technique.ResultsRegarding changes in expected cases for 2015 vs. 2017, an increase of 12 % is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 23 % increase in financial requirements. The total amount for hypertension in 2016 (US dollars) will be $6306,685,320 Of these, $ 2990,109,035 will be as direct costs and $ 3316,576,285 as indirect costs.ConclusionsIf the risk factors and care models remain as they are currently in the health system, the financial consequences will have a major impact on the out-of-pocket users, following in order of importance, on social security providers and on public assistance providers.

Mortality in Patients With Chronic Renal Disease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy

“…The main causes of CKD in our country are diabetes mellitus, primary systemic hypertension, and obesity. 33 , 34 The Ministry of Health has already promoted a national policy for a healthier diet, including a reduced intake of dietary salt, refined sugars, carbohydrates and fats, and has also established health promotion and care programs, such as the National Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes. 35 However, these programs and initiatives, as they are, have proven to be insufficient to control and prevent the incidence of CKD.…”

Attributable burden and expenditure of cardiovascular diseases and associated risk factors in Mexico and other selected mega-countries

“…For example, estimates in Mexico indicate that only four kinds of these diseases consumed approximately USD-PPP $11.2 billion in 2015 or the equivalent to ≈4% of the total health expenses in the country [44]. Although this study, considerably similar to another in Brazil [59], concerns direct costs such as patients' hospital care and the loss of economic productivity, these statistics and those from previous years would increase if outof-pocket expenditures were included, which represent 44% of the total health expenditure and more than 50% of the total expenses associated with hypertension in Mexican adults [45,46]. Out-of-pocket CVD expenses for 15 months in countries such as China and India have been reported to be 15.0-40.1% and 39.3-54.9% of the annual household expenses, respectively [118].…”

“…The SS, IMSS, and ISSSTE were expected to respectively allocate USD-PPP $1.6, $2.7, and $1.1 billion to address the increased demand of health services associated with hypertension in 2016. The expenditures expected for users surpassed the sum of these previous amounts, being USD-PPP $5.6 billion [45]. A similar pattern in the proportion of these expenses among health care providers and users over 60 years old was observed by 2015 [46].…”

“…Total costs associated with hypertension expected for 2016 in Mexico, including indirect and direct expenditures for SS, IMSS, ISSSTE, and users, were identified in a study published in 2015 [45]. These estimates were based on national registries and were calculated through a modelling approach considering the changes in cases and demand of health services in the health system.…”

“…In contrast, estimates from Japan were obtained from a study which adapted the Cost of Illness method, taking into account direct costs of medical attention, morbidity, mortality, and the long-term costs and economic burden for families [52,68]. In Mexico, four recent studies developed through different solid methods, national registries, and population-based datasets cover economic estimates for hypertension, IHD, heart failure, myocardial infarction, and atrial fibrillation from 2012 to 2017 [43][44][45][46]. On the other hand, though a considerable number of studies at regional level focused on catastrophic health expenditures or with micro-costing approaches in India and Nigeria was identified, the nationwide current information on total CVDrelated costs was limited.…”