The cost of providing hypertension health care in public health facilities case study of the NCD clinic at Rwinkwavu district hospital

Abstract

Background: The cost of hypertension healthcare services is increasing worldwide due to increase of its prevalence estimated to 40% in adults globally and high prevalence 46% is in Sub-Saharan African. The purpose of this study is to provide information of the cost of hypertension health care services in monetary values on one hand and to determine the cost of health care services of each stage of hypertension at district hospital in rural Rwanda. The study benefits the care givers of hypertension care to understand the socioeconomic status of the patients and plan their management. Methods: Retrospective study of 68 patients followed-up in the NCD clinic from January to December, 2013. The data have been collected using patients' files included demographic information, numbers of visits, diagnostic tests and medications. The Ministry of Health tariff, the information from the charts and Excel cost analysis was done to discover the average cost per patient and requirement of good care at each stage of hypertension. Results: Of the 68 patients analyzed, 74% were female and 26% were male. Their socioeconomic status was generally very low; most of the patients had zero formal education 37% and 34% patients had only a primary education level; 53% patients were famers owned small pieces of lands which are not considerably productive and 18% patients were unemployed. The cost of providing hypertension healthcare services estimated in monetary values was 53,656,736 Rwf excluding the maintenance cost in financial year 2013. The driving cost of hypertension care delivery was the expenditure on medicines, which were estimated at 9,343,956 Rwf per year. The capital cost was 52% and the recurrent cost was 65% of the total cost of hypertension care. The average costs of hypertension care per patient for each stage per year were 25,431 Rwf for stage one, 45,812 Rwf for stage two and 82,778 Rwf for stage three. Conclusion and implications for translation: The overall control of hypertension with insurance coverage is good at Rwinkwavu District Hospital. Hypertension health care services can be effectively implemented in every district hospital in Rwanda through the NCD program. The cost of providing hypertension health care services information are critically missing in the region, more studies are needed on cost of NCDs health care services and their countries' economy impact as the prevalence increasing rapidly.

The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review

“…Study characteristics are summarized in Table 1 , a more detailed version can be found in additional file 2 . Regarding the economic study design, 21 studies followed a partial economic evaluation (nine cost descriptions [ 33 , 35 – 38 , 44 , 47 , 49 , 56 ], eight cost analyses [ 41 , 45 , 46 , 48 , 50 , 57 , 58 , 64 ] and four cost-outcome descriptions [ 32 , 34 , 43 , 63 ]. The remaining studies followed a full economic evaluation design (seven cost effectiveness analyses [ 39 , 40 , 54 , 59 – 62 ], three cost utility analyses [ 42 , 51 , 52 ] and two cost minimization analysis [ 53 , 55 ]).…”

“…The remaining studies followed a full economic evaluation design (seven cost effectiveness analyses [ 39 , 40 , 54 , 59 – 62 ], three cost utility analyses [ 42 , 51 , 52 ] and two cost minimization analysis [ 53 , 55 ]). The following costing approaches were used: Bottom up [ 32 – 39 , 41 , 42 , 44 – 49 , 51 , 54 , 55 , 58 – 60 , 63 ], top down [ 40 , 43 , 50 , 52 , 56 , 57 , 61 , 62 ] and a combination of both [ 53 , 64 ], human capital [ 35 , 38 , 44 ], replacement value [ 38 ] and willingness to pay [ 46 ].…”

“…The timeframe for data collection ranged from 20 days to 18 months. For the cost calculation, most studies used medical records [ 32 – 35 , 38 , 45 , 47 – 49 , 54 – 57 , 63 ] or questionnaires and interviews [ 33 – 39 , 43 – 45 , 50 , 64 ]. Additional sources were price lists [ 41 , 46 , 47 , 49 , 51 , 54 , 57 – 59 , 62 ], facility records [ 34 , 39 – 41 , 43 , 46 , 52 , 53 , 56 , 64 ] and other literature such as studies on income in South Africa [ 59 , 65 ] or World Health Organization (WHO) reports [ 40 , 43 , 59 , 66 ].…”

“…One study had a global focus [ 46 ]. Most studies focused on a rural setting [ 32 , 44 , 52 – 54 , 56 , 57 ] or had a mixed urban-rural focus [ 35 , 37 , 38 , 41 , 50 , 61 , 64 ] with data collected from hospitals [ 33 , 35 – 38 , 45 , 47 – 49 , 53 – 57 ], health care or community centers [ 32 , 40 , 43 , 58 , 61 , 63 ] and a mix of facility types [ 34 , 39 , 41 , 44 , 50 , 64 ].

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“…We found that the definition of hypertension was heterogeneous. Thirteen studies only considered patients diagnosed with hypertension [ 32 , 34 , 36 – 38 , 40 , 45 , 47 , 49 , 53 , 55 – 57 ], five studies included only patients who were actually receiving some form of treatment for hypertension [ 33 , 39 , 44 , 48 , 63 ], and five studies did not provide any specific information other than referring to patients living with hypertension or hypertensive disease [ 41 , 50 , 59 , 61 , 64 ].…”