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

Abstract

Background and Objectives Hypertension is one of the leading cardiovascular risk factors with high numbers of undiagnosed and untreated patients in Sub Saharan Africa (SSA). The health systems and affected people are often overwhelmed by the social and economic burden that comes with the disease. However, the research on the economic burden and consequences of hypertension treatment remains scare in SSA. The objective of our review was to compare different hypertension treatment costs across the continent and identify major cost drivers. Material and Methods Systematic literature searches were conducted in multiple databases (e.g., PubMed, Web of Science, Google Scholar) for peer reviewed articles written in English language with a publication date from inception to Jan. 2022. We included studies assessing direct and indirect costs of hypertension therapy in SSA from a provider or user perspective. The search and a quality assessment were independently executed by two researchers. All results were converted to 2021 US Dollar. Results Of 3999 results identified in the initial search, 33 were selected for data extraction. Costs differed between countries, costing perspectives and cost categories. Only 25% of the SSA countries were mentioned in the studies, with Nigeria dominating the research with a share of 27% of the studies. We identified 15 results each from a user or provider perspective. Medication costs were accountable for the most part of the expenditures with a range from 1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes. Conclusion Hypertension poses a significant economic burden for patients and governments in SSA. Interpreting and comparing the results from different countries and studies is difficult as there are different financing methods and cost items are defined in different ways. However, our results identify medication costs as one of the biggest cost contributors. When fighting the economic burden in SSA, reducing medication costs in form of subsidies or special interventions needs to be considered. Trial registration Registration: PROSPERO, ID CRD42020220957.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…In a systematic review of 33 studies reporting cost of care with hypertension from sub-Saharan Africa, only 25% of the countries were represented. 105 The included studies reported costs from the public sector or used a mixed approach including private, nongovernmental, or missionary facilities. Medication costs were accountable for the most part of the monthly expenditures with a range from $1.7 to $97.1 from a patient perspective and $0.1 to $193.6 from a health care professional perspective (per patient per month).…”

Health System Determinants of Hypertension Care and Outcomes in Sub-Saharan Africa: A Systematic Review

“…While the decentralization of care might address geographic barriers to hypertension care access, other factors of accessibility such as cost of care and time of services require additional and potentially different interventions. Extensively, the current and previous literature have shown that the high direct and indirect costs of care hamper patients’ use of health services and lead to poor health outcomes and among patients with hypertension, poor blood pressure control [54, 66, 90]. The time of operation of clinics, though limited evidence exists, has an impact on the staffing hence the long queues of patients at the in- and outpatient departments which discourages patients’ attendance to their appointments and encourages loss to follow-up [67, 91, 92].…”

“…It is crucial to ensure that the detachment of hypertension care from the general outpatient department or from the well-equipped hospital does not hamper the patients' initiation on hypertension treatment through the internal transfer processes and that patients with hypertension continue to receive holistic care for other health problems they might have in addition to hypertension. poor health outcomes and among patients with hypertension, poor blood pressure control [54,66,90]. The time of operation of clinics, though limited evidence exists, has an impact on the staffing hence the long queues of patients at the in-and outpatient departments which discourages patients' attendance to their appointments and encourages loss to follow-up [67,91,92].…”

Blood pressure and the hypertension care cascade in The Gambia: Findings from a nationwide survey

“…The complications of hypertension in these countries are increasingly experienced by younger people who form the productive base of the economy. This can impede economic development and exacerbates poverty by diverting vital economic resources from other areas of national development 5–7 …”

“…This can impede economic development and exacerbates poverty by diverting vital economic resources from other areas of national development. [5][6][7] Hypertension is frequently undetected, and untreated or suboptimally treated. 8 Each of these scenarios is associated with complications.…”