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.

Keywords: Economic; Hypertension; Sub-Saharan Africa.

Fig. 1

PRISMA flow chart. A flow chart according to the PRISMA guidelines representing the number of studies at each stage of the review

Fig. 2

Map of researched countries in Sub Saharan Africa. A map of researched countries in Sub Saharan Africa. The number of studies reported was presented with sizeable dots

Fig. 3

Costs from a patient and user perspective (US$ 2021) per month by cost category. Cost categories were divided into summary costs (Panel a) and the subcategories direct medical (Panel b) and direct non-medical costs (Panel c), displayed by visit type (Panel a), setting (Panel b, c) and country. Each circle in the box plot represents an individual result with bigger circles the mean cost in the subcategory by country and the 95% Confidence Interval (vertical lines)

Fig. 4

Monthly costs from a provider perspective by cost category. Cost categories were divided into summary costs (Panel a) and the subcategories direct (Panel b) and indirect costs (Panel c), displayed by country. Each circle in the box plot represents an individual result with bigger circles the mean cost in the subcategory by country and the 95% Confidence Interval (vertical lines)

Fig. 5

Economic outcomes per episode and clinic costs. Cost categories were divided into Costs per episode (Panel a) and costs for clinics per year (Panel b), displayed by country. Each circle in the box plot represents an individual result with bigger circles the mean cost in the subcategory by country and the 95% Confidence Interval (vertical lines)