Global comparison of the economic costs of coronary heart disease: a systematic review and meta-analysis

Abstract

Objectives: Coronary heart disease (CHD) is the leading cause of global morbidity and mortality, yet no comprehensive evaluation of its global economic costs exists. We conducted a systematic review with meta-analysis to examine the costs of CHD treatment by region and CHD subtypes, examine whether there are cost difference by sex, and examine costing methodologies.

Design: We conducted a systematic review and meta-analysis of non-randomised studies.

Data sources: We searched Medline, Embase, CINAHL, EconLit and Google Scholar from 1 January 2000 to February 2023.

Eligibility criteria for selecting studies: We included observational studies reporting economic costs of CHD treatment and outcomes for adults that were published in English.

Data extraction and synthesis: Data extraction and quality assessment were independently undertaken by two reviewers. Costs were converted to percentage of gross domestic product (GDP) per capita of corresponding country. A random-effects model was used for meta-analysis using StataSE V.18 to calculate the pooled percentage. Heterogeneity was assessed using the I² statistic. Meta-regression and bias assessment were performed.

Results: Out of 20 100 records identified, 37 studies (including 2 564 189 individuals) from 22 countries were included in the qualitative synthesis and the quantitative meta-analysis. In most countries, the annual cost of CHD exceeds many times the total health expenditure per capita. The pooled direct annual cost of CHD per patient varied from 4.9% to 137.8% of GDP per capita (Int$ purchasing power parity), with pooled percentage of 21.7% (95% CI 15.3, 28.1) for those with CHD. Slight difference in the annual pooled cost of CHD was observed, with a 2% of GDP per capita higher cost in men (95% CI 0.8, 3.2). Most studies applied a top-down costing approach (n=21).

Conclusions: The review illustrates the expense associated with CHD, which is varied by region and CHD subtypes. The observed cost difference by sex warrants further exploration of sex-specific factors influencing cost disparities. Exploring advanced costing methods such as time-driven activity-based costing can optimise resource allocation and identify opportunities to reduce unnecessary costs and cost disparities.

Prospero registration number: CRD42023412044.

Keywords: Coronary heart disease; HEALTH ECONOMICS; Meta-Analysis; Systematic Review.

Figure 1. PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analyses; RCT, Randomised Controlled Trial.

Figure 2. Forest plot of mean annual cost of CHD treatment. CHD, coronary heart disease; REML, Residual Maximum Likelihood.