Economic burden of hypertension to outpatients attending the Ho Teaching Hospital in the Volta Region of Ghana: a cross-sectional study

Abstract

Background: Hypertension is a leading risk factor for cardiovascular morbidity and mortality globally, and its management imposes a significant economic burden on patients. This study assessed the economic costs incurred by patients in accessing hypertension care at the Ho Teaching Hospital, a tertiary facility in Ghana.

Methods: A cross-sectional study was conducted from July to September 2024 among 116 adult patients (≥ 18 years) clinically diagnosed with hypertension and on antihypertensive treatment. Cost analysis was conducted from the patient perspective, focusing on out-of-pocket payments (OOPPs) for direct medical costs (consultation fees, medications, and laboratory services), direct non-medical costs (transportation to and from healthcare facilities), and indirect costs associated with productivity losses. Indirect costs were estimated using the human capital approach, based on the number of hours lost while seeking hypertension care, including travel and waiting time. Catastrophic Health Expenditure (CHE) was estimated using thresholds of 10% and 40% of individual income, based on both total costs and direct costs alone. Individual income was proxied using Ghana's 2024 national monthly minimum wage.

Results: The study involved 116 respondents, the majority of whom were female (55. 17%), about 33.62% of respondents earned less than USD33.33 a month, with 96.55% enrolled in the National Health Insurance Scheme (NHIS). On average, patients incurred monthly direct medical costs of USD11.01 per visit-comprising USD5.15 for consultations, USD2.56 for medications and USD15.27 for laboratory services. Direct non-medical costs per visit, primarily for transportation, averaged USD7.33. Indirect costs, mainly due to productivity losses due to time spent for care, averaged USD1.31 per visit. The total average monthly cost per patient was USD19.52 (Median: USD13.91), translating to an estimated annual cost of USD234.29. Notably, 49.14% of patients experienced catastrophic health expenditure, exceeding 40% of the minimum national monthly wage. CHE prevalence on total cost was 49.14% and 99.14% at 40% and 10% thresholds respectively (total cost).

Conclusions: Despite being enrolled on the NHIS, hypertensive patients face considerable economic burdens, with high rates of catastrophic health expenditure. There is, therefore, an urgent need for improve access to affordable antihypertensive medications at NHIS accredited health facilities and reduce geographic barriers to care, particularly transportation costs and time spent accessing services.

Keywords: Cost; Economic burden; Ghana; Hypertension; Out-of-Pocket payments.

Fig. 1

Catastrophic Health Expenditure (CHE) at different threshold levels