The costs of interventions for type 2 diabetes mellitus, hypertension and cardiovascular disease in South Africa – a systematic literature review

Abstract

Background In the context of a move to universal health coverage, three separate systematic reviews were conducted to summarise available evidence on the direct costs of interventions for type 2 diabetes mellitus, hypertension, and cardiovascular disease in South Africa. Methods PubMed® and Web of Science was searched for literature published between 01 and 1995 and 27 October 2022. Additionally, reference and citations lists of retrieved articles and experts were consulted. We also tracked reference lists of previous, related systematic reviews. Eligible publications were cost analyses of clinical interventions targeted at adults age 15 + reporting primary estimates of in- and out-of-hospital costs from a provider perspective. Costs were extracted and converted to 2021 US dollars, and article methodological and reporting quality was appraised using the 2013 CHEERS checklist. Results Of the 600, 1,172 and 1,466 identified publications for type 2 diabetes mellitus, hypertension, and cardiovascular disease, respectively, 10, 12, and 17 met full inclusion criteria. 60% of articles reported cardiovascular disease costs, 52% were of good reporting quality, and 10%, 50%, and 39% of type 2 diabetes mellitus, hypertension and cardiovascular disease papers reported private-sector costs only. Hypertension drug costs ranged from $2 to $85 per person-month, while type 2 diabetes mellitus drug costs ranged between $57 and $630 per person-year (ppy). Diabetes-related complication treatment costs ranged from $55 for retinopathy treatment to $25,193 ppy for haemodialysis, while cardiovascular disease treatment costs were between $160 and $37,491 ppy. Drugs and treatment of complications were major cost drivers for hypertension and type 2 diabetes mellitus, while hospitalisation drove cardiovascular disease costs. Conclusion The intervention costs of type 2 diabetes mellitus, hypertension and cardiovascular disease care have received more attention recently, particularly diabetes-related complications and cardiovascular disease. However, 39% of identified cardiovascular disease treatment costs used a private sector perspective, leaving significant research gaps in the public sector and the cheaper to treat hypertension and type 2 diabetes mellitus. This review fills an information gap regarding the intervention costs of these diseases in South Africa.

The Economic Burden of Type 2 Diabetes on the Public Healthcare System in Kenya: A Cost of Illness Study

“…In South Africa, the medication costs accounted for 33% of the direct cost breakdown, however, the retinopathy and renal disease complications had the largest cost implications on the total direct cost of managing T2D 16 . It is evident that in both LMICs and high income countries that diabetes complications take the largest chunk of the resources both to patients and the government 16,30,31,32 . This is similar to Kenya where the major cost drivers for the overall direct costs to the public health system are the T2D complications such as management of retinopathy, foot ulcers, and nephropathy 16 .…”

The cost of adding rapid screening for diabetes, hypertension, and COVID-19 to COVID-19 vaccination queues in Johannesburg, South Africa

“…There is limited South African evidence on the cost of integrating NCD screening into routine care. Our systematic literature review which included papers on the costs of NCDs in South Africa published between 1995 and 2022 13 , only identified one study which reported the cost of integrating NCD screening to existing HIV testing, excluding point-of-care cholesterol testing, at an additional $2.24 per person screened. 16 This cost is comparable to our mean cost of $2.53 per person screened even though their study estimated the costs of an operational model as opposed to a research-related one and assumed task shifting to community care workers instead of nurses costed in our study.…”

“…10 , 11 While the diagnosis, treatment and management of underlying DM and HTN are generally affordable, the expenses associated with treating their complications can be substantial. 12 Screening can identify people at risk for these conditions and refer them to appropriate care. Our recent systematic literature review found only 3 studies that reported the costs of screening for DM or HTN in South Africa between 1995 and 2022.…”

“…Our recent systematic literature review found only 3 studies that reported the costs of screening for DM or HTN in South Africa between 1995 and 2022. 13 Two reported the costs of screening for diabetic retinopathy and found the screening methods used to be cost-effective, 14 , 15 , while the third estimated that integrating NCD screening to existing HIV testing increased the cost per person screened but had the potential to efficiently utilise resources compared to stand-alone services. 16 Currently, the South African National Department of Health (NDOH) recommends that all participants should be assessed for HTN at their first visit to a primary health care (PHC) facility by taking two readings 1–2 minutes apart using a blood pressure cuff and, if need be, a third, confirmatory reading.…”