The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review

Abstract

BackgroundThe evidence on the economic burden of cardiovascular disease (CVD) in low- and middle- income countries (LMICs) remains scarce. We conducted a comprehensive systematic review to establish the magnitude and knowledge gaps in relation to the economic burden of CVD and hypertension on households, health systems and the society.MethodsWe included studies using primary or secondary data to produce original economic estimates of the impact of CVD. We searched sixteen electronic databases from 1990 onwards without language restrictions. We appraised the quality of included studies using a seven-question assessment tool.ResultsEighty-three studies met the inclusion criteria, most of which were single centre retrospective cost studies conducted in secondary care settings. Studies in China, Brazil, India and Mexico contributed together 50% of the total number of economic estimates identified. The quality of the included studies was generally low. Reporting transparency, particularly for cost data sources and results, was poor. The costs per episode for hypertension and generic CVD were fairly homogeneous across studies; ranging between $500 and $1500. In contrast, for coronary heart disease (CHD) and stroke cost estimates were generally higher and more heterogeneous, with several estimates in excess of $5000 per episode. The economic perspective and scope of the study appeared to impact cost estimates for hypertension and generic CVD considerably less than estimates for stroke and CHD. Most studies reported monthly costs for hypertension treatment around $22. Average monthly treatment costs for stroke and CHD ranged between $300 and $1000, however variability across estimates was high. In most LMICs both the annual cost of care and the cost of an acute episode exceed many times the total health expenditure per capita.ConclusionsThe existing evidence on the economic burden of CVD in LMICs does not appear aligned with policy priorities in terms of research volume, pathologies studied and methodological quality. Not only is more economic research needed to fill the existing gaps, but research quality needs to be drastically improved. More broadly, national-level studies with appropriate sample sizes and adequate incorporation of indirect costs need to replace small-scale, institutional, retrospective cost studies.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5806-x) contains supplementary material, which is available to authorized users.

Acceptability of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda: a qualitative study

“…In Mukono and Buikwe districts, among persons aged 15 years and above, the age standardized prevalence of hypertension is 27.2% [7]. The high CVD burden and risk factors in LMICs are negatively impacting health systems placing a high strain on the scarce health resources and contributing to significant social and economic consequences including loss of economic productivity and high treatment costs negatively affecting household incomes [3,8].…”

Cardiovascular Disease Trends in Nepal - An Analysis of Global Burden of Disease Data 2017

“…The growing burden of CVDs worldwide is already beginning to have serious financial implications. In LMICs, both the direct cost of annual care and the cost for seeking care for an acute episode of CVD exceeded the per capita health expenditure 33 . The costs per episode for CVDs were estimated as between $500 and $1500; and about $5000 for a stroke episode 33 .…”

“…In LMICs, both the direct cost of annual care and the cost for seeking care for an acute episode of CVD exceeded the per capita health expenditure 33 . The costs per episode for CVDs were estimated as between $500 and $1500; and about $5000 for a stroke episode 33 . The monthly cost for hypertension treatment are estimated to be around $22 33 .…”

Developing and applying a costing tool for hypertension and related cardiovascular disease: Attributable costs to salt/sodium consumption

“…There is scarce evidence on the economic impact of cardiovascular diseases and low‐and medium‐income countries, although studies are increasingly being published in Brazil and in Latin America . Recent studies have shown that CVDs are the main cause of years lost to premature death and have a large economic impact on society (estimated at 9.5% of the Gross National Product), considering direct health costs and indirect costs, such as premature retirements and productivity losses …”