The economic impact of treating hypertension in sub–Saharan Africa - A systematic review

BACKGROUND: Hypertension is a leading risk factor for cardiovascular diseases, with high numbers of undiagnosed and untreated patients in sub-Saharan Africa (SSA). While the disease poses a substantial social and economic burden for patients and health systems, research on the economic consequences remains scarce. This systematic review compared hypertension treatment costs in SSA and identified possible cost drivers and opportunities to reduce the economic burden. METHODS: A systematic search was performed in six databases (PubMed, Web of Science, CINAHL, ISPOR, EconLit and Google Scholar) for peer-reviewed articles published in English from inception to Jan. 2022. We included studies assessing the direct or indirect costs of hypertension treatment across SSA. All results were converted to 2021 US Dollars. RESULTS: Of 3999 initial articles, 33 were included in the systematic review. Only 12 of 48 SSA countries provided data on the economic burden of hypertension, and results varied according to their perspective and setting. Total treatment costs per patient ranged from monthly 2.70$ for medicine collection visits in Ghana to 46.24$ for emergency visits in Kenya for patients and from 6.52$ in Ghana to 28.19$ in Rwanda for providers. Medication costs had the most significant impact and were the most reported cost item. Treatment in higher-level hospitals and private institutions was considered more expensive. Single or combinative use of angiotensin-converting enzyme inhibitors, calcium channel blockers and diuretics were the cheapest treatment options across SSA. CONCLUSIONS: Hypertension care poses a significant economic burden for health systems and patients. While the costs were heterogeneous according to measuring and financing methods, medication was identified as the most critical cost factor. Reducing medication costs, supporting patients through subsidies, using generics and cheaper therapy options should be considered. KEY MESSAGES: • Hypertension costs in sub-Saharan Africa are a significant burden mainly driven by medications. • Introducing targeted subsidies, generics, and low-priced therapies could reduce medication costs.