The managed hypertensive: the costs of blood pressure control in a Nigerian town

BACKGROUND: The health systems designed to cater for patients with chronic illnesses like hypertension have not fully evaluated the burden of long term therapy and its effect on patient outcome. This study assessed the financial implication and cost effectiveness of hypertension treatment in a rural Nigerian town. METHODS: A chart review of 250 rural patients with primary hypertension at a regional hospital in Southwest Nigeria was conducted. RESULTS: The mean age of patients was 61±11.2 years, 59.2% were females, 67% had an income < ₦20,000 ($133.3) monthly. Diuretics and alpha-Methyl Dopa were the most prescribed drugs. The median number of prescribed drugs was two (range1-4). Mean cost of treatment was ₦1440±560 ($9.6±3.7) with 52.8% spending 𢙔 10% of their income on treatment. The most cost effective therapies were Methyl Dopa and Diuretics with Cost-effectiveness ratios of 8 and 12.8 respectively. Patients with co-morbidities, stage 2 hypertension and those on three or four drug regimen had significantly higher treatment costs. CONCLUSION: The financial burden of long term antihypertensive therapy appears substantial, cost reduction strategies are needed to optimize hypertension treatment in societies with limited resources. Hypertensive management therefore requires a response adapted to the local context.