The economic burden of hypertension in Sub-Saharan Africa: a systematic literature review

Abstract

Abstract Background Quantifying the economic burden of disease is vital for informing healthcare resource allocation and priority setting particularly in Sub-Saharan Africa (SSA) where the incidence of non-communicable diseases (NCDs) is rising among the region’s predominantly youthful population. In 2022, Gnugesser et al. conducted the first systematic review on the economic burden of hypertension in SSA. This review aims to provide an updated and comprehensive account of the costs of hypertension in SSA. Methods A systematic review was conducted of peer-reviewed studies reporting cost of illness (COI) estimates for hypertension in SSA. Using the PICOS framework, the articles reviewed were limited to those with adult populations (≥ 18 years) in SSA that were published in English between 2021 and 2024. The selected time frame was one year prior to the review published by Gnugesser et al. to account for any indexing lag. Searches were conducted in Medline, Embase and the Global Health database using economic and hypertension-related terms. Costs were standardised to 2024 international dollars using purchasing power parities and the quality of studies was assessed. Results Building on the first systematic review (33 studies), this review identified 22 studies published between 2021 and 2024 of which 21 are newly identified studies. More than half of the studies were conducted in East Africa and no studies were identified from Central Africa. Substantial heterogeneity was observed across study time horizons, costing perspectives and cost categories. Among studies reporting monthly direct medical costs from a patient perspective ( n = 4), costs ranged from $1.39- $179.52. Among studies reporting annual mean costs per patient per year ( n = 4), costs ranged from $154.00 - $ 1,010.27. Costs reported from provider, health-system and societal perspectives (presented as per-visit, lifetime or aggregate national costs) are reported in Table 3. Conclusions Despite a growing policy focus on NCDs, evidence to support the economic burden of hypertension in SSA remains sparse. More standardised, comprehensive COI studies are needed to inform decision-making, budget allocation, and comparisons within and across countries in order to sharing best practices where applicable.