Health System and Provider Costs for Prevention and Treatment of Cardiovascular and Related Conditions in Low and Middle-Income Countries: A Systematic Review

Authors: Elizabeth Brouwer, David Watkins, Zachary Olson, Jane Goett, Carol Levin

Abstract:

Background: The burden of cardiovascular and related conditions is rapidly increasing in low- and middle-income countries, where health systems are generally ill-equipped to manage chronic disease. Policy makers and health systems need to make decisions on how to allocate limited health resources with an understanding of the drivers and costs of CVD-related conditions.  

Methods: A systematic review of the published literature on providing preventive care and treatment for cardiovascular and related diseases in low- and middle-income countries was undertaken. Total costs of prevention or treatment per person or per year were inflated to 2012 USD for comparability across geographic settings and time periods.

Results: Sixty-nine articles and one hundred and eighty-five unit costs were identified regarding cardiovascular and related conditions including: treatment and prevention of CVD risks factor at the individual and population levels, treatment and prevention of ischemic heart disease, stroke, heart failure, non-ischemic heart disease, diabetes, and chronic kidney disease. Most articles evaluated clinical interventions in middle-income countries, with China, India, Brazil, and South Africa predominating. Disease prevention at the population and community levels were the lowest-cost interventions, while treatment of chronic kidney disease was the most expensive.

Conclusions: Prevention interventions and treatment of conditions at early stages are much less expensive to provide than other treatments for cardiovascular and related diseases at advanced stages. Low- and middle-income countries who are beginning to fund CVD interventions can more efficiently allocate resources given an understanding of what drives costs of CVD prevention and treatment.