Transcript Economic impact of CVD in Africa

Economic impact of
Cardiovascular Disease and
Hypertension in Africa
Paper presented at the 3rd International Forum for Hypertension
in Africa conference at Sheraton Hotel, Abuja, Nigeria on the 26th
September 2009
by
Dr. Kingsley K. Akinroye, President, African Heart Network
Global Cardiovascular Disease Burden
17 million global deaths due to CVD
¾ in Developing Countries
Hypertension is the most common risk factor
for CVD morbidity and mortality.
 Hypertension is the most common risk factor for
CVD morbidity and mortality


972 million people world wide are hypertensive
(will rise to 1.6 billion people by 2025)
7.1 million deaths globally
 Onset of CVD at an earlier age; and death at a
younger age
 Wide spread social and economic hardship
Global Heath burden
CVD- leading cause of death world-wide
Estimated global deaths by cause, all ages, 2005
20000000
C a rdio v a s c ula r
dis e a s e s
18000000
16000000
14000000
12000000
10000000
8000000
C a nc e r
6000000
C hro nic re s pira t o ry
dis e a s e s
4000000
H IV / A ID S
2000000
T ube rc ulo s is
M a la ria
0
Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment»
D ia be t e s
Projected global deaths by cause (in millions), 2005
0.883
Malaria
1.125
Diabetes
1.607
Tuberculosis
WHO Report 2005
2.83
HIV/AIDS
4.057
Chr Resp Dse
7.586
Cancer
17.528
CVD
0
5
10
15
20
Projected death rates by specific causes
for selected countries, all ages, 2005
Age-standardized death rates per 100,000
HIV/AIDS, TB, Malaria
CVD
800
700
600
500
400
300
200
100
0
Tanzania
Nigeria
India
WHO Report 2005
China
UK
Hypertension burden in Africa

Stroke is a major complication of Hypertension in Africa
Lemogoum et al, Am J Prev Med 2005;29 (5SI):95-101

Stroke mortality and case fatality in some Africa
countries exceed those in the developed world
Walker et al, Lancet 2000;355:1684-87

Hypertension is the most consistent and powerful
predictor of stroke and is causally involved in more
than 70% of stroke cases
Lavados et al, Lancet 2005; 365:2206-15. Bronner et al, N Engl
J Med 1995;333: 1392-400
Stroke mortality by region (1990)
Mortality rate
(per 100,000)
Former socialist economies
China
Established market economies*
Sub-Saharan Africa
India
Middle Eastern Crescent
Other Asian countries and islands
Latin America
192.35
112.12
98.02
76.25
72.89
65.08
51.34
28.49
*Western Europe, USA, Canada, Australia,
New Zealand, Japan
Adapted from Reddy KS, Yusuf S. Circulation 1998;97:596-601
Tobacco use on the rise in developing
countries
ECONOMIC IMPEDIMENTS IN
AFRICA
 Multiplicity of health care providers
 Abundant alternate care givers
 Lack of capacity of health care providers
 Affordability of physician for health care
 Out –of-pocket payment for health care
 Abandonment of treatment/non compliance
Cost of Illness
 Cost of illness (COI) studies are a useful
means of beginning to illustrate the
economic magnitude of CVD or its risk
factors, accounting for both direct medical
expenditures and losses due to foregone
productivity
COI Studies
 3 components

Direct cost

Indirect cost

Intangible cost
Direct Economic Impact
 Cost of medical care for health services and
medications




Ambulances
Inpatient or outpatient care
Rehabilitation
Community health services
Indirect Economic Impact
Indirect costs:
 Reduction in income owing to lost productivity from illness
or death
 The cost of adult household members caring for those who
are ill
 Reduction in future earnings by the selling of assets to cope
with direct costs and unpredictable expenditures
 Lost opportunities for young members of the household who
leave school in order to care for adults who are ill or to help
the household economy
Indirect Economic Impact contd:
 Reduction in income.

In more than 80% of African countries
disability insurance systems are
underdeveloped or non-existent
 Macroeconomic consequences of CVD in
Africa

Health in general – measured as life
expectancy or adult mortality – is a robust and
strong predictor of economic growth
Adult life Expectancy in Africa
vs Developed Countries
Africa
Developed Countries
Ghana - 59.85
Japan – 82.1
Kenya – 57.86
France – 80.98
Uganda – 52.72
Finland – 78.97
Tanzania – 52.01
United Kingdom – 79.01
Nigeria – 46.94
Germany – 79.4
Liberia – 41.84
Spain – 80.9
Mozambique – 41.18
Ireland – 78.9
Change in life expectancy
 A 5 – year increase in life expectancy will
give a country a 0.3 – 0.5% higher annual
GDP growth rate in subsequent years
(Barrow 1996)
CVD mortality vs economic
growth
 Suhrcke and Urban(2006) study: To assess the
impact of CVD mortality among the working-age
population on economic growth, in developed
and developing countries
 Result:- In the high-income country
sample(developed country): a 1% increase in the
mortality rate was found to decrease the growth
rate of per - person income in the subsequent five
years.
 No significant difference in developing countries
Factors responsible for lack of cost
effectiveness studies for CVD and
Hypertension intervention in Africa
 Newness of the appearance and awareness of CVD and




hypertension in Africa;
For prevention in particular, a lack of potential profit for
suppliers of the intervention;
The multitude of possible interventions because of multitude
health outcomes to examine;
Multi-sectoral sources of the problem complicate the design
of possible solutions;
Few randomized clinical trials testing interventions
Cost-Effectiveness in Africa
 Unwin (2001) : There are no “off-the-shelf”
interventions for changing lifestyle that can
be assumed to be effective within subSaharan Africa;
What can be done now?
 Municipalities can build pedestrian and
bicycle lanes
 Companies can manufacture and market
heart healthy products;
 Agricultural policies that subsidise excess
production of unhealthy foods can be
terminated
Challenge of CVD in Africa
 Double burden of disease
 Changing pattern of disease and risk factor
exposure
 Infectious disease priorities;
 Constrained budgets
 Focus on population approaches to
prevention
Challenge of CVD in Africa
 Prevention and surveillance
 The need for appropriate care for CVD places
enormous pressure on the already fragile health
care systems jeopardizing the viability of
poorly funded public health services
 The need for cost-effective strategies in limited
resource SSA countries