Costs of cardiovascular disease prevention care and scenarios for cost saving: a micro-costing study from rural Nigeria.
OBJECTIVE
To assess the costs of cardiovascular disease (CVD) prevention care according to international guidelines, in a primary healthcare clinic in rural Nigeria, participating in a health insurance programme.


METHODS
A micro-costing study was conducted from a healthcare provider perspective. Activities per patient per year (e.g., consultations, diagnostic tests) were based on clinical practice in the study clinic. Direct (e.g., staff, drugs) and indirect cost items (overheads) for each activity were measured. A cohort study, patient and staff observations, and interviews in the study clinic provided patient resource utilization data. Univariate sensitivity analyses were performed. Scenario analyses evaluated cost-saving options. The main outcome was the costs of CVD prevention care per patient per year.


RESULTS
The costs of CVD prevention care were United States dollars (USD) 144 (range 130-158) per patient per year. Direct costs were USD 82 and indirect costs were USD 62. The main cost drivers were drugs (USD 39) and diagnostic tests (USD 36). The costs of hypertension care were USD 118 (107-132) and that of diabetes care USD 263 (236-289) per patient per year. A combination of task-shifting from doctors to nurses, reduction of appointment frequencies, and minimal organ damage screening would result in a direct cost reduction of 42%.


CONCLUSIONS
This is the first study to report the costs of CVD prevention care in sub-Saharan Africa, based on prospectively collected operational data. The costs observed in our study are unaffordable in many countries in sub-Saharan Africa, highlighting the need for innovative financing mechanisms to fund CVD prevention care.
aDepartment of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands bDepartment of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria cInstitute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands dHygeia Nigeria Ltd, Victoria Island, Lagos, Nigeria eOgo Oluwa Hospital, Bacita, Kwara State, Nigeria *Deceased.
Marleen E
ME
Hendriks
Oladimeji A
OA
Bolarinwa
Heleen E
HE
Nelissen
Alexander C
AC
Boers
Gabriela B
GB
Gomez
Siok Swan
SS
Tan
William
W
Redekop
Peju
P
Adenusi
Joep M A
JM
Lange
Kayode
K
Agbede
Tanimola M
TM
Akande
Constance
C
Schultsz
D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D015331:Cohort Studies; D003153:Community Health Services / Q000191:economics*; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D009549:Nigeria; D011320:Primary Health Care; D012424:Rural Population