title: Economic burden of heart failure: investigating outpatient and inpatient costs in Abeokuta, Southwest Nigeria.
abstract: BACKGROUND
  Heart failure (HF) is a deadly, disabling and often costly syndrome world-wide. Unfortunately, there is a paucity of data describing its economic impact in sub Saharan Africa; a region in which the number of relatively younger cases will inevitably rise.
  
  
  METHODS
  Heath economic data were extracted from a prospective HF registry in a tertiary hospital situated in Abeokuta, southwest Nigeria. Outpatient and inpatient costs were computed from a representative cohort of 239 HF cases including personnel, diagnostic and treatment resources used for their management over a 12-month period. Indirect costs were also calculated. The annual cost per person was then calculated.
  
  
  RESULTS
  Mean age of the cohort was 58.0 ± 15.1 years and 53.1% were men. The total computed cost of care of HF in Abeokuta was 76, 288,845 Nigerian Naira (US$508, 595) translating to 319,200 Naira (US$2,128 US Dollars) per patient per year. The total cost of in-patient care (46% of total health care expenditure) was estimated as 34,996,477 Naira (about 301,230 US dollars). This comprised of 17,899,977 Naira- 50.9% ($US114,600) and 17,806,500 naira -49.1%($US118,710) for direct and in-direct costs respectively. Out-patient cost was estimated as 41,292,368 Naira ($US 275,282). The relatively high cost of outpatient care was largely due to cost of transportation for monthly follow up visits. Payments were mostly made through out-of-pocket spending.
  
  
  CONCLUSIONS
  The economic burden of HF in Nigeria is particularly high considering, the relatively young age of affected cases, a minimum wage of 18,000 Naira ($US120) per month and considerable component of out-of-pocket spending for those affected. Health reforms designed to mitigate the individual to societal burden imposed by the syndrome are required.
authors.affiliation: Division of cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Okechukwu S
authors.initials: OS
authors.lastname: Ogah
authors.affiliation: Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health and Medical research Council Centre of Research Excellence to Reduce, Inequality in Heart Disease, Melbourne, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria.
authors.forename: Obinna E
authors.initials: OE
authors.lastname: Onwujekwe
authors.affiliation: Division of cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria.
authors.forename: Ayodele O
authors.initials: AO
authors.lastname: Falase
authors.affiliation: Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria.
authors.forename: Saheed O
authors.initials: SO
authors.lastname: Adebayo
authors.affiliation: Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria.
authors.forename: Taiwo
authors.initials: T
authors.lastname: Olunuga
authors.affiliation: Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hatter Institute for Cardiovascular Research in Africa and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
mesh_terms: D000328:Adult; D000368:Aged; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010045:Outpatients / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000191:economics; D014187:Transportation of Patients / Q000191:economics