About 41% of deaths in Ghana may be linked to complications of four non-communicable diseases (NCDs): stroke, myocardial infarction, heart failure, and chronic kidney disease by 2034.

A recent study published in Sage Journals on March 29, 2024, titled; Estimating the lifetime cost of managing hypertension in Ghana: a modelling study, by Fidelis Atibila, James Avoka Asamani, Emmanuel Timmy Donkoh, Rob Ruiter, Gerjo Kok, and Gill Ten Hoor has predicted.

According to the research simulation, within 10 years of being diagnosed with hypertension and its complications, the likelihood of surviving while dealing with stroke is 2%; myocardial infarction 5%; heart failure 9%; and chronic kidney disease 18%.

The report also indicates that by 20 years after diagnosis, the likelihood of mortality is estimated to be 70%. The probability of remaining alive with any of the four complications is about 18%, whereas the chances of survival with only stroke are about 1%; myocardial infarction 2%; and chronic kidney disease 13%.

By the 30 years, the chances of mortality within the group increase to 82%. Conversely, the likelihood of remaining alive without any complications is minimal, around 1%, while the probability of survival with at least one of the four complications is about 8%.

Estimated lifetime, annual, and monthly cost of treatment

The total cost of treating hypertension (HPT) over a lifetime is estimated to be about GHS 869,106, with a potential range between GHS 570,239 and GHS 1.202 million, considering significant uncertainty. This amounts to USD 119,056, with a range between USD 78,115 and USD 164,723.

The report emphasizes that by outlining the lifetime cost of treating hypertension (HPT) in Ghana, it enables the formulation of policies regarding HPT treatment costs by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health.

“This lifetime cost assumes that the cohort is initially 1 or more of 4 complications (ie, stroke, myocardiac infarction, heart failure, and chronic kidney disease),” it said.

As per the research findings, the unadjusted monthly treatment cost is projected to average around GHS 3,908, with potential fluctuations ranging from GHS 2,091 to GHS 5,801, equivalent to approximately USD 535.36, with a range from USD 286.40 to USD 794.63. However, these expenses significantly differ based on the specific complications experienced by each patient.

“For  example,  hypertensive  patients  with  chronic kidney disease who may require haemodialysis have an undiscounted  estimated  monthly  cost  of  GHS  2790  as compared to GHS 57 for those with stroke, but not needing hospital admission.”

The average monthly cost of treating chronic kidney disease is estimated to be at least 8 times higher than that of heart failure, 6.5 times higher than that of myocardial infarction, and up to 10 times higher than that of hypertensive patients without complications.

“When the plausible range of uncertainty associated with the transition probability is taken into consideration, the cost differential between hypertensive patients with chronic kidney disease compared with those with heart failure is 6.7 to 7.4-folds  and as much as 22 to 24 folds for patients without any complication,” the authors said.

The findings reveal that the total undiscounted cost for treating hypertension and its related complications from the patient's perspective, assuming all patients were diagnosed and received treatment, amounts to about GHS 438.124 million (USD 60.017 million), translating to a monthly cost of GHS 36.5 million (USD 5 million).

When considering the associated uncertainty in the prevalence of hypertension, the estimated monthly cost ranges from GHS 31.4 million (USD 4.3 million) to GHS 41.93 million (USD 5.744 million).

A significant portion, about 71%, of the estimated cost is likely attributed to treatment for chronic kidney disease, with 7% allocated to hypertension without complications, 9% to heart failure, and 11% to myocardial infarction.

Recommendations for Addressing Hypertension and Associated Complications in Ghana 

The authors suggest that Ghana should implement comprehensive healthy lifestyle interventions aimed at delaying the onset of hypertension (HPT) and promoting routine blood pressure monitoring. They argue that such measures are essential for early detection and effective management of pre-hypertension and hypertension.

According to the authors, chronic kidney disease (CKD), identified as a complication that could account for about 67% of the lifetime treatment costs associated with hypertension, underscores the need for future health policies to prioritize community-based hypertension prevention and management strategies.

The authors recommend that the Government of Ghana address the impoverishing out-of-pocket payments linked to hypertension-related complications, particularly since CKD treatment costs significantly exceed average income levels in Ghana and are not covered by the National Health Insurance Scheme (NHIS) benefit package. Thus, future health policies should incorporate strategies to alleviate the economic burden posed by these complications.

Addressing the challenges within the Ghanaian health system, the authors emphasize the establishment of wellness centers and non-communicable disease (NCD) clinics within all primary healthcare facilities.

This strategic approach aims to enhance the healthcare system's capacity to deliver comprehensive and effective care for hypertension and its associated complications, ultimately improving public health outcomes.