Economic Burden of Metabolic Syndrome among People Living with HIV in Addis Ababa, Ethiopia: A Cost of Illness Analysis

Abstract Objectives: The importance of metabolic syndrome (MS) among people living with HIV (PLHIV) has grown substantially. However, little is known about its economic impact. Therefore, we aimed to estimate the cost of care for MS among PLHIV and the factors associated with higher costs. Methods: a cross-sectional study was conducted among adult PLHIV with comorbid MS at ALERT Comprehensive Specialized Hospital in Addis Ababa, Ethiopia, from October 2021 to July 2022. The study participants were enrolled in the study in consecutive order and data were collected using a structured questionnaire, document reviews, and expert consultations. A bottom-up costing approach was applied to all cost categories, except for laboratory tests and hospitalization, for which a top-down costing approach was used due to inaccessible of unit-level cost data. Descriptive statistics, including frequency distribution, means, and standard deviations were employed. Linear regression analysis was also conducted to assess factors associated with a higher MS care cost. Results: A total of 244 PLHIV were involved. The mean annual cost of care for MS incurred by the society was 40.1 US dollars ($). Being widow ( Exp (B): 1.7, 95% CI, 1.1 – 2.7, six to 10 years duration of HIV (Exp (B): 1.8, 95% CI: 1.1 - 2.7, being on a lipid-lowering medication (Exp (B) 2.1, 95% CI, 1.6 – 2.8, taking insulin (Exp (B): 1.7, 95% CI: 1.0 – 2.8, having two MS components (Exp (B): 1.3, 95% CI: 1.0 – 1.7 and being on one (Exp (B): 3.8, 95% CI: 2.1 – 5.5, or two (Exp (B): 6.5, 95% CI: 4.5 – 9.4 or three (Exp (B): 7.6, 95% CI: 5.1 – 11.3 medications and hospitalization (Exp (B): 4.1, 95% CI: 2.7 – 6.2 were found to have a statistically significant association with a higher cost of care for MS. Conclusion: Considering the per capita health expenditure of Ethiopia, the cost of care for MS was substantial. Hence, it is important to initiate interventions targeted at preventing or delaying the onset of MS and thereby minimize the high healthcare cost associated with its management. Keywords: PLHIV, Metabolic syndrome, hypertension, diabetes, dyslipidemia, cost, Ethiopia