Estimating investment costs to improve hypertension care in Lagos, Nigeria

Low- and middle-income countries (LMICs) house 66% of all hypertension patients, many of whom are undertreated, leading to severe health risks and higher healthcare costs. This study examined the required investments to improve hypertension control in Lagos, Nigeria, using real-world medical records and cost data. We analyzed routine medical records from 1249 hypertension patients across 74 public and private facilities in Lagos State and combined these with facility-level cost data to estimate the investment required to deliver guideline-based care. Patient-level gaps were extrapolated to the state level using prevalence-based scenarios, and linear random effects regression was used to assess associations between care completeness and blood pressure change. We found that adherence to consultations and medications according to guidelines was significantly associated with a 5–6 mmHg reduction in systolic blood pressure. These reductions correspond to a 6–14% decrease in cardiovascular complication risk and would require an average annual investment of USD 120 per patient. Medications are the main cost driver. Statewide, providing complete care for all hypertension patients would require a yearly investment of $300 million, or $5000 to $13,000 per saved life year. The identified required investments are currently far outside an acceptable range when compared to the Gross Domestic Product (GDP) of Lagos State, Nigeria. To make chronic care investments feasible, hypertension management must become more efficient, including reducing high medication costs through bulk purchasing, adopting innovative, group-based blended care models, and increasing health insurance coverage. In Nigeria, more than one in three adults has high blood pressure, yet many people are not diagnosed or do not receive adequate treatment. This study estimated how much extra investment is needed to provide recommended care for people with high blood pressure in Lagos State, Nigeria. We used routine medical records from 1249 patients treated in 74 public and private clinics, and we collected real prices for clinic visits, counseling, and medicines. We found that a full year of care based on medical guidelines costs about 148 USD per patient, and medicines make up around 70% of this costs. The gap between current care and recommended care is large with 120 USD, and even larger for uninsured patients with 142 USD. It is concerning that medicines make up such a large share of the total costs, as this limits access for many patients which increases health inequalities. Reducing drug prices through bulk purchasing and expanding health insurance coverage could make life-saving care for high blood pressure more affordable. Dieteren et al. analyze real world medical record and cost data from hypertension patients in Lagos, Nigeria, to estimate the investment required to deliver guideline-based care. They find a large treatment gap, high medication driven costs, and investment needs that exceed commonly used cost effectiveness thresholds.