Comparative direct costs for hypertension management between hypertensive patients with normal body mass index and those with excess body weight: a patient-level analysis in primary care in Bobo-Dioulasso, Burkina Faso

Abstract

The primary objective of this study was to compare the direct costs of management between hypertensive patients with normal body mass index (BMI) and those with excess body weight, and secondarily to determine the associated factors with high direct costs in primary care, at primary health care centers (PHCCs) in Bobo-Dioulasso, Burkina Faso. This patient-level analysis was cross-sectional and used an adapted version of the 'Costs for Patients Questionnaire', which includes different components to estimate direct costs. Adults with hypertension were interviewed in 20 public PHCCs in Bobo-Dioulasso between January and February 2022. The 377 participants with a BMI≥ 18.5 kg/m² included in the analysis had a mean age of 56.2 ± 10.4 years and a mean duration of diagnosis of 8.2 ± 6.6years. The prevalence of excess body weight (overweight plus obesity) was 48%. Annually and per patient, the average estimated direct costs in CFA francs (95% CI) were 105853 (89195 -122511) for hypertensive patients with overweight/obesity compared to 54085 (43794 -64377) for hypertensive patients with a normal BMI, p = 0.0001. In logistic regression, the factors associated with high direct costs, reaching the 4th quartile, were: age between fifty and sixty years, being educated, long duration of diagnosis, elevated systolic blood pressure, bi-/tritherapy, overweight (aOR=1.9, p=0.042) and obesity (aOR=6.5, p=0.0001). Direct costs were higher for individuals who were overweight, which is a modifiable factor. This intervention is crucial for the efficient implementation of an operational and sustainable health care system targeting chronic diseases, including hypertension