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AFRICAN JOURNAL OF HEALTH ECONOMICS - Volume 11 Issue 2, December 2022

Pages: 1-11

Date of Publication: 01-Dec-2022

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Economic analysis of hypertension management in public hospitals in Southwestern Nigeria: evidence from secondary data analysis

Author: Theophilus Ehidiamen Oamen, Kanayo Patrick Osemene, Maduabuchi Romanus Ihekoronye

Category: Review & Research


Background: The rising out-of-pocket expenditure on anti-hypertension medications is a huge economic concern for low-income patients. In resource-limited settings, healthcare providers require empirical evidence to support cost reduction without compromising treatment effectiveness. The study aims to conduct a comparative economic analysis of hypertension management in public hospitals in Southwestern Nigeria. Methods: A retrospective cross-sectional study of randomly selected two hundred and fifty-five (N=255) hypertensive patients from two purposively selected public hospitals (n=145 in secondary and n=110 in tertiary) in Abeokuta, Ogun state. Stratification into 3 treatment groups was based on Eighth Joint National Convention guidelines. The perspective of the economic analysis was healthcare provider based and focused only on direct medical costs. Costs were computed from the prices of generic drugs prescribed per clinic visit. The outcome measure was the attainment of blood pressure below < 140mmHg systolic and/or 90mmHg diastolic or <130 mmHg systolic and/or 80mmHg for diabetic hypertensive patients at the end of the 1-year study. Incremental cost-effectiveness ratios (ICERs) namely cost/mmHg and cost/controlled patient were computed by comparing treatment versus 'no therapy' groups. Results: Total medication costs were higher in the tertiary hospital (US$29,218.3) compared to the secondary (US$19,357.4). Hypertension medication costs were higher in the tertiary hospital (US$12,388.2) compared to the secondary (US$9,583.7). The cost per mmHg was generally lower in the tertiary hospital due to better treatment outcomes. Costs per controlled patient were more favorable in the secondary hospital due to higher patient numbers. Conclusion: Higher medication costs were associated with better blood pressure control. The study provided useful cost analysis information for subgroups of hypertensive patients in different healthcare settings. ICERs enable healthcare providers to execute evidence-based resource allocation.

Keywords: Hypertension, Cost-Effectiveness, Public Hospitals, Pharmacoeconomics, Economic Evaluation, Antihypertensive drugs




  1. World Health Organisation. Raised blood pressure. WHO. 2015. Available from:
  2. World Heart Federation: Hypertension. WHF 2015. Available from:
  3. Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria; a systematic review and meta-analysis. Journal of Hypertension. 2015; 23(2)230-242.
  4. Ekwunife OI, Okafor CE, Ezenduka CC, Udeogaranya PO. Cost-utility analysis of antihypertensive medications in Nigeria: a decision analysis. Cost Effectiveness and Resource Allocation. 2013. 11:2.
  5. Ekwunife OI, Udeogaranya PO, Nwatu IL. Prevalence, awareness, treatment, and control of hypertension in a Nigerian population. Health. 2010. 2(7):731-735.
  6. James P, Oparil S, Carter B. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Journal of American Medical Association. 2014.
  7. Saseen J. Essential hypertension. In: Alldredge BK, Corelli RL, Ernst ME, Guglielmo BJ, Jacobson PA, Kradjan WA, Williams BR, editors. Koda-Kimble and Young’s Applied Therapeutics: The Clinical Use of Drugs. 10th ed. Philadelphia: Lippincott Williams & Wilkins. 2013. Chapter 14
  8. Oamen TE, Osemene KP. Drug utilization evaluation of medications used by hypertensive patients in hospitals in Nigeria. Hospital Topics. 2021. 100(1):1-10.
  9. Almalki ZS, Iqbal MS., Alabian FM, Alenazi RK, Tasha AR, Daghar MF, et al. Long-term cost-effectiveness of a systolic blood pressure goal of < 120mmHg in hypertensive patients without Diabetes mellitus. Value in Health. 2020; 21; 157-163.
  10. Ilesanmi S, Ige O, Adebiyi A. The managed hypertensive; the costs of blood pressure control in a Nigerian Town. Pan African Med J 2012; 12; 96
  11. Osibogun A, Okwor T. Antihypertensive prescription and cost to patients in an outpatient department of teaching hospital in Lagos, Nigeria. Open J Preventive Med. 2014; (4)156-163
  12. Abubakar I, Obansa S. Antihypertensive use, prescription patterns and cost of medication in a teaching hospital in Lagos, Nigeria. Inter J of Soc Sc and Econ Rev 2020; 2(2)
  13. Akunne O, Adedapo A. Antihypertensive prescription among black patients without compelling indications: prescription, effectiveness, quality, and cost of medication. BMC Health Services Research. 2019; 19; 373
  14. Costa F. Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: the role of Olmesartan-based treatment. High Blood Press Cardiovascular Preview. 2017; 24 (3); 265-274.
  15. Chanhyun P, Guijing W, Jefferey M, Jing F. Cost-effectiveness Analyses of Antihypertensive Medicines: A Systematic Review. American Journal of Preventive Medicine. 2017; 53(6s2): S131-S142.
  16. Kostas A, Kyriakis S, and Yannis Y. Short-term cost-effectiveness analysis ofHypertension treatment in Greece. Hellenic Journal of Cardiology 2014; 66:197-203
  17. Tolla MT, Norheim OF, Memirie ST, Abdisa SG, Ababulga A, Jerene D, et al. Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis. Cost Effectiveness Resource Allocation. 2016; 14:10
  18. Oamen TE, Osemene KP, Ihekoronye RM.Assessing the application of pharmacoeconomic evaluations in medicines management by hospital pharmacists in Nigeria: a cross-sectional survey. Hospital Topics. 2021;1-10.
  19. Elliot R, Payne K. Essentials of Economic Evaluation in Healthcare. Pharmaceutical Press. 2005.
  20. National population commission [NPC]. Nigeria national census: Population distribution by sex, state, LGAs, and senatorial district. 2006.
  21. Turner HC, Archer PA, Downey LE, Isaranuwatchai W, Chalkidou K, Jit M, Teerawattananon Y. An introduction to the main types of economic evaluations used for informing priority setting and resource allocation in healthcare: Key features, uses, and limitations, Frontiers in Public Health. 2021. 9:722927.
  22. Krejcie, RV., & Morgan, DW. Determining Sample Size for Research Activities. Educational and Psychological Measurement. 1970.
  23. Oostenbrink JB., Koopmanschap MA, Rutten FFH. Standardizations of Costs. Pharmacoeconomics. 2002; 20:443-454.
  24. Sangwan A, Prinja S, Aggarwal S, Aggarwal S, Jagnoor J, Bahuguna P, Ivers R. Cost of Trauma care in secondary- and Tertiary care public hospitals in North India. Appl Health Econ Health Policy. 2017;15(5):681-692.
  25. Hughes D, Reynolds DJ. Pharmacoeconomic principles and relevance to the activities of drug and therapeutics committees. Clinical Medicine 2009;9(5):490-492.
  26. Fadare JO, Ogunleye O, Obiako R, Orubu S, Enwere O, Ajemigbitse AA, Meyer JC, Enato E, Massele A, Godman B, Gustafsson LL. Drug and Therapeutics Committees in Nigeria: evaluation of scope and functionality. Expert review of clinical pharmacology. 2018;11(12):1255-1262.