Exploring the Socio-Economic Toll of Non-Communicable Diseases in Low-Resource Settings: Novel Evidence From Mozambique.

backgroundThe socio-economic burden of increasingly prevalent non-communicable diseases (NCDs) in low-income countries is substantial and widely recognised. This study aimed to fill the remaining evidence gap for type 2 diabetes (T2DM) and hypertension (HTN) patients in selected health facilities across two provinces in Mozambique.

methodsA cross-sectional cost-of-illness study was conducted measuring the societal costs incurred by patients enroled in an integrated disease management programme. Direct healthcare and non-healthcare costs, and indirect costs, were reported in current US$ ($) values per month per patient. The dimensions across which the costs were analysed from an equity lens were disease groups, location, sex, and income groups using the World Bank's poverty line thresholds for Mozambique.

resultsProgramme costs amounted to $1.2 M ($3.2 per patient visited), while the recurrent costs averaged $49.8 per month per patient, with direct non-healthcare costs as the main driver at 74% of the total recurrent costs. Higher costs across all cost categories were consistently reported by T2DM patients, males, and patients from the upper-income group. Higher direct but lower indirect costs were reported by patients from rural rather than urban locations. The costs of the lowest-income group accounted for the majority of their reported monthly income, while 3% of the sample reported that their income is insufficient to cover the costs of managing their disease.

conclusionsThe socio-economic burden was disproportionately higher in the lowest income group. The study highlighted the need for policies and interventions such as targeting the financing of managing chronic diseases, including potential increases in funding, the introduction of patient cost-sharing mechanisms, and effective intersectoral coordination to mitigate economic strain in low-income settings.