THE HEALTH AND ECONOMIC THREATS OF NON-COMMUNICABLE DISEASES IN THE MIDDLE EAST AND NORTH AFRICA, CV BoD in Egypt/ MENA Prepared and presented by : Mahmoud Diaa Elmahdawy President, ISPOR Egypt s chapter Overview Introduction Healthcare system in Egypt Country outlook Definition of CV disease Clinical and Economic burden Global statistics Conclusion Questions 2 ISPOR Arabic Forum, DC. May 2016 1
Introduction Healthcare system In Egypt: Fragmented with multiple sources of financing Misallocation of resources Opportunity for better utilization of resources through HTA implementation Lack of NUMERICAL data Opportunity to better utilize RWE Rationalize HC spending with focus on priority DZ consuming significant HC budget, including CVD, Hepatitis C. 3 Egypt, Country outlook Country Description Area: 1,001,450 km 2 Inhabited area: 6 % of total area Capital: Cairo Population: 85 million Pop. annual growth: 1.9% Life expectancy: 71 Economy Currency: 1 EGP (=0.16 $) GDP/capita: 3,112 $ GDP growth: 2010: 4.8% 2011E: 3% 2015: Target 3.8 % Inflation: 10.5% Unemployment: 8.4% Pop. below poverty: 15 % ISPOR Arabic Forum, DC. May 2016 4 2
Macro Egypt, National Health Accounts 1994/95 2001/02 2007/08 2008/09 THE per Capita (LE) 127.0 346.0 566.4 800.1 Percent of GDP Spent on Health 3.7% 6.0% 4.8% 5.9% Public Health Expenditures Percent of THE 33.0% 30.0% 33.0% 24.8% MOHP Expenditures Percent of THE 22.0% 23.0% 24.0% 16.5% Out-of-Pocket Expenditures as Percent of THE 51.0% 62.0% 60.0% 71.8% Pharmaceuticals as Percent of THE 36.0% 37.0% 26.0% 34.2% Public Spending as Percent of GOE Expenditures MOHP Expenditures as Percent of GOE Expenditures 5.0% 5.0% 4.3% 4.0% 3.5% 2.8% Source: Egypt NHA1-4 WE NEED TO PUMP MORE MONEY INTO HEALTHCARE How did we affect y? Who Manages? Who pays? Others 3% Who Pays? Households 70% MOHP 17% Other Government 4% HIO 6% Source: Egypt NHA4 MOH has solidified it s stance on implementing the new Social health Insurance System. Paradox : Despite Egypt s increased spending on Primary care and expansion of insurance coverage by HIO, the percentage out of pocket expenditure is increasing!! Pharmaceutical system/expenditures is symptomatic of our healthcare struggles. What to do? (all or some?) 1. Social Health Insurance System (ultimate Solution?) 2. Pump more money into PTES. 3. Increase utilization in HIO 4. Huge misallocation of resources 3
Egypt Compared to other Middle Income Countries in the Region Percent GDP Spent on Health Government Spending as Percentage of THE Health Spending as Percentage of Total Government Budget Out-of-Pocket Expenditure as Percentage of THE Algeria 4.49% 83.85% 10.65% 15.30% Djibouti 8.54% 76.07% 14.15% 23.60% Egypt 5.90% 24.80% 4.30% 71.80% Iran 6.30% 45.72% 11.40% 51.68% Jordan 9.10% 62.20% 11.35% 33.40% Lebanon 8.76% 48.99% 12.39% 39.95% Libya 2.80% 75.88% 5.38% 24.12% Morocco 5.33% 34.97% 6.17% 56.13% Syria 3.23% 45.13% 6.01% 54.87% Tunisia 5.95% 49.57% 8.90% 42.52% Sources: World Health Organization (WHO) NHA data, Egypt NHA results, Jordan NHA Report Egypt has highest burden of out-of-pocket spending. Government spending both as a percent of THE and Budget is ISPOR Arabic Forum, DC. May 2016 7 the lowest. Linking Spending to Disease Burden and Demographic Trends - Move resources to high disease-burden governorates. -Increase focus on Prevention. -Focus on and prioritize chronic diseases, CVD s, Hepatitis C. - Develop programs for the new developing groups. Eg, elderly. - Think of decreasing funds for diseases we suffer no more from. eg. Filaria, Malaria, Leishmania, etc 8 4
Cardiovascular Disease, WHO/ AHA Group of disorders affecting heart and blood vessels, including: Coronary heart disease: disease of the blood vessels supplying the heart muscle (HTN a major risk factor) Cerebrovascular disease: disease of the blood vessels supplying the brain; Peripheral arterial disease: disease of blood vessels supplying the arms and legs; Rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria; Heart failure : Heart isn't pumping blood as well as it should Heart failure can get worse if it's not treated. New innovative products offer lots of hope to patients 9 CV Burden of Disease, Shocking figures! CVDs are the number 1 cause of death globally, same applies for MENA countries. more people die annually from CVDs than from any other cause. An estimated 17.5 million people died from CVDs in 2012, representing 31% of all global deaths. 7.4 million were due to coronary heart disease and 6.7 million were due to stroke Over 35% of deaths in MENA are attribute to CVD CV disease constitutes 50 % of deaths attributed to NCD deaths Out of the 16 million deaths under the age of 70 due to noncommunicable diseases, 82% are in low and middle income countries and 37% are caused by CVDs. Ref :http://www.who.int/mediacentre/factsheets/fs317/en/ (updated Jan 2015) 10 5
CV BoD, Cont By 2030, almost 23.6 million people will die from CVD, mainly from heart disease and stroke. It is projected to remain the single leading cause of death Most cardiovascular diseases can be prevented by addressing behavioral risk factors Smoking Stress Exercise Dietary habits Reduction of other risk factors CVD is responsible for 10 per cent of disability adjusted life years (DALYs) lost in low- and middle-income countries 11 CVD, Global Economic Burden 12 6
CVD, Economic burden 23 LMIC(Including MENA countries) reported losing $84 billion in economic output in 2006 15 from coronary heart disease & stroke. As little as a 2% yearly additional reduction in mortality rates from chronic diseases would save almost 10% of the expected loss in income= 8$f for LMIC Egypt :1.26 Billion USD in cumulative GDP loss due to CVD in 2015 ( according to 2007 estimates) Ref : Lancet, vol 370, 2007 13 HTN, Globally Worldwide, elevated blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths worldwide This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS Globally, the overall prevalence of raised blood pressure in adults aged 25 and over was around 40% in 2008. Across the income groups of countries, the prevalence of raised blood pressure was consistently high, with low, lower middle and upper middle countries all having rates of up to around 40%. Cost in the US exceeding 50 BN annually Big variations across income groups and LMIC vs High income countries Obesity Lower educational status Higher stress levels Lower exercise rates Well over 1 billion patients globally with HTN, (Numbers expected to grow with ageing population) Ref: Global health repository ( WHO): http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/ 14 7
Egypt, HTN (Clinical Burden) National hypertension project : Prevalence rate= 26.3 % Astounding 24 million Egyptians with hypertension Only 38 % of hypertensive patients in Egypt are aware they have HTN Only 24 % receiving treatment ONLY 8 % at control rates ( less than 140/90 mmhg) Significant comorbidities exist within pt. population including (CAD, HF, RF) Prevalence increases with age Urgent need for development of Nat l HTN guidelines aimed at Improving awareness TX/control of Hypertension Improving prognosis and associated morbidities Lack of data on economic burden Ref :Egyptian Heart Journal, Ibrahim et al, Vol 66, issue 2, June 2014 15 Heart failure, (Clinical Burden) Heart failure affects 1-2 % of the adult population with Incidence around 26 million patients globally. Incidence increase with age, Hence with an aging global population there is an expected increase over time. Significant reduction in ADL * accompanied with CV and non CV related morbidities Primary cause of hospitalization for patients above 65 Y/O 50% mortality rate for 5 year period Growing Healthcare problem due to ageing population Ref :Mozaffarian et al 2015 *ADL= Activities of daily living 16 8
Heart failure, (Economic Burden) Heart failure carries a significant economic burden. Estimated at 108 billion $ annually Direct and indirect medical and treatment costs ( cook et al,2014) Average cost of hospitalization in Egypt/day for HF Average back of the envelope calculation= 2300 Egp = 260 $ Average of private/public hospitals Significant clinical and economic burden and increasing burden of hospitalization ( lack of ICU beds) Estimated total HF costs for selected MENA countries Egypt expenditures on HF= 169 Mil $ Saudi Arabia= 648 Mil $ UAE=387 Mil $ Algeria = 134 Mil $ Ref : Cook et al, 2014, Int l Journal cardiology 171 (2014), Recent progress in treatment can reduce BoD, hospitalization and mortality Access to innovation VS Disease burden 17 Conclusion CVD across MENA/Globe is also a long-term problem, requiring long term solutions. Clinical and economic burden is significant Focus should be on prevention as well as treatment Growing problem due to aging population Innovative treatments/interventions/preventions strategies/screening can provide cost effective solutions More research, Burden of disease studies are needed to quantify economic burden across Egypt and MENA countries, 18 9
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