The Economic Costs of Cardiovascular Disease, Diabetes Mellitus, and Associated Complications in South Asia: A Systematic Review

Ian F. Walker*, Fredrike Garbe, Judy Wright, Ian Newell, Naveen Athiraman, Nida Khan, Helen Elsey

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

24 Citations (Scopus)


Background More than 80% of global deaths caused by cardiovascular disease (CVD) and diabetes mellitus (DM) occur in developing countries. The burden of noncommunicable disease in South Asia is increasing rapidly. Objectives To estimate the costs of CVD and the costs of DM to individuals and society in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Methods We systematically searched six health and economic databases for studies identifying costs related to CVD or DM and their respective complications. Costs were extracted from included studies and converted to US $ for the price year 2015 to enable meaningful comparisons. Results Of the 71 articles suitable for full-text review, 29 studies met the inclusion criteria. Most were cost-of-illness studies (n = 27) and were from the patient perspective (n = 23). Most collected data since 2000 (n = 23) and included data from India (n = 24). No studies included longitudinal costs at the patient level. Medical costs for routine management of CVD and DM were broadly similar. These costs escalate significantly once complications occur, which require treatment, particularly for stroke, major coronary events, and amputations. Costs are mainly borne by the individual and family. Some included studies modeled rapidly rising future costs. Most studies included had methodological weaknesses. Conclusions Marked increases in costs have been identified when complications of these chronic diseases occur, underlining the importance of secondary prevention approaches in disease management in South Asia. Higher quality studies, especially those that include longitudinal costs, are required to establish more robust cost estimates.

Original languageEnglish
Pages (from-to)12-26
Number of pages15
JournalValue in Health Regional Issues
Publication statusPublished - May 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017


  • South Asia
  • cardiovascular diseases
  • complications
  • costs and cost analysis
  • diabetes mellitus
  • systematic review


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