OBJECTIVES : The burden of cardiovascular diseases is growing in countries of Middle East and North Africa (MENA), and health systems are under pressure for efficient resource allocation. However, local data are scarce for health economic evaluation. Our aim was to systematically review the methodology of studies and analyse the intra-regional transferability of hospitalisation costs of chronic cardiovascular conditions within MENA.

METHODS : A systematic review of studies reporting disease-related costs from MENA between 1995-2019 was conducted. PubMed and the reference lists of four regional systematic reviews were searched. Studies reporting cardiovascular disease-related costs were considered eligible. The diagnosis, country of origin, main methods and elements of reported costs were analysed descriptively.

RESULTS : From 1,646 citations we identified 13 eligible studies reporting 302 cardiovascular cost items between 2006-2019. Most frequent diagnoses were stroke (n=3), coronary heart disease (n=3) and atrial fibrillation (n=2), followed by hypertension(n=1) , chronic heart failure (n=1), deep vein thrombosis (n=1), cardiac arrest (n=1) and unspecified cardiovascular disease (n=1). Seven studies reported costs from Saudi Arabia, two from Algeria, and one study from Bahrain, Palestine, Syria and Tunisia. Altogether, 32 hospitalisation costs were reported by one study from Algeria (atrial fibrillation, n=15) and three studies from Saudi Arabia (deep vein thrombosis, n=2; congestive heart failure, n=10; ischemic heart disease, n=5). The components of hospitalisation costs differed for all four studies. Bed utilisation was included in all four studies, but medicines, procedures, physicians, nursing and laboratory costs were included by two studies in different combinations. Furthermore, two studies reported costs by disease severity level.

CONCLUSIONS : Our study demonstrated striking methodological heterogeneity of hospitalisation costs of cardiovascular diseases in MENA. When transferring costs from other jurisdictions within the region to substitute missing local costs, this heterogeneity needs to be taken into consideration and adjusted for with appropriate econometric methods.