Economic Burden and Disability-Adjusted Life Years (DALYs) Associated with Cardiac Diseases in Pakistan: A Comprehensive Cross-Sectional Analysis

Abstract

Background: Cardiac diseases represent a major public health challenge in Pakistan, contributing significantly to mortality, morbidity, and economic burden. Despite the prevalence of cardiovascular conditions in low- and middle-income countries, comprehensive data on economic impact and disability burden remains limited in Pakistan. This study aimed to explore the economic burden and quantify disability-adjusted life years (DALYs) associated with cardiac diseases across healthcare settings in Pakistan.

Methods: A cross-sectional mixed-methods analysis was conducted across major healthcare facilities in Islamabad and Sindh (Hyderabad) from January 2023 to December 2024. Primary data collection involved 1,486 cardiac patients combined with secondary analysis of hospital records. Direct, indirect, and intangible costs were systematically assessed using a societal perspective. DALYs were calculated using WHO methodology, incorporating years of life lost (YLL) and years lived with disability (YLD). Statistical analysis included descriptive statistics, regression modeling, and sensitivity analyses.

Results: Mean annual direct medical costs were PKR 387,450 per patient in Islamabad and PKR 298,750 in Hyderabad. Total societal costs reached PKR 892,340 and PKR 674,890 respectively. Catastrophic health expenditure affected 68.4% of Islamabad families and 74.2% in Hyderabad. The analysis identified 847,620 DALYs lost annually, with ischemic heart disease accounting for 52.3% of burden. Regional disparities showed higher DALY rates in Sindh (1,456 per 100,000) versus Islamabad (1,289 per 100,000).

Conclusions: This comprehensive assessment reveals substantial healthcare and societal costs, with widespread catastrophic health expenditure indicating significant financial vulnerability. The considerable DALY burden underscores urgent needs for enhanced prevention strategies and improved care services, with critical implications for healthcare policy and resource allocation.