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

Nusrat  Naseem; Aqeel  Ahmed; Satish  Kumar; Attiya  Rabbani; Aniqa  Tariq; Shoukat  Ali; Hifsa  Tariq

doi:10.63516/

Authors

Nusrat Naseem Health Services Academy, Islamabad Author
Aqeel Ahmed Isra University, Islamabad Campus Author
Satish Kumar Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan Author
Attiya Rabbani Iqra University, Islamabad Campus Author
Aniqa Tariq Iqra University, Islamabad Campus Author
Shoukat Ali PAEC G Hospital, Islamabad Author
Hifsa Tariq Comwave, Islamabad Author

DOI:

https://doi.org/10.63516/

Keywords:

cardiac diseases, economic burden, disability-adjusted life years, healthcare costs

Abstract

Background: Cardiac diseases represent a significant 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 remain 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 modelling, 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 the burden. Regional disparities showed higher DALY rates in Sindh (1,456 per 100,000) versus Islamabad (1,289 per 100,000).

Conclusion: 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.

Author Biographies

Nusrat Naseem , Health Services Academy, Islamabad

Assistant Professor
Aqeel Ahmed, Isra University, Islamabad Campus

Principal, Isra Institute of Rehabilitation Sciences, Alnafees Medical College
Satish Kumar, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan

Lecturer
Attiya Rabbani, Iqra University, Islamabad Campus

Head of Department
Aniqa Tariq, Iqra University, Islamabad Campus

Lecturer
Shoukat Ali, PAEC G Hospital, Islamabad

PMO/Medical Specialist
Hifsa Tariq, Comwave, Islamabad

Physiotherapist

References

1. Adeniji, F. I. P., & Obembe, T. A. (2023). Cardiovascular disease and its implication for higher catastrophic health expenditures among households in sub-Saharan Africa. Journal of Health Economics and Outcomes Research, 10(1), 59.

2. Ahmad, F., & Anwar, S. (2023). Socio economic factors associated with prevalence of non-communicable diseases among adults in Punjab, Pakistan. Annals of Punjab Medical College, 17(3), 275-280.

3. Chong, B., Jayabaskaran, J., Jauhari, S. M., Chan, S. P., Goh, R., Kueh, M. T. W., ... & Chan, M. Y. (2024). Global burden of cardiovascular diseases: projections from 2025 to 2050. European Journal of Preventive Cardiology, zwae281.

4. Daroudi, R., Akbari Sari, A., Nahvijou, A., & Faramarzi, A. (2021). Cost per DALY averted in low, middle-and high-income countries: evidence from the global burden of disease study to estimate the cost-effectiveness thresholds. Cost Effectiveness and Resource Allocation, 19, 1-9.

5. Ferrari, A. J., Santomauro, D. F., Aali, A., Abate, Y. H., Abbafati, C., Abbastabar, H., ... & Bell, M. L. (2024). Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 403(10440), 2133-2161.

6. Goh, R. S. J., Chong, B., Jayabaskaran, J., Jauhari, S. M., Chan, S. P., Kueh, M. T. W., ... & Chew, N. W. (2024). The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions. The Lancet Regional Health–Western Pacific, 49.

7. Jafar, A., & Quadri, U. F. (2023). Macroeconomic outcomes of healthcare financing reforms in Nigeria: a computable general equilibrium analysis.

8. Kazi, D. S., Elkind, M. S., Deutsch, A., Dowd, W. N., Heidenreich, P., Khavjou, O., ... & American Heart Association. (2024). Forecasting the economic burden of cardiovascular disease and stroke in the United States through 2050: a presidential advisory from the American Heart Association. Circulation, 150(4), e89-e101.

9. Kumar, A., Siddharth, V., Singh, S. I., & Narang, R. (2022). Cost analysis of treating cardiovascular diseases in a super-specialty hospital. Plos one, 17(1), e0262190.

10. Li, Z., Lin, L., Wu, H., Yan, L., Wang, H., Yang, H., & Li, H. (2021). Global, regional, and national death, and disability-adjusted life-years (DALYs) for cardiovascular disease in 2017 and trends and risk analysis from 1990 to 2017 using the global burden of disease study and implications for prevention. Frontiers in public health, 9, 559751.

11. Masaebi, F., Salehi, M., Kazemi, M., Vahabi, N., Azizmohammad Looha, M., & Zayeri, F. (2021). Trend analysis of disability adjusted life years due to cardiovascular diseases: results from the global burden of disease study 2019. BMC Public Health, 21, 1-13.

12. Mensah, G. A., Fuster, V., Murray, C. J., Roth, G. A., & Global Burden of Cardiovascular Diseases and Risks Collaborators. (2023). Global burden of cardiovascular diseases and risks, 1990-2022. Journal of the American College of Cardiology, 82(25), 2350-2473.

13. Munir, M., Oubaid, M., Baig, A. A., Azam, A., & Khalil, H. (2023). Recent facts of eating habits and obesity among adolescent; a case of Pakistan. International Journal of Natural Medicine and Health Sciences, 2(2), 49-57.

14. Nammi, J. Y., Pasala, R., Kotaru, S., Bandikolla, S. S., Andhe, N., & Gouravaram, P. R. (2024). Cardiovascular Disease Prevalence in Asians Versus Americans: A Review of Genetics, Diet, and the Call for Enhanced Prevention and Screening. Cureus, 16(4).

15. Raheem, A., Ahmed, S., Kakar, A. W., Majeed, H., Tareen, I., Tariq, K., ... & Karim, M. (2022). Burden of cardiovascular diseases in South Asian region from 1990 to 2019: Findings from the global burden of disease study. Pakistan Heart Journal, 55(1), 15-21.

16. Rwebembera, J., Marangou, J., Mwita, J. C., Mocumbi, A. O., Mota, C., Okello, E., ... & Reményi, B. (2024). 2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease. Nature Reviews Cardiology, 21(4), 250-263.

17. Saeed, A., Saeed, F., Saeed, H., Saleem, Z., Yang, C., Chang, J., ... & Babar, Z. U. D. (2021). Access to essential cardiovascular medicines in Pakistan: a national survey on the availability, price, and affordability, using WHO/HAI methodology. Frontiers in pharmacology, 11, 595008.

18. Sharma, M., John, R., Afrin, S., Zhang, X., Wang, T., Tian, M., ... & Saif-Ur-Rahman, K. M. (2022). Cost-effectiveness of population screening programs for cardiovascular diseases and diabetes in low-and middle-income countries: a systematic review. Frontiers in public health, 10, 820750.

19. Shams, P., Hussain, M., Karani, S., Mahmood, S., Hasan, A., Siddiqi, S., ... & Samad, Z. (2021). Can sound public health policies stem the tide of burgeoning epidemic of cardiovascular disease in South Asians?. Current Cardiology Reports, 23, 1-11.

20. Vaduganathan, M., Mensah, G. A., Turco, J. V., Fuster, V., & Roth, G. A. (2022). The global burden of cardiovascular diseases and risk: a compass for future health. Journal of the American College of Cardiology, 80(25), 2361-2371.

21. Waghmare, H., Chauhan, S., & Sharma, S. K. (2022). Prevalence and determinants of nutritional status among women and children in Pakistan. BMC Public Health, 22(1), 766.

22. Xu, X., Islam, S. M. S., Schlaich, M., Jennings, G., & Schutte, A. E. (2024). The contribution of raised blood pressure to all-cause and cardiovascular deaths and disability-adjusted life-years (DALYs) in Australia: Analysis of global burden of disease study from 1990 to 2019. Plos one, 19(2), e0297229.

23. Yan, W., Yan, X., Mubarik, S., & Nawsherwan. (2023). Epidemiological trend and age-period-cohort effects on cardiovascular disease mortality and disability-adjusted life years attributable to dietary risks and high body mass index at the regional and country level across China and Pakistan. Frontiers in nutrition, 10, 1158769.