Costs and cost-effectiveness of type 2 diabetes management in Sub-Saharan Africa: a systematic review.

BACKGROUND: Type 2 Diabetes (T2D) is rapidly increasing in Sub-Saharan Africa (SSA), with related health and financial implications. Knowledge of the costs and cost-effectiveness of managing diabetes is needed to increase awareness, improve resource allocation and enhance the use of evidence-based decision-making. Accordingly, this study sought to synthesise and critically review evidence on the costs and cost-effectiveness of managing T2D in Sub-Saharan Africa (SSA). METHODS: A systematic search was conducted in multiple databases, including PubMed-Medline, Africa-Wide Information, Web of Science, Cochrane Library, CINAHL, Scopus, and Google Scholar, to identify studies published between January 2010 and December 2023; the searches were updated in June 2024. All cost data were converted to 2024 United States dollars (US$) using appropriate inflation adjustments and exchange rates. The review protocol was registered with PROSPERO (CRD42022300580). RESULTS: The search yielded 4137 unique abstracts, and 18 studies were included for review, most originating from Nigeria. Most studies assessed costs from a provider perspective, focusing on direct medical costs (e.g., outpatient consultations, medications, diagnostic and monitoring tests, and follow-up care). Reported costs of T2D management were substantial across settings. Annual costs ranged from US$337.50 for basic medical care of uncomplicated T2D to US$2330.74 in total provider cost per patient. The highest burden was reported among individuals in the low-income quantile. Only five studies assessed cost-effectiveness, most using modelling and simulation approaches. T2D management programmes can be cost-effective, but the evidence remains limited. CONCLUSIONS: This review identified substantial variation in methods, perspectives, and cost components across T2D cost studies in SSA, which limits direct comparability. Improving methodological transparency and reporting, alongside addressing data-collection gaps, would strengthen the evidence base. Further context-specific economic evaluations, particularly those incorporating affordability, implementation feasibility, and budget impact, are needed to support priority setting and resource allocation for T2D management in SSA.