Assessing costs of a hypertension program in primary care: evidence from the HEARTS program in Mexico

Abstract

Objective. In 2021, Mexico launched the HEARTS program to improve the prevention and control of cardiovascular disease (CVD) risk factors in 20 primary care facilities in the states of Chiapas and Yucatán. This study projects the annual cost of program implementation and discusses budgetary implications for scaling up the program. Methods. We obtained district-level data on treatment protocols, medication costs, and other resources required to prevent and treat CVD. We used the HEARTS Costing Tool to estimate total and per-patient costs. A “partial implementation” scenario calculated the costs of implementing HEARTS if existing pharmacological treatment protocols are left in place. The second scenario, “full implementation,” examined costs if programs use HEARTS pharmacological protocol. Results. Respectively in the partial and full implementation scenarios, total annual costs to implement and operate HEARTS were $260 023 ($32.1 per patient/year) and $255 046 ($31.5 per patient/year) in Chiapas, and $1 000 059 ($41.3 per patient/year) and $1 013 835 ($43.3 per patient/year) in Yucatán. In Chiapas, adopting HEARTS standardized treatment protocols resulted in a 9.7 % reduction in annual medication expenditures relative to maintaining status-quo treatment approaches. In Yucatán, adoption was $12 875 more expensive, in part because HEARTS hypertension treatment regimens were more intensive than status quo regimens. Conclusion. HEARTS in the Americas offers a standardized strategy to treating and controlling CVD risk factors. In Mexico, approaches that may lead to improved program affordability include adoption of the recommended HEARTS treatment protocols with preferred medications and task shifting of services from physicians to nurses and other providers.

Can the HEARTS initiative reduce the burden of cardiovascular disease?

“…Cost might be a significant barrier with estimates of US$9–US$44 per person treated per year, and antihypertensive drugs need to be priced low enough to reach <$5 per patient per year to provide medications alone in the public sector but still can significantly impact national budgets when scaled up 8. However, the adoption of HEARTS standardised protocols in Chiapas, Mexico, resulted in a 9.7% reduction in annual medication expenditure, a substantive saving that can help offset the overall pressure on healthcare budgets 9. These findings are consistent with the extensive evidence of the effectiveness, cost-effectiveness and population impact on hypertension control, which is considered one of WHO’s Best Buys.…”

HEARTS en las Américas: impulsar el cambio en el sistema de salud para mejorar el control de la hipertensión en la población

“…En México, la aplicación de esta iniciativa está dando lugar a cambios importantes en los sistemas de información, centrados en el fortalecimiento de la red de atención primaria [ 77 ]. El modelo de México no solo está haciendo que mejoren los resultados de salud con respecto al control de la hipertensión, sino que también está propiciando propuestas para realizar otras intervenciones eficaces, de aplicación sistemática y basadas en la evidencia, que pueden reducir los costos en la implementación de los programas [ 78 ].…”

Building the health-economic case for scaling up the WHO-HEARTS hypertension control package in low- and middle-income countries

“…In 2021, the Mexican states of Chiapas and Yucatan launched the HEARTS program in 20 primary care facilities. ( 17 ) A cost analysis of the program in Chiapas found that the types of hypertension medications recommended by the HEARTS program (chlorthalidone, amlodipine, lisinopril) were less costly than those currently in use (telmisartan, hydrochlorothiazide, captopril, enalapril, amlodipine, losartan). In Chiapas, adoption of standardized treatment protocols was estimated to result in a 9.7% reduction in annual medication expenditures relative to maintaining status-quo treatment approaches.…”