Assessing costs of a hypertension management program: An application of the HEARTS costing tool in a program planning workshop in Thailand

Husain, Muhammad Jami; Allaire, Benjamin T.; Hutchinson, Brian; Ketgudee, Lalida; Srisuthisak, Sasamon; Yueayai, Khanuengnij; Pisitpayat, Nichakul; Nugent, Rachel; Datta, Biplab Kumar; Joseph, Kristy; Kostova, Deliana

doi:10.1111/jch.13773

Cited by 6 publications

(8 citation statements)

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“…Programme costs were assessed using the HEARTS costing tool, an Excel-based instrument to collect, track and evaluate the incremental annual cost of implementing the HEARTS programme from the health system perspective. The tool is organised by HEARTS modules 24. In July–August 2020, we obtained unit costs from four upazila complexes and used these to project annual resource needs for implementing the CVD prevention programme at the subdistrict population level.…”

Section: Methodsmentioning

confidence: 99%

“…The tool is organised by HEARTS modules. 24 In July-August 2020, we obtained unit costs from four upazila complexes and used these to project annual resource Open access needs for implementing the CVD prevention programme at the subdistrict population level. The researchers completed in-person collection of data from the four facilities on human resource and time costs, diagnostic prices, time-motion on laboratory diagnostics, market price of medicines and others.…”

Section: Hearts Costing Toolmentioning

confidence: 99%

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Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application

et al. 2022

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ObjectiveTo estimate the costs of scaling up the HEARTS pilot project for hypertension management and risk-based cardiovascular disease (CVD) prevention at the full population level in the four subdistricts (upazilas) in Bangladesh.SettingsTwo intervention scenarios in subdistrict health complexes: hypertension management only, and risk-based integrated hypertension, diabetes, and cholesterol management.DesignData obtained during July–August 2020 from subdistrict health complexes on the cost of medications, diagnostic materials, staff salaries and other programme components.MethodsProgramme costs were assessed using the HEARTS costing tool, an Excel-based instrument to collect, track and evaluate the incremental annual costs of implementing the HEARTS programme from the health system perspective.Primary and secondary outcome measuresProgramme cost, provider time.ResultsThe total annual cost for the hypertension control programme was estimated at US$3.2 million, equivalent to US$2.8 per capita or US$8.9 per eligible patient. The largest cost share (US$1.35 million; 43%) was attributed to the cost of medications, followed by the cost of provider time to administer treatment (38%). The total annual cost of the risk-based integrated management programme was projected at US$14.4 million, entailing US$12.9 per capita or US$40.2 per eligible patient. The estimated annual costs per patient treated with medications for hypertension, diabetes and cholesterol were US$18, US$29 and US$37, respectively.ConclusionExpanding the HEARTS hypertension management and CVD prevention programme to provide services to the entire eligible population in the catchment area may face constraints in physician capacity. A task-sharing model involving shifting of select tasks from doctors to nurses and local community health workers would be essential for the eventual scale-up of primary care services to prevent CVD in Bangladesh.

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Section: Methodsmentioning

confidence: 99%

Section: Hearts Costing Toolmentioning

confidence: 99%

Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application

et al. 2022

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“… 36 Capacity building for local health economists and budget specialists has enabled health ministries to participate in the all-important government budgeting cycle, 37 and those responsible for NCD strategy implementation need to be involved. 38 …”

Section: Step 3: Making the Plans And Priorities Implementablementioning

confidence: 99%

“…The situation is improving, however, as global NCD service cost estimates have recently become available36 and more countries have costed NCD strategies 36. Capacity building for local health economists and budget specialists has enabled health ministries to participate in the all-important government budgeting cycle,37 and those responsible for NCD strategy implementation need to be involved 38…”

Section: Step 3: Making the Plans And Priorities Implementablementioning

confidence: 99%

‘Implementability’ matters: using implementation research steps to guide and support non-communicable disease national planning in low-income and middle-income countries

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The ‘implementation gap’ between national plans and successful implementation is a central theme in addressing non-communicable diseases (NCDs). It is a factor that has undermined Sustainable Development Goal 3.4, which aims to achieve a one-third reduction in premature mortality from four major NCDs by 2030. Responding to the potential of implementation research to support low-income and middle-income countries to effectively advance their strategies, we describe ways to make NCD plans more robust by including implementation steps. These steps are (1) choosing some (but not all) effective and cost-effective options; (2) tailoring interventions and their scale-up to national capacity; and (3) making the priorities implementable. We illustrate with examples from several countries.

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“…The Excel-based HEARTS Costing Tool is designed to assist decision makers to plan and budget for the HEARTS program. The tool is available online and its structure and methods are described in detail in an accompanying user guide (16)(17)(18). Using a healthcare system perspective, the tool calculates the HEARTS costs over a one-year time horizon.…”

Section: The Hearts Costing Toolmentioning

confidence: 99%

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

Chivardi

Hutchinson

Molina

et al. 2022

Revista Panamericana De Salud Pública

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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.

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Assessing costs of a hypertension management program: An application of the HEARTS costing tool in a program planning workshop in Thailand

Cited by 6 publications

References 3 publications

Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application

Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application

‘Implementability’ matters: using implementation research steps to guide and support non-communicable disease national planning in low-income and middle-income countries

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

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