Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program

Rosendaal, Nicole; Hendriks, Marleen Elisabeth; Verhagen, Mark D.; Bolarinwa, Oladimeji Akeem; Sanya, Emmanuel; Kolo, P.M.; Adenusi, Peju; Agbede, Kayode; Eck, Diederik van; Tan, Siok Swan; Akande, T.M.; Redekop, William K.; Schultsz, Constance; Gomez, Gabriela B.

doi:10.1371/journal.pone.0157925

Cited by 36 publications

(71 citation statements)

References 61 publications

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“…A Markov model-based Costs and cost-effectiveness of hypertension screening and treatment in adults with hypertension in rural Nigeria showed that Screening and treatment for hypertension was potentially cost-effective with a wide range of uncertainty (24). This is in line with other studies that screening for adults below age 40 years is not-cost effective.…”

Section: Discussionsupporting

confidence: 80%

“…There is no enough evidence to recommend screening asymptomatic adults with no risk factor for hypertension. All studies form developed and developing countries revealed that screening adults aged 40 years with one or more risk factor is cost-effective (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). This is in line with WHO PEN package interventions for primary health care in developing countries (34).…”

Section: Discussionmentioning

confidence: 73%

“…Concerning the target populations four studies included people aged 40 years and above (13)(14)(15)(16), three studies included people aged 50 years and above (17)(18)(19), two studies included age 30 years and above (20,21) and two studies included age 15 years and above (Table 2) (22,23).…”

Section: Resultsmentioning

confidence: 99%

“…A Costs and cost-effectiveness of hypertension screening and treatment in adults with hypertension in rural Nigeria showed that the ICER for the first (hypertension and risk based) and second (risk based) strategy respectively ranged from US $1,406 to US $7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment. Cost-effectiveness of Screening for hypertension was sensitive to changes in underlying assumptions with a wide range of uncertainty (24).…”

Section: Cost-effectiveness Analysis Of Screening For and Managing Idmentioning

confidence: 99%

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Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

Davari¹,

Sorato²,

Nikfar³

2020

Preprint

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Background: Hypertension is one of major modifiable risk factors contributing for development of ischemic heart disease, diabetes, kidney disease, cerebrovascular disease and peripheral arterial disease. Silent nature of the disease, delayed presentation of patients to health system after development of significant cardiovascular events and poor access to comprehensive health care are major challenge of hypertension control. Early screening, detection and treatment of hypertension is effective for control of the disease progression. However, there is no robust evidence on whether screening general population for hypertension is cost-effective or not. Therefore, this review was conducted t o generate evidence on cost effectiveness of population-based hypertension screening for asymptomatic individuals as early detection strategy for the primary prevention of cardiovascular diseases. Methods: PubMed/Medline , Scopus, Web of sciences and Google Scholar were searched from January 2000 to 11 December 2019. Two investigators independently selected and reviewed fair and good-quality pharmacoeconomic studies for the cost-effectiveness of asymptomatic screening for hypertension in the community. Quality of selected literatures are evaluated by authors based on comprehensive tool developed for critical appraisal of pharmacoeconomic studies. Results: Eleven included Pharmacoeconomic studies reported favorable results for screening asymptomatic adults for hypertension. Most of studies agreed on cost-effectiveness of screening adults aged 40 years and older. Screening of general adult population for hypertension is not-cost effective. Conclusion: Screening population 40 years and older with or without additional risk factors is cost-effective in reducing hypertension and associated cardiovascular disease morbidity and mortality in developed and developing countries.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Section: Cost-effectiveness Analysis Of Screening For and Managing Idmentioning

confidence: 99%

See 2 more Smart Citations

Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

Davari¹,

Sorato²,

Nikfar³

2020

Preprint

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“…Cost studies exist from several countries [4][5][6][7][8][9] around the world and in Africa for prevention [10] and for arterial hypertension [11].…”

Section: Introductionmentioning

confidence: 99%

Direct Cost of Cardiovascular Diseases in Cardiology Department of University Hospital Gabriel Touré (Uh Gt): Comparative Study Between Patients With and Without Medical Insurance

Ba¹,

Camara²,

Sangaré³

et al. 2018

Cardiol Vasc Res

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Aim: This study aims to compare cardiovascular diseases direct costs for patients with and those without medical insurance. Methods: It was a prospective study from Mai 02 to August 31 2016 in the cardiology department of the UH GT. All outpatients aged 15 years and older, who came to visit, accepted to participate in the study and were involved. Direct costs (transport, consultation, labor tests and medicaments) were recorded for each patient at each visit. Data were inserted in a MS Access 2010 database and exported in SPSS 20 for analysis, comparing 2 groups (patients with and without medical insurance). Chi-2 and Fisher tests if applicable were used for statistical tests. Results: All patients seen in the study time (922 patients of whom 62.9% were female and 35.7% between 60-74 years) were included. A proportion of 30.5% had medical insurance (281/922). Patients with diabetes, dyslipidemia and obesity were found among patients with medical insurance with respectively 47.5, 62.4 and 49.2%. Most frequent cardiovascular diseases among patients with medical insurance were high blood pressure without and with complications, acute coronary syndrome with respectively 36.2, 34.7 and 29.2%. Direct costs for patients with medical insurance were 1.06 to 1.77 times higher. Labor tests generated the highest costs. Direct costs for all cardiovascular diseases were higher for patients without medical insurance, up to 4 times for venous thrombo-embolic disease. Total costs were higher for patients with medical insurance.

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Cost-effectiveness of a Multicomponent Intervention for Hypertension Control in Low-Income Settings in Argentina

et al. 2021

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IMPORTANCE Hypertension is highly prevalent in low-and middle-income countries, and it is an important preventable risk factor for cardiovascular diseases (CVDs). Understanding the economic benefits of a hypertension control program is valuable to decision-makers.OBJECTIVE To evaluate the long-term cost-effectiveness of a multicomponent hypertension management program compared with usual care among patients with hypertension receiving care in public clinics in Argentina from a health care system perspective. DESIGN, SETTING, AND PARTICIPANTSThis economic evaluation used a Markov model to estimate the cost-effectiveness of a hypertension management program among adult patients with uncontrolled hypertension in a low-income setting. Patient-level data (743 individuals for multicomponent intervention; 689 for usual care) from the Hypertension Control Program in Argentina trial (HCPIA) were used to estimate treatment effects and the risk of CVD. Three health states were included in each strategy: (1) low risk of CVD, (2) high risk of CVD, and (3) death. The total time horizon was the lifetime, and each cycle lasted 6 months. MAIN OUTCOMES AND MEASURES Model inputs were based on trial data and other published sources. Cost and utilities were discounted at a rate of 5% annually. The incremental costeffectiveness ratio (ICER) between the multicomponent intervention and usual care was calculated using the difference in costs in 2017 international dollars (INT $) divided by the difference in effectiveness in quality-adjusted life-years (QALYs). One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the uncertainty and robustness of the results. RESULTS In the original trial, the 743 participants in the intervention group (349 [47.0%] men) had a mean (SD) age of 56.2 (12.0) years, and the 689 participants in the control group (311 [45.1%] men) had a mean (SD) age of 56.2 (11.7) years. In the base-case analysis, the HCPIA program yielded 8.42 discounted QALYs and accrued INT $3096 discounted costs, while usual care yielded 8.29 discounted QALYs and accrued INT $2473 discounted costs. The ICER for the HCPIA program was INT $4907/QALY gained. The model results remained robust in sensitivity analyses, and the model was most sensitive to parameters of program costs. CONCLUSIONS AND RELEVANCEIn this study, the HCPIA multicomponent intervention vs usual care was a cost-effective strategy to improve hypertension management and reduce the risk of associated CVD among patients with hypertension who received services at public clinics in Argentina. This intervention program is likely transferable to other settings in Argentina or other lower-and middle-income countries.

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Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program

Cited by 36 publications

References 61 publications

Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

Direct Cost of Cardiovascular Diseases in Cardiology Department of University Hospital Gabriel Touré (Uh Gt): Comparative Study Between Patients With and Without Medical Insurance

Cost-effectiveness of a Multicomponent Intervention for Hypertension Control in Low-Income Settings in Argentina

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