Cost-effectiveness and budget impact of the community-based management of hypertension in Nepal study (COBIN): a retrospective analysis

Anirudh Krishnan, Eric Andrew Finkelstein, Per Kallestrup, Arjun Karki, Michael Hecht Olsen, Dinesh Neupane

Research output: Contribution to journalArticle

Abstract

Background: The greatest risk factor for cardiovascular disease is hypertension, which can be alleviated via diet, exercise, and adherence to medication. Yet, blood pressure control in Nepal is inadequate, which is partly hindered by a lack of evidence-based, low-cost, scalable, and cost-effective cardiovascular disease prevention programmes. The the community-based management of hypertension in Nepal (COBIN) study was a 12-month community-based hypertension management programme of blood pressure monitoring and lifestyle counselling intervention undertaken by female community health volunteers (FCHVs) in Nepal, against usual care, which showed success in reducing blood pressure. Here we aimed to retrospectively quantify the budget impact and cost-effectiveness of the scale-up of the programme. Methods: In this retrospective analysis, we collected participant-level data from the COBIN study; programme delivery cost data from programme administrators from the COBIN study group; and popualtion and other data from WHO, the World Bank, and the Nepalese Government. We estimated costs per participant and total costs of a national scale-up of the COBIN programme focusing on two scenarios: scenario A, delivery of the intervention to only people aged 25–65 years with hypertension; and scenario B, delivery of the intervention to all adults aged 25–65 years regardless of hypertension status. Effectiveness was based on in-trial blood pressure reductions converted to cardiovascular disease disability-adjusted life-years (DALYs) averted. The primary cost-effectiveness measure was incremental cost per averted cardiovascular disease DALY (calculated using the incremental cost-effectiveness ratio [ICER]) from a health system perspective, including programme delivery and incremental medication costs. We did univariate sensitivity analyses of scenario B to assess the effect of uncertainty in key parameter values in our calculations. Findings: From a health system perspective, the first-year budget impact was US$7·1 million in scenario A and $10·8 million in scenario B. With each subsequent year, the costs decreased by approximately 50%. In the base-case cost-effectiveness analysis, from the health system perspective, scenario A resulted in an ICER of $582 per DALY averted and scenario B resulted in an ICER of $411 per DALY averted. The ICER was most sensitive to uncertainty in the number of total avertable cardiovascular disease DALYs in the eligible population. Interpretation: The programme is projected to be highly cost-effective in both scenarios compared with the WHO thresholds for cost-effectiveness for Nepal. For policy makers intending to meet the UN Sustainable Development Goal of reducing premature mortality from non-communicible diseases, this intervention should be considered. Funding: Duke-NUS Medical School, Singapore.

Original languageEnglish (US)
Pages (from-to)e1367-e1374
JournalThe Lancet Global Health
Volume7
Issue number10
DOIs
StatePublished - Oct 1 2019

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Nepal
Budgets
Cost-Benefit Analysis
Hypertension
Costs and Cost Analysis
Quality-Adjusted Life Years
Cardiovascular Diseases
Blood Pressure
United Nations
Health
Administrative Personnel
Uncertainty
Premature Mortality
Medication Adherence
Singapore
Conservation of Natural Resources
Medical Schools
Life Style
Counseling
Volunteers

ASJC Scopus subject areas

  • Medicine(all)

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Cost-effectiveness and budget impact of the community-based management of hypertension in Nepal study (COBIN) : a retrospective analysis. / Krishnan, Anirudh; Finkelstein, Eric Andrew; Kallestrup, Per; Karki, Arjun; Olsen, Michael Hecht; Neupane, Dinesh.

In: The Lancet Global Health, Vol. 7, No. 10, 01.10.2019, p. e1367-e1374.

Research output: Contribution to journalArticle

Krishnan, Anirudh ; Finkelstein, Eric Andrew ; Kallestrup, Per ; Karki, Arjun ; Olsen, Michael Hecht ; Neupane, Dinesh. / Cost-effectiveness and budget impact of the community-based management of hypertension in Nepal study (COBIN) : a retrospective analysis. In: The Lancet Global Health. 2019 ; Vol. 7, No. 10. pp. e1367-e1374.
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