The cost-effectiveness of hypertension management in low-income and middle-income countries: A review

Deliana Kostova, Garrison Spencer, Andrew E. Moran, Laura K. Cobb, Muhammad Jami Husain, Biplab Kumar Datta, Kunihiro Matsushita, Rachel Nugent

Research output: Contribution to journalReview articlepeer-review

Abstract

Hypertension in low-income and middle-income countries (LMICs) is largely undiagnosed and uncontrolled, representing an untapped opportunity for public health improvement. Implementation of hypertension control strategies in low-resource settings depends in large part on cost considerations. However, evidence on the cost-effectiveness of hypertension interventions in LMICs is varied across geographical, clinical and evaluation contexts. We conducted a comprehensive search for published economic evaluations of hypertension treatment programmes in LMICs. The search identified 71 articles assessing a wide range of hypertension intervention designs and cost components, of which 42 studies across 15 countries reported estimates of cost-effectiveness. Although comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score, most interventions that reported cost per averted disability-adjusted life-year (DALY) were cost-effective, with costs per averted DALY not exceeding national income thresholds. Programme elements that may reduce cost-effectiveness included screening for hypertension at younger ages, addressing prehypertension, or treating patients at lower cardiovascular disease risk. Cost-effectiveness analysis could provide the evidence base to guide the initiation and development of hypertension programmes.

Original languageEnglish (US)
Article numbere002213
JournalBMJ Global Health
Volume5
Issue number9
DOIs
StatePublished - Sep 9 2020

Keywords

  • health economics
  • hypertension
  • review

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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