Hypertension screening and treatment within a subsidized health insurance program in rural Nigeria yielded an incremental cost-effectiveness ratio between US$ 732 and US$ 7,815 per DALY averted.
Is population-level hypertension screening and treatment cost-effective in adults aged 30-79 without previous CVD in rural Nigeria?
Hypertension screening and treatment within a subsidized private health insurance program may be cost-effective in rural Nigeria, providing a model for financing CVD prevention in sub-Saharan Africa.
Effect estimate: ICER US$ 732 to US$ 7,815
BACKGROUND: High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA). We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria. METHODS: A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD) within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY) averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1) presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy) and 2) presence of hypertension in combination with a CVD risk of >20% (risk based strategy). We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario. RESULTS: Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second 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. CONCLUSIONS: Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities to finance CVD prevention care in SSA.
Rosendaal et al. (Mon,) conducted a other in Hypertension (n=10,000). Hypertension screening and antihypertensive treatment (KSHI program) vs. No access to hypertension care was evaluated on Incremental cost per disability-adjusted life year (DALY) averted (ICER US$ 732 to US$ 7,815). Hypertension screening and treatment within a subsidized health insurance program in rural Nigeria yielded an incremental cost-effectiveness ratio between US$ 732 and US$ 7,815 per DALY averted.