The Community-based Hypertension Improvement Project (ComHIP) was unlikely to be cost-effective compared with standard care, costing US$12,189 to US$6,530 per DALY averted.
Is the Community-based Hypertension Improvement Project (ComHIP) cost-effective compared to standard care for hypertension management in Ghana?
A community-based hypertension intervention in Ghana was found to be unlikely to be cost-effective due to high overhead and patient costs.
OBJECTIVE: To undertake a cost-effectiveness analysis of a Community-based Hypertension Improvement Project (ComHIP) compared with standard hypertension care in Ghana. DESIGN: Cost-effectiveness analysis using a Markov model. SETTING: Lower Manya Krobo, Eastern Region, Ghana. INTERVENTION: We evaluated ComHIP, an intervention with multiple components, including: community-based education on cardiovascular disease (CVD) risk factors and healthy lifestyles; community-based screening and monitoring of blood pressure by licensed chemical sellers and CVD nurses; community-based diagnosis, treatment, counselling, follow-up and referral of hypertension patients by CVD nurses; telemedicine consultation by CVD nurses and referral of patients with severe hypertension and/or organ damage to a physician; information and communication technologies messages for healthy lifestyles, treatment adherence support and treatment refill reminders for hypertension patients; Commcare, a cloud-based health records system linked to short-message service (SMS) /voice messaging for treatment adherence, reminders and health messaging. ComHIP was evaluated under two scale-up scenarios: (1) ComHIP as currently implemented with support from international partners and (2) ComHIP under full local implementation. MAIN OUTCOME MEASURES: Incremental cost per disability-adjusted life-year (DALY) averted from a societal perspective over a time horizon of 10 years. RESULTS: ComHIP is unlikely to be a cost-effective intervention, with current ComHIP implementation and ComHIP under full local implementation costing on average US12 189 and US6530 per DALY averted, respectively. Results were robust to uncertainty analyses around model parameters. CONCLUSIONS: High overhead costs and high patient costs in ComHIP suggest that the societal costs of ensuring appropriate hypertension care are high and may not produce sufficient impact to achieve cost-effective implementation. However, these results are limited by the evidence quality of the effectiveness estimates, which comes from observational data rather than from randomised controlled study design.
Pozo-Martin et al. (Wed,) conducted a other in Hypertension. Community-based Hypertension Improvement Project (ComHIP) vs. Standard hypertension care was evaluated on Incremental cost per disability-adjusted life-year (DALY) averted from a societal perspective. The Community-based Hypertension Improvement Project (ComHIP) was unlikely to be cost-effective compared with standard care, costing US$12,189 to US$6,530 per DALY averted.