Key result
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.
Why the study?
To evaluate the cost-effectiveness of a Community-based Hypertension Improvement Project compared with standard hypertension care in Ghana.
Is the Community-based Hypertension Improvement Project (ComHIP) cost-effective compared to standard care for hypertension management in Ghana?
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.
ComHIP unlikely cost-effective at current costs; leaves open whether optimized local implementation improves value in Ghana or similar settings.
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 US$12 189 and US$6530 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.
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Pozo-Martin et al. (2021) studied 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.
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