September 1, 2020Open Access
The cost-effectiveness of hypertension management in low-income and middle-income countries: a review
Key Result
Most hypertension management interventions in low- and middle-income countries were cost-effective, with costs per averted DALY not exceeding national income thresholds.
Structured PICO
Are hypertension interventions cost-effective in low-income and middle-income countries?
P
Population
Published economic evaluations of hypertension treatment programmes in low-income and middle-income countries (LMICs) (71 articles identified, 42 reporting cost-effectiveness across 15 countries)
I
Intervention
Hypertension interventions and treatment programmes
O
Outcome
Cost-effectiveness (cost per averted disability-adjusted life-year [DALY])
Hypertension management programs in LMICs are generally cost-effective, though screening at younger ages or treating lower-risk patients may reduce cost-effectiveness.
Limitations
- Comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score
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.