Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka

Abstract

Summary Background COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios. Methods In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective. Findings Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10·65 for Bangladesh, $10·25 for Pakistan, and $6·42 for Sri Lanka. Per-capita costs were $0·63 for Bangladesh, $0·29 for Pakistan, and $1·03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh, $2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79·3% in Bangladesh, 85·2% in Pakistan, and 99·8% in Sri Lanka. Interpretation The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study. Funding The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust.

Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review

“…The screening interventions were divided into three main categories ( Supplementary Table 1 ): six studies described interventions focusing on CVD ( 31 , 34 , 36 , 38 , 39 , 41 ), five studies described interventions focusing on diabetes ( 5 , 32 , 33 , 37 , 42 ), and four studies described interventions focusing on both CVD and diabetes ( 16 , 30 , 35 , 40 ).…”

“…Of the total studies, 11 adopted a health payer perspective ( 30 – 34 , 36 , 38 – 42 ), four studied costs from a societal perspective ( 5 , 16 , 35 , 37 ). A summary of different costs included in each study is given in Supplementary Table 1 .…”

Hypertension and Nutrition Core Group of IAPEN India

“…Task shifting is the name given to a process of delegation in which responsibilities are delegated to less skilled health personnel when suitable. Task shifting can make more efficient use of the human resources already available by rearranging the workforce in this way (7) .…”

“…These time and mistake penalties rise as the activities get more complicated. Each task switch may just take a fraction of a second, but if you perform a lot of switching in a day, it can cost you 40% of your productivity (7) .…”

“…These two techniques might be part of a bigger plan to enhance and strengthen health-care system capacity in order to increase access to hypertension treatment while sustaining important health-care services. Furthermore, by lowering the strain of the healthcare profession, these techniques can assist safeguard and sustain their health and well-being (7) .…”