Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application

Abstract

ObjectiveTo estimate the costs of scaling up the HEARTS pilot project for hypertension management and risk-based cardiovascular disease (CVD) prevention at the full population level in the four subdistricts (upazilas) in Bangladesh.SettingsTwo intervention scenarios in subdistrict health complexes: hypertension management only, and risk-based integrated hypertension, diabetes, and cholesterol management.DesignData obtained during July–August 2020 from subdistrict health complexes on the cost of medications, diagnostic materials, staff salaries and other programme components.MethodsProgramme costs were assessed using the HEARTS costing tool, an Excel-based instrument to collect, track and evaluate the incremental annual costs of implementing the HEARTS programme from the health system perspective.Primary and secondary outcome measuresProgramme cost, provider time.ResultsThe total annual cost for the hypertension control programme was estimated at US$3.2 million, equivalent to US$2.8 per capita or US$8.9 per eligible patient. The largest cost share (US$1.35 million; 43%) was attributed to the cost of medications, followed by the cost of provider time to administer treatment (38%). The total annual cost of the risk-based integrated management programme was projected at US$14.4 million, entailing US$12.9 per capita or US$40.2 per eligible patient. The estimated annual costs per patient treated with medications for hypertension, diabetes and cholesterol were US$18, US$29 and US$37, respectively.ConclusionExpanding the HEARTS hypertension management and CVD prevention programme to provide services to the entire eligible population in the catchment area may face constraints in physician capacity. A task-sharing model involving shifting of select tasks from doctors to nurses and local community health workers would be essential for the eventual scale-up of primary care services to prevent CVD in Bangladesh.

Evaluation of the WHO HEARTS hypertension control package in primary care clinics of rural Bangladesh: a quasi-experimental trial

“…14,15 A prior costing study established the budget impact of Bangladesh HEARTS program implementation. 16 Nonetheless, even at the intervention sites there is ample room for continous quality improvement in these processes for the Bangladesh HEARTS program.…”

The HEARTS partner forum—supporting implementation of HEARTS to treat and control hypertension

“…The HEARTS costing tool provides a standardized template for assessing the resources needed for HEARTS activities, including medications, training, and staff time. 6 Health experts from several countries have employed the tool to understand the budgetary needs for the program, as well as differences between the costs of usual care and the HEARTS-recommended approach ( 21 – 23 ).…”

Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

“…Forty-five studies described the training provided to nurses prior to them participating in or implementing a nurse-led model of care, with a focus on the particular tasks(s), tools and/or health conditions they were to be involved in (Ahmed et al, 2013;Ajay et al, 2016;Anson et al, 2022;Asgary et al, 2020;Barton et al, 2013;Bedelu et al, 2007;Brennan et al, 2011;Carroll, 2021;Chin-Quee et al, 2020;Clarke et al, 2020;Cohen et al, 2009;Datta et al, 2010;Delahunty-Pike et al, 2023;Everitt-Penhale et al, 2019;Fairall et al, 2012;Fairall et al, 2016;Frieden et al, 2020;Howland et al, 2020;Hunkeler et al, 2000;Husain et al, 2022;Iversen et al, 2020;Jindal et al, 2022;Jordan et al, 2011 Thomas et al, 2023;Vierhile, 2017;Wartko et al, 2023;Zewdu et al, 2022). If nurses were deemed to have existing skills and qualifications, they were not required to undertake further training to deliver the nurse-led model (Billington et al, 2015;McKissick et al, 2017;Walker et al, 2015).…”