The cost-effectiveness of hypertension management in low-income and middle-income countries: a review

• Main Authors: Kunihiro Matsushita, Andrew E Moran, Rachel Nugent, Laura K Cobb, Deliana Kostova, Garrison Spencer, Muhammad Jami Husain, Biplab Kumar Datta
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2020-09-01
• Series: BMJ Global Health
• Online Access: https://gh.bmj.com/content/5/9/e002213.full

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.