Abstract 14229: Cost-Effectiveness of a Multicomponent Intervention for Hypertension Control in Public Sector Primary Healthcare Services in Singapore

Abstract

Introduction: Recently the SingHypertension cluster-randomized controlled trial investigated integrating a multicomponent intervention (MCI) into Singapore public sector primary care clinics for patients with uncontrolled hypertension. MCI consisted of physician training in risk-based treatment, antihypertensive medication subsidies, nurse-delivered motivational conversations and telephone follow-ups. While MCI improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care (UC), the cost-effectiveness of MCI is unknown. Aim: We evaluated the incremental cost-effectiveness of MCI over a ten-year period following the intervention, from Singapore’s health system perspective. Methods: We used a Markov model to simulate the risks and outcomes associated with heart attacks and strokes for a hypothetical cohort of patients based on the trial profile. Costs included MCI administration and oversight, antihypertensive medications, consultations, diagnostics, and hospitalizations. Effectiveness was calculated in terms of disability-adjusted life years (DALYs) averted. Due to differences in outcomes by risk-group, we reported incremental cost effectiveness ratios (ICERs) separately for patients with low and high baseline risk of CVD, as well as an overall ICER. We also assessed the robustness of our results with deterministic and probabilistic sensitivity analyses. Results: Based on a willingness-to-pay threshold of USD 55,600 per DALY, MCI was incrementally cost-effective to UC for both low- (ICER: USD 35,700 per DALY averted) and high-risk patients (ICER: USD 55,500 per DALY averted), with a combined ICER of USD 45,400 per DALY averted. ICERs were most sensitive to the effectiveness of MCI; a reduction in QCVD TM 3 score of at least 0.56 for low-risk patients and 1.00 for high-risk patients was needed for cost-effectiveness. MCI had a 99% and 50% probability of being cost-effective for low- and high-risk patients respectively. Conclusions: MCI is likely cost-effective in reducing the incidence of heart attacks and strokes, especially for lower risk hypertensive patients. Wide-scale implementation of this intervention should be considered to improve blood pressure control in Singapore and beyond.