Abstract MP71: Female Community Health Volunteer-Led Lifestyle Intervention is a Highly Cost-Effective, Low-Cost and Scalable Solution for Blood Pressure Control in Nepal

Abstract

Introduction: Cardiovascular disease (CVD) has become the leading cause of death worldwide, accounting for 32% of global deaths in 2016. Hypertension, which can be mitigated through diet, exercise and adherence to medication, is the greatest risk factor for CVD. However, public spending on CVD prevention remains low in many low- and middle-income countries partly due to a lack of evidence of low-cost, scalable, cost-effective and evidence-based CVD prevention programs. The goal of this study was to quantify the scalability and cost effectiveness of an evidence-based community-based hypertension management study (COBIN) in Nepal. Hypothesis: A community health worker-led BP monitoring and lifestyle counseling intervention is a cost-effective solution to achieving greater BP control in Nepal. Methods: We conducted a cost-effectiveness (CE) and budget impact (BI) analysis of a community health worker-led hypertension prevention and management intervention in Nepal that has previously been shown to reduce BP. Costs were retrospectively collected to estimate per capita and total costs of a national scale-up focusing on three scenarios: (A) hypertensives only; (B) prehypertensives and hypertensives; and (C) all adults aged 25-65 years. The primary CE measure was incremental cost per CVD disability-adjusted life year (DALY) averted. Both CE and BI analyses were conducted for each scenario. One-way sensitivity analyses were conducted to assess the impact of uncertainty in key parameter values on the primary CE measure. Results: The first-year BI was estimated to be an average of US$0.88 per participant: a total of US$2,698,181, US$5,667,503, and US$10,832,403 in scenarios A, B, and C respectively. In subsequent years costs are roughly half as much. In the base-case CE analysis, scenarios A, B, and C resulted in an incremental cost-effectiveness ratio (ICER) of US$185, US$340, and US$303/DALY respectively. One-way sensitivity analyses around the base-case analysis for scenario C show that the ICER was most sensitive to uncertainty in the estimate of SBP reduction among normotensives, varying the ICER between US$225 and US$465/DALY. Conclusions: The program is highly cost effective in all three scenarios compared to the WHO threshold of US$835/DALY for Nepal. This work presents the first evidence from Nepal that a community-based hypertension prevention and management program can be a cost-effective, low-cost, and scalable solution to control blood pressure nationwide.