Abstract
BackgroundHigh blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA). We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria.MethodsA Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD) within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY) averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1) presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy) and 2) presence of hypertension in combination with a CVD risk of >20% (risk based strategy). We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario.ResultsScreening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$ 1,406 to US$ 7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment.ConclusionsHypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities to finance CVD prevention care in SSA.
Highlights
Raised blood pressure is the leading risk factor for disease burden and mortality worldwide, mainly due to associated cardiovascular diseases (CVD).[1,2] Nearly 80% of CVD-related mortality occurs in low- and middle-income countries (LMICs).[3,4] People in LMICs die from CVD at a younger age compared to people in high income countries, often in their most productive years
We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria
Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities to finance CVD prevention care in sub-Saharan Africa (SSA)
Summary
Raised blood pressure is the leading risk factor for disease burden and mortality worldwide, mainly due to associated cardiovascular diseases (CVD).[1,2] Nearly 80% of CVD-related mortality occurs in low- and middle-income countries (LMICs).[3,4] People in LMICs die from CVD at a younger age compared to people in high income countries, often in their most productive years. The prevalence of hypertension and its complications is increasing rapidly in sub-Saharan Africa (SSA) with an age-standardized hypertension prevalence of 19.1% in 1990 compared to 25.9% in 2010.[1,5,6] Adequate treatment of hypertension greatly reduces the risk of CVD.[7] treatment coverage of antihypertensive medication is low due to limited awareness, accessibility and affordability of quality treatment for hypertension in settings with overburdened health systems.[6,8,9,10,11] There is an urgent need to develop and evaluate the costs and effects of innovative service delivery models for the management of hypertension that guarantee access to high quality care for patients. We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria
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