Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application. Issue 6 (27th June 2022)

• Record Type: Journal Article
• Authors: Husain, Muhammad Jami; Haider, Mohammad Sabbir; Tarannum, Renesa; Jubayer, Shamim; Bhuiyan, Mahfuzur Rahman; Kostova, Deliana; Moran, Andrew E; Choudhury, Sohel Reza
• Is Part Of: BMJ open. Volume 12:Issue 6(2022)
• Publication Date: 2022-06-27
• Subjects: program cost -- hearts hypertension management and cvd prevention program -- scale-up of primary care services -- bangladesh; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-061467
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To 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. Settings: Two intervention scenarios in subdistrict health complexes: hypertension management only, and risk-based integrated hypertension, diabetes, and cholesterol management. Design: Data obtained during July–August 2020 from subdistrict health complexes on the cost of medications, diagnostic materials, staff salaries and other programme components. Methods: Programme 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 measures: Programme cost, provider time. Results: The 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. Conclusion: Expanding 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.