Table 1.
Cost per mm Hg reduction in systolic and/or diastolic blood pressure (2017 US$)
| Country income group | Country | Author | Study type | Sample size | Study design | Provider | Intervention details | Time period | Cost elements | Intervention subgroup | Cost – systolic (2017 US$) | Cost – diastolic (2017 US$) |
| Lower middle | India | Anchala | Pharm plus | 1638 | Cluster randomised control study | Doctors | Primary healthcare physicians received training to use decision support system (DSS) software for management of HTN or received chart-based support with HTN guidelines on a poster. | 1 year | Drugs, laboratories, labour, travel/transportation/per diem, building overhead costs, depreciation, equipment costs and office supplies, training costs, intervention development costs, translation charges. | Decision support system | 37.82 | |
| Chart-based support | 99.29 | |||||||||||
| Upper middle | South Africa | Anderson A | Pharm only | 1473 | Meta-analysis | Not specified | Comparison of the angiotensin receptor blockers (ARBs) currently available in South Africa: candesartan, losartan, irbesartan and valsartan. | 1 year | Drugs | Candesartan | 4.6 | |
| Losartan | 5.47 | |||||||||||
| Irbesartan | 6.11 | |||||||||||
| Valsartan | 6.77 | |||||||||||
| Upper middle | Argentina | Augustovski | Pharm plus | 1432 | Cluster randomised control study | Community health workers, doctors | Multicomponent strategy that included community health worker home-based intervention, physician education and a text-messaging intervention. | 1.5 years | Drugs, laboratories, labour, costs of medical visit or screening - not further disaggregated, equipment costs and office supplies, intervention development costs, training costs, health education/promotion/ media costs. | Control group | 15.37 | 29.57 |
| Intervention group | 19.51 | 32.72 | ||||||||||
| Upper middle | China | Bai | Pharm plus | 818 | Observational study | Doctors, nurses, pharmacists, other | Community health centres that are part of a chronic disease control government programme. Components of intervention include classifying patients into four groups based on BP and risk; conduct diet, exercise, smoking and drinking interventions consisting of educational sessions, supervision and face-to-face consultation as necessary; standardise drug therapies according to 2005 Chinese national guidelines for hypertension prevention and control; conduct follow-up visits on a regular basis; provide other services, such as physician recommendations, if necessary. | 1 year | Labour, building overhead costs, depreciation, equipment costs and office supplies, health education/promotion costs. | Best case scenario - based on the lowest per capita cost and greatest blood pressure reduction of the community health centres | 0.35 | 0.75 |
| Community health centre in Beijing | 0.61 | 1.05 | ||||||||||
| Overall - all three community health centres | 0.67 | 1.33 | ||||||||||
| Community health centre in Hangzhou | 0.75 | 1.61 | ||||||||||
| Community health centre in Chengdu | 0.83 | 1.62 | ||||||||||
| Worst case scenario - based on the highest per capita cost and smallest blood pressure reduction of the community health centres | 1.76 | 3.43 | ||||||||||
| Blend | Blend | Basu | Pharm only - modelled | Not applicable | Hypothetical population-level model | Not specified | A ‘treat-to-target’ (TTT) strategy in which BP therapy is titrated until blood pressures fall below a threshold, a ‘benefit-based, tailored’ (BBT) strategy in which BP therapy is initiated for patients with high estimated CVD risk, and a hybrid strategy that combines TTT and BBT. | Simulation period: 10 years | Drugs, costs of medical services - including patient-borne costs | BBT - China | 0.12 | |
| Hybrid - China | 0.13 | |||||||||||
| TTT - China | 0.14 | |||||||||||
| BBT - India | 0.17 | |||||||||||
| TTT - India | 0.2 | |||||||||||
| Hybrid - India | 0.28 | |||||||||||
| Upper middle | Argentina | He | Pharm plus | 1357 | Cluster randomised control study | Community health workers, doctors | Intervention clinics implemented a community health worker-led home-based programme including health coaching, and BP monitoring. Physicians at the clinics received online education course on HTN management, and patients received individualised text messages. Control clinics maintained usual care: monthly visits after initiation of antihypertensive treatment and every 3 to 6 months for patients with controlled BP. | 18 months | Drugs, laboratories, labour, costs of medical visits or screening not further disaggregated, equipment costs, intervention development costs, training costs, media costs | Usual care | 5.59 | 10.56 |
| Intervention | 9.25 | 14.06 | ||||||||||
| Lower middle | Pakistan | Jafar | Other | 1044 | Cluster randomised control study | Community health workers, doctors | Family-based home health education by community health workers and special training of general practitioners on treatment and management of HTN. | 2 years | Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs, training costs, health education/promotion/ absenteeism or lost productivity and fruits and vegetables. | Home health education and general practitioner training | 54.72 | |
| Home health education only | 83.01 | |||||||||||
| General practitioner training only | 113.53 | |||||||||||
| Low | Nepal | Krishnan | Pharm plus – modelled |
Not applicable | Hypothetical population-level model | Community health workers | Community health workers provide blood pressure screening, lifestyle counselling, referrals and follow-up on adherence to antihypertensive medication via home visits | 1 year | Drugs, labour, travel, training costs, administrative costs | Adults aged 25 to 65 with hypertension | 1.64 | |
| All adults aged 25 to 65 | 0.51 | |||||||||||
| Upper middle | Brazil | Obreli-Neto | Pharm plus | 200 | Randomised controlled clinical trial | Doctors, nurses, pharmacists | The control group received the usual care offered by the primary healthcare unit (medical and nurse consultations). The intervention group received the usual care plus a pharmaceutical care intervention. | 3 years | Drugs, labour and cost of medical visit or screening - not further disaggregated. | Intervention group (cost per patient divided by average change during study period) | 12.67 | 19.69 |
| Lower middle | India | Patel | Pharm only | 60 | Observational study | Not specified | Comparing two beta blockers - nebivolol and metoprolol. | 2 months | Drugs | Nebivolol 2.5 mg | 0.57 | 0.81 |
| Nebivolol 5 mg | 0.64 | 1.02 | ||||||||||
| Metoprolol 25 mg | 0.89 | 1.07 | ||||||||||
| Metoprolol 50 mg | 1.07 | 1.31 | ||||||||||
| Nebivolol 10 mg | 1.09 | 1.3 | ||||||||||
| Metoprolol 100 mg | 1.13 | 1.29 | ||||||||||
| Upper middle | Brazil | Tsuji | Pharm only | 418 | Observational study | Not specified | Traditional treatment (hydrochlorothiazide and atenolol) and current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension. For patients with grade 3 hypertension, a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. | 1 year | Drugs | Traditional: Grade 1 or 2 HTN | 44.68 | 66.47 |
| Traditional: Grade 3 HTN | 81.73 | 107.88 | ||||||||||
| Current: Grade 3 HTN | 82.82 | 103.52 | ||||||||||
| Current: Grade 1 or 2 HTN | 90.45 | 130.77 | ||||||||||
| Upper middle | China | Wang X | Pharm plus | 436 | Randomised controlled trial | Doctors | Provider training in guideline-oriented primary healthcare HTN management programme covering detection, evaluation, non-pharmaceutical and pharmaceutical treatment, follow-up and management, two-way referral, prevention and health education for hypertension. | 1 year | Drugs, labour, travel/transportation/per diem and training costs. | PP analysis rural intervention | 3.73 | 5.99 |
| ITT analysis rural intervention | 3.85 | 6.22 | ||||||||||
| ITT analysis rural control | 4.8 | 9.1 | ||||||||||
| ITT analysis urban intervention | 5.32 | 15.22 | ||||||||||
| PP analysis urban intervention | 5.37 | 15.76 | ||||||||||
| PP analysis rural control | 5.55 | 11.09 | ||||||||||
| ITT analysis urban control | 7.94 | 34.8 | ||||||||||
| PP analysis urban control | 9.06 | 51.96 | ||||||||||
| Upper middle | China | Wang Z | Pharm only | 623 | Observational study | Not specified | Treatment with nitrendipine with hydrochlorothiazide, or treatment with nitrendipine with metoprolol. | 6 months | Drugs, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem | Nitrendipine + hydrochlorothiazide. Women. | 1.47 | 3.05 |
| Nitrendipine + hydrochlorothiazide. Men. | 1.47 | 2.95 | ||||||||||
| Nitrendipine + hydrochlorothiazide. 65 years and older. | 1.47 | 2.95 | ||||||||||
| Nitrendipine + hydrochlorothiazide. All patients. | 1.47 | 2.95 | ||||||||||
| Nitrendipine + hydrochlorothiazide. Under 65 years old. | 1.58 | 3.37 | ||||||||||
| Nitrendipine + metoprolol. Women. | 1.89 | 3.89 | ||||||||||
| Nitrendipine + metoprolol. 65 years and older. |
2 | 3.89 | ||||||||||
| Nitrendipine + metoprolol. All patients. |
2 | 4 | ||||||||||
| Nitrendipine + metoprolol. Men. |
2.1 | 4.1 | ||||||||||
| Nitrendipine + metoprolol. Under 65 years old. |
2.31 | 4.52 |
‘Pharm only’ indicates interventions or studies in which pharmacotherapy is the only form of treatment for hypertension. This includes testing various combinations of drugs and drug classes, different providers and delivery platforms. ‘Pharm plus’ indicates combination programmes that incorporated other forms of treatment for hypertension, such as patient education or lifestyle changes. ‘Other’ indicates a programme in which there was no pharmacological treatment.
BP, blood pressure; CVD, cardiovascular disease; HTN, hypertension; ITT, intention-to-treat; PP, per protocol; US$, US dollars.