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. 2020 Sep 9;5(9):e002213. doi: 10.1136/bmjgh-2019-002213

Table 3.

Annual cost per hypertension patient (2017 US$)

Country income group Country Author Study type Sample size Study design Provider Intervention details Cost elements Intervention subgroup Cost (2017 US$)
Upper middle Mexico Arredondo Pharm only - modelled Not applicable Hypothetical population-level model Not specified Analysis of healthcare costs of changes in epidemiological profile in Mexico, using hypertension as one of four tracer diseases. Drugs, laboratories, labour, equipment costs and office supplies Total hospital and ambulatory costs per case of hypertension 904.73
Upper middle Malaysia Alefan Pharm only 600 Observational Doctors, nurses, pharmacists Comparing different antihypertensive drug classes and combinations: Diuretics, BB, ACEIs, CCBs, prazosin, diuretics and ACEIs and other combinations Drugs, laboratories, labour, and travel/transportation/per diem. Diuretics 522.32
Diuretics + beta blockers 614.41
Beta blockers 626.32
ACE inhibitors 651.69
Calcium channel blockers 723.4
Prazosin 753.06
Other combinations 826.64
Lower middle India Anchala Pharm plus 1638 Cluster randomised control trial Doctor 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. Drugs, laboratories, labour, travel/transportation/per diem, building overhead costs, depreciation, equipment costs and office supplies, training costs, intervention development costs, translation charges. Chart-based support 356.47
Decision support system 383.15
Upper middle Argentina Augustovski Pharm plus 1432 Cluster randomised control trial Community health workers, doctors Multicomponent strategy that included community health worker home-based intervention, physician education and a text-messaging intervention. 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. Intervention group 202.85
Control group 102.49
Upper middle China Bai Other 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 lifestyle education sessions, supervision, and one-on-one sessions; standardise drug therapies according to 2005 Chinese national guidelines; conduct follow-up visits on a regular basis; provide other services, such as physician recommendations, if necessary. Labour, building overhead costs, depreciation, equipment costs and office supplies, and health education/promotion costs. Community health centre in Beijing 6.19
Community health centre in Chengdu 6.35
Overall - all three community health centres 8.19
Community health centre in Hangzhou 13.38
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. Drugs, costs of medical services - including patient-borne costs TTT - India 48.88
TTT - China 57.41
BBT - India 76.57
Hybrid - China 87.69
Hybrid - India 90.72
BBT - China 99.14
Upper middle Brazil Bueno Pharm only 377 Cross-sectional study Not specified Analysis of the association between physical activity level and healthcare costs among hypertensive non-institutionalised older people. Drugs, cost of medical visit or screening - not further disaggregated Activity level: active 36.08
Activity level: insufficiently active 144.51
Activity level: sedentary 158.81
Upper middle Mexico Calvo-Vargas Pharm only Not reported Longitudinal study Not specified Analysis of the annual cost of antihypertensive medications with the cost of medical consultations and laboratory tests. Drugs, laboratories, cost of medical visit or screening - not further disaggregated Annual cost of treatment with diuretics 90.3
Annual cost of treatment with beta blockers 176.54
Annual cost of treatment with calcium channel blockers 451.65
Annual cost of treatment with ACE inhibitors 701.3
Upper middle Brazil Cazarim Pharm plus 51 Quasi-Experimental study Doctors, pharmacists Prior to intervention, the public health service did not offer pharmaceutical care for hypertension. Intervention involved blood pressure measurements and CV risk measures, analysis of medications and test results, education in health matters with guidelines on patient behaviours, adherence to treatment and, when necessary, interventions in pharmacotherapy Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs, equipment costs and office supplies, and absenteeism or lost productivity. Intervention period 203.85
Pre-intervention period 205.15
Post-intervention period 222.31
Upper middle South Africa Gaziano Pharm plus - modelled Not applicable Hypothetical population-level model Not specified Intervention included screening for HTN and six different eligibility criteria for initiating pharmacological treatment (two BP-based criteria and four risk-based criteria) and a no treatment scenario in which individuals are screened but not treated. Drugs and cost of medical visit or screening - not further disaggregated. Screened - no treatment 80.55
Eligibility: absolute risk >40% 80.66
Eligibility: absolute risk >30% 81.3
Eligibility: absolute risk >20% 84.57
Eligibility: absolute risk >15% 87.9
Eligibility: 1995 South African guidelines - target level 160/95 88.83
Eligibility: Current guidelines - target level 140/90 93.22
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. Drugs, laboratories, labour, costs of medical visits or screening not further disaggregated, equipment costs, intervention development costs, training costs, media costs Intervention 119.07
Usual care 45.07
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. 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 only 232.42
Home health education and general practitioner training 295.49
General practitioner training only 317.89
Upper middle China Le Pharm only 9396 Cross-sectional study Not specified Estimation of the economic burden of hypertension using cross-sectional health examination and questionnaire survey. Care includes outpatient visits, hospitalisation and medication. Drugs, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, absenteeism or lost productivity, other unspecified Men 609.38
Women 511.14
Age 19 to 44 years old 326.33
Age 45 to 59 years old 427.73
Age 60 years and older 654.35
Overall 547.78
Upper middle South Africa Makkink Pharm only 28 165 Observational study Not specified ACE inhibitors compared with angiotensin receptor blockers (ARBs) in management of hypertension. Data analysed for 2 years, 2010 and 2011. Drugs and other unspecified costs. ACE inhibitor (year 2010) 574.06
ACE inhibitor (year 2011) 625.06
ARB (year 2010) 727.3
ARB (year 2011) 866.27
Combined (year 2010) 2019.93
Combined (year 2011) 2417.85
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. Drugs, labour and cost of medical visit or screening - not further disaggregated. Control group 73.15
Intervention group 97.14
Lower middle Kenya Oyando Pharm only 212 Cross-sectional study Not specified Examination of patient costs associated with obtaining care for HTN in public healthcare facilities. Drugs, laboratories, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem Overall median annual hypertension care cost at a public facility 282.7
Overall mean annual hypertension care cost at a public facility 476.5
Upper middle Argentina Perman Pharm plus - modelled Not applicable Hypothetical population-level model Doctors, medical students, health workers Usual hypertension care (primary care physicians) compared with a new hypertension programme that added personal and telephone contact with patients by medical students; support with diet and activity; educational material; workshops; and, electronic health records. Programme was for middle-class patients 65 years or older. Drugs, laboratories, labour, building overhead costs, equipment costs and office supplies, health education/promotion Hypertension programme 240.43
Usual care 196.50
Lower middle India Praveen Pharm only 62 194 Cross-sectional study Not specified Comparing the BP lowering treatment eligibility standards compared with an untreated population. The different treatment standards were: (1) current practice (not further defined); (2) treating people with HTN using the 140/90 mm Hg threshold; (3) treatment according to the new Indian NPCDCS guidelines (drug therapy recommended in patients with CVD risk 20% to 30% and BP levels ≥140/90 mm Hg or CVD risk of ≥30% and BP levels ≥130/80 mm Hg; (4) treating everyone in the intermediate and high risk categories (regardless of BP level); and (5) treating only those in the high risk category (regardless of BP level). Drugs, costs of medical visit or screening - not further disaggregated Treatment of all above 55 years of age 34.92
Treatment of all at high risk 35.07
Treatment of all above 45 years of age 35.08
Treatment according to NPCDCS guidelines 35.13
Treatment of all at intermediate and high risk 35.18
Current practice (undefined) 35.23
Treatment of patients with BP greater than 140/90 mm Hg 54.56
Lower middle Kenya Subramanian Pharm only Not reported Observational study Doctors and others Analysis of payment data on CVD, diabetes, breast and cervical cancer and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital and the Kibera South Health Centre - a public outpatient facility, and private sector practitioners and hospitals. A treatment framework was developed using an itemisation cost approach to estimate payments. Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated Public facility - monotherapy - costs to patient 25.64
Public facility - two drug combination therapy - costs to patient 67.25
Public facility - three drug combination treatment - costs to patient 81.2
Public facility - four drug combination therapy - costs to patient 110.33
Public facility - patients with resistant hypertension (high BP despite use of combination medications) - costs to patient 159.36
Private facility - monotherapy - costs to patient 418.2
Private facility - two drug combination therapy - costs per patient 596.44
Private facility - three drug combination therapy - costs per patient 948.06
Private facility - resistant hypertension (high BP despite the use of combination medications) - costs to patient 987.17
Upper middle China Wang X Pharm plus 436 Randomised controlled trial Doctors Provider training in guideline-oriented HTN management programme covering detection, evaluation, non-pharmaceutical and pharmaceutical treatment, follow-up and management, two-way referral, prevention and health education for hypertension. Drugs, labour, travel/transportation/per diem, and training costs. Rural intervention group - intention-to-treat analysis 70.58
Rural intervention group - per protocol analysis 73.03
Rural control group - intention-to-treat analysis 80.12
Rural control group - per protocol analysis 86.52
Urban intervention group - intention-to-treat analysis 108.05
Urban intervention group - per protocol analysis 116.63
Urban control group - intention-to-treat analysis 135.71
Urban control group - per protocol analysis 155.87
Upper middle China Xie Pharm only - modelled Not applicable Hypothetical population-level model Not specified A computer simulation model to project the consequences and cost-effectiveness of intensive hypertension control (reducing systolic/diastolic BP to 133/76 mm Hg) compared with standard hypertension control (based on the Chinese guidelines for the management of hypertension in 2011, involves the reduction of systolic/diastolic BP to 140/90 mm Hg). Drugs, cost of medical visit or screening - not further disaggregated, monitoring costs Standard - all men 58.92
Standard - all women 63.27
Intensive - all men 69.21
Standard - all men and all women 70.96
Intensive - all men and all women 70.96
Intensive - all women 72.99

ACEIs, ACE inhibitors; BB, beta blockers; BP, blood pressure; CCBs, calcium channel blockers; CVD, cardiovascular disease; HTN, hypertension; NPCDCS, National Program on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke; US$, US dollars.