Table 4.
Cost per averted disability-adjusted life year (2017 US$D, unless indicated otherwise)
| Country income group | Country | Author | Study type | Sample size | Study design | Provider | Intervention details | Cost elements | Intervention subgroup | Cost (2017 US$) | 2017 country GDP per capita |
| 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 | BBT - China | 220.90 | 8826 |
| BBT - India | 290.61 | 1939 | |||||||||
| Hybrid - India | 371.58 | 1939 | |||||||||
| TTT - India | 412.85 | 1939 | |||||||||
| Hybrid - China | 449.25 | 8826 | |||||||||
| TTT - China | 450.80 | 8826 | |||||||||
| Lower middle | Ghana | Gad | Pharm only – modelled | Not applicable | Hypothetical population-level model | Not specified | A core treatment model was used to estimate the long-term costs and health effects of the five main classes of antihypertensive drugs and a ‘no intervention” comparator: ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers (BB), calcium channel blockers (CCB), thiazide-like diuretics | Drugs, cost medical visits not further disaggregated | Diuretics | 61.24 | 2025 |
| CCB | 799.35 | 2025 | |||||||||
| ACEI | 1555.47 | 2025 | |||||||||
| ARB | 1808.72 | 2025 | |||||||||
| BB | 1462.90 | 2025 | |||||||||
| Lower middle | Vietnam | Ha | Pharm plus - modelled | Not applicable | Hypothetical population-level model | Doctors, nurses | Comparison of a set of personal and non-personal prevention strategies to reduce CVD in Vietnam, including mass media campaigns for reducing consumption of salt and tobacco, drugs for lowering blood pressure or cholesterol, and combined pharmacotherapy for people at varying levels of absolute risk of a cardiovascular event. | Drugs, laboratories, labour, travel/transportation/per diem and media costs. | Education and individual treatment (beta-blocker and diuretic) for treatment of SBP >160. | 94.24 | 2343 |
| Education and individual treatment (beta-blocker and diuretic) for treatment of SBP >140. | 268.83 | 2343 | |||||||||
| Upper middle | Thailand | Khonputsa | Pharm only – modelled | Not applicable | Hypothetical population-level model | Doctors | Analysis of monotherapy and combination therapy of thiazide diuretics (D), CCB, BB, ACEI and ARB. Cost-effectiveness analysis includes cost-offsets, that is, the cost of disease treatments that are avoided by prevention. The study calculated cost-effectiveness figures using the lowest cost generic and the median cost medication shown in the Ministry of Health website. The figures reported in this table are based on the median cost. | 10-year CVD risk 5% to 9.9%, D+CCB+ACEI | 2077.34 | 6578 | |
| 10-year CVD risk 5% to 9.9%, D | 692.45 | 6578 | |||||||||
| 10-year CVD risk 5% to 9.9%, CCB | 1483.41 | 6578 | |||||||||
| 10-year CVD risk 5% to 9.9%, ACEI | 2934.65 | 6578 | |||||||||
| 10-year CVD risk 5% to 9.9%, BB | 6594.72 | 6578 | |||||||||
| 10-year CVD risk 5% to 9.9%, ARB | 10 221.82 | 6578 | |||||||||
| 10-year CVD risk 10% to 19.9%, D | 286.87 | 6578 | |||||||||
| 10-year CVD risk 10% to 19.9%, CCB | 890.29 | 6578 | |||||||||
| 10-year CVD risk 10% to 19.9%, ACEI | 1912.47 | 6578 | |||||||||
| 10-year CVD risk 10% to 19.9%, BB | 5935.25 | 6578 | |||||||||
| 10-year CVD risk 10% to 19.9%, ARB | 7583.93 | 6578 | |||||||||
| 10-year CVD risk 20% and up, CCB | 309.95 | 6578 | |||||||||
| 10-year CVD risk 20% and up, ACEI | 956.24 | 6578 | |||||||||
| 10-year CVD risk 20% and up, BB | 3627.10 | 6578 | |||||||||
| 10-year CVD risk 20% and up, ARB | 4616.31 | 6578 | |||||||||
| Low | Nepal | Krishnan | Pharm plus – modelled | Not applicable | Hypothetical population-level model | Community health workers provide blood pressure screening, lifestyle counselling, referrals and follow-up on adherence to antihypertensive medication via home visits | Drugs, labour, travel, training costs, administrative costs | Adults aged 25 to 65 with hypertension | 568.16 | 911 | |
| All adults aged 25 to 65 | 401.23 | 911 | |||||||||
| Upper middle | Sri Lanka | Lung | Pharm only – modelled | Not applicable | Hypothetical population-level model | Doctors | The intervention group received the triple pill consisting of amlodipine, telmisartan and chlorthalidone (with discontinuation of current monotherapy, if applicable) as part of their usual hypertension clinic visits. There were scheduled clinic visits at 6, 12 and 24 weeks (end of study), which included blood pressure measurement, potential changes in medications in line with local guidelines at the discretion of the treating physician, and assessment of adverse events. | Drugs, cost of outpatient and inpatient visits not further disaggregated | Usual care | 1323.46 | 4105 |
| Intervention group | 1693.92 | 4105 | |||||||||
| Blend | Blend | Murray* | Pharm plus - modelled | Not applicable | Hypothetical population-level model | Not specified | Seventeen non-personal and personal health-service interventions or combinations, including salt reduction through voluntary agreements with industry and salt intake legislation, health education campaigns and treatment and education for hypertension. Hypertension treatment for people with BP above two thresholds (140 and 160) was a standard regimen of beta blockers and diuretics. Treatment for people with absolute risk of cardiovascular event over next 10 years based on four thresholds (35%, 25%, 15% and 5%) with a statin, diuretic, beta blocker and aspirin. | Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs, training costs and media costs. | Eligibility: SBP above 160 (SE Asia) | 51.24* PPP dollars |
n/a |
| Eligibility: SBP above 160 (Latin America) | 115.30* PPP dollars |
n/a | |||||||||
| Eligibility: SBP above 140 (SE Asia) | 128.11* PPP dollars |
n/a | |||||||||
| Eligibility: SBP above 140 (Latin America) | 264.76* PPP dollars |
n/a | |||||||||
| Eligibility: SBP above 160 (Europe) | 288.96* PPP dollars |
n/a | |||||||||
| Eligibility: SBP above 140 (Europe) | 646.25* PPP dollars |
n/a | |||||||||
| Treatment of risk above 35% (Latin America) | 37.26* PPP dollars |
n/a | |||||||||
| Treatment of risk above 25% (Latin America) | 52.67* PPP dollars |
n/a | |||||||||
| Treatment of risk above 15% (Latin America) | 76.87* PPP dollars |
n/a | |||||||||
| Treatment of risk above 5% (Latin America) | 132.38* PPP dollars |
n/a | |||||||||
| Treatment of risk above 25% (Europe) | 239.14* PPP dollars |
n/a | |||||||||
| Treatment of risk above 15% (Europe) | 306.04* PPP dollars |
n/a | |||||||||
| Treatment of risk above 5% (Europe) | 446.97* PPP dollars |
n/a | |||||||||
| Treatment of risk above 25% (SE Asia) | 46.97* PPP dollars |
n/a | |||||||||
| Treatment of risk above 15% (SE Asia) | 68.33* PPP dollars |
n/a | |||||||||
| Treatment of risk above 5% (SE Asia) | 109.61* PPP dollars |
n/a | |||||||||
| Low | Tanzania | Ngalesoni | Pharm only - modelled | Not applicable | Hypothetical population-level model | Not specified | Pharmaceutical treatment with ACE inhibitors and diuretics modelled for four different risk levels. Very high risk is categorised as having SBP of 160 to 179 and being a smoker; high risk is having SBP of 160 to 179 and not being a smoker; moderate risk is having SBP of 140 to 159; and low risk is having SBP of 120 to 139. | Drugs, costs of medical visit or screening - not further disaggregated | Moderate risk | 2616.98 | 936 |
| High risk | 1761.58 | 936 | |||||||||
| Very high risk | 1533.00 | 936 | |||||||||
| Low risk | 1419.41 | 936 | |||||||||
| Blend | Sub-Saharan Africa region and South East Asia region | Ortegon | Pharm plus – modelled | Not applicable | Hypothetical population-level model | Not specified | Cost-effectiveness analysis of 123 single or combined prevention and treatment strategies for cardiovascular disease, diabetes and smoking. Relevant interventions were treatment with beta blockers and diuretics and along with patient education for two eligibility criteria (those with SBP above 140 and those above 160). | Drugs, laboratories, cost of medical visit or screening not further disaggregated, intervention development cost, training cost, media cost, monitoring and evaluation cost, other unspecified costs | Sub-Saharan Africa, eligibility: SBP >160 | 180.95* PPP dollars |
n/a |
| Sub-Saharan Africa, eligibility: SBP >140 | 504.36* PPP dollars | n/a | |||||||||
| South East Asia, eligibility: SBP >160 | 182.24* PPP dollars | n/a | |||||||||
| South East Asia, eligibility: SBP <140 | 621.14* PPP dollars | n/a | |||||||||
| Lower middle | India | Praveen | Pharm only | 62 194 | Cross-sectional study | Not specified | Comparing the BP lowering effect of 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 level’s ≥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 at high risk | 213.72 | 1939 |
| Treatment of all at intermediate and high risk | 241.03 | 1939 | |||||||||
| Treatment according to NPCDCS guidelines | 365.43 | 1939 | |||||||||
| Current practice (undefined) | 380.27 | 1939 | |||||||||
| Treatment of patients with BP greater than 140/90 mm Hg | 459.66 | 1939 | |||||||||
| Treatment of all above 55 years of age | 472.51 | 1939 | |||||||||
| Treatment of all above 45 years of age | 601.69 | 1939 | |||||||||
| Low | Tanzania | Robberstad | Pharm only - modelled | Not applicable | Hypothetical population-level model | Not specified | Fourteen pharmaceutical interventions of primary prevention of cardiovascular disease, four of which specifically target hypertension exclusively. | Drugs, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs (utilities, maintenance, and so on), equipment costs and office supplies | Diuretics | 106.68 | 936 |
| Beta blockers | 412.93 | 936 | |||||||||
| Calcium channel blockers | 1374.33 | 936 | |||||||||
| Diuretics and beta blockers | 155.63 | 936 | |||||||||
| Lower middle | Nigeria | Rosendaal | Pharm plus - modelled | Not applicable | Hypothetical population-level model | Not specified | Population-level hypertension screening and subsequent antihypertensive treatment for high CVD risk individuals in the context of the KSHI programme. Two eligibility strategies: first was CVD risk and BP level, in which all individuals with HTN stage 1 combined with a 10-year CVD risk greater than 20% as well as all individuals with stage 2 HTN regardless of risk were treated. The second was CVD based only, in which all individuals with 10-year CVD risk greater than 20% were eligible. Three estimates of relative risk reduction, based on (1) Lawes, (2) Rapsomaniki and (3) Framingham. | Labs, labour, cost of medical visit or screening - not further disaggregated, building overhead costs, and training costs. | Treatment eligibility: Risk based. Risk reduction: Lawes et al | 3649.84 | 1968 |
| Treatment eligibility: Risk + HTN. Risk reduction based: Lawes et al | 3998.39 | 1968 | |||||||||
| Treatment eligibility: Risk based. Risk reduction: Rapsomaniki et al | 11 553.36 | 1968 | |||||||||
| Treatment eligibility: Risk based. Risk reduction: Framingham score. | 13 616.78 | 1968 | |||||||||
| Treatment eligibility: Risk + HTN. Risk reduction: Rapsomaniki et al | 17 138.03 | 1968 | |||||||||
| Treatment eligibility: Risk + HTN. Risk reduction: Framingham score. | 21 268.82 | 1968 | |||||||||
| Upper middle | Argentina | Rubinstein* | Pharm plus - modelled | Not applicable | Hypothetical population-level model | Not specified | Population and clinical interventions, including mass media campaigns to promote tobacco cessation, reduction of salt in bread, bupropion for tobacco cessation, high blood pressure treatment, high cholesterol treatment and polypill strategy for people with CVD risk greater than 20%. | Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, trainings costs and media costs. | Lifestyle change promotion and pharmacological therapy to achieve BP control. | 2596.97 | 14 401 |
| Low | Ethiopia | Tolla | Pharm plus – modelled | Not applicable | Hypothetical population-level model | Not specified | Analysis included cost-effectiveness analysis of 15 interventions; relevant interventions were antihypertensive treatment with 25 mg hydrochlorothiazide and 50 mg atenolol per day. Patients assumed to have four visits to a health centre for the first year followed by three visits per year for the remaining 9 years. Additionally, 20% will have 1.5 visit per year at primary hospital. | Drugs, laboratories, cost of medical visit or screening not further disaggregated, intervention development cost, training cost, media cost, monitoring and evaluation cost, other unspecified costs | Eligibility: SBP >160 | 80.18 | 768 |
| Eligibility: SBP >140 | 166.86 | 768 |
BP, blood pressure; CVD, cardiovascular disease; HTN, hypertension; KSHI, Kwara State Health Insurance; n/a, not available; NPCDCS, National Program on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke; PPP, purchasing-power-parity; SBP, systolic blood pressure; SE Asia, South East Asia; US$, US dollars.