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Hirashiki A, Shimizu A, Nomoto K, Kokubo M, Suzuki N, Arai H. Systematic Review of the Effectiveness of Community Intervention and Health Promotion Programs for the Prevention of Non-Communicable Diseases in Japan and Other East and Southeast Asian Countries. Circ Rep 2022; 4:149-157. [PMID: 35434409 PMCID: PMC8977194 DOI: 10.1253/circrep.cr-21-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide. However, current evidence regarding the efficacy and cost-effectiveness of community intervention and health promotion programs for NCDs, specifically hypertension, obesity, diabetes, and dyslipidemia, in East and Southeast Asia has not yet been systematically reviewed. We systematically reviewed the literature from East and Southeast Asian countries to answer 2 clinical questions: (1) do health promotion programs for hypertension, obesity, diabetes, and dyslipidemia reduce cardiovascular events and mortality; and (2) are these programs cost-effective? Methods and Results: Electronic literature searches were performed across Medline, Cochrane Library, and Ichushi using key words and relevant subject headings related to randomized controlled trials, comparative studies, quasi-experimental studies, or propensity score matching that met eligibility criteria that were defined for each question. In all, 3,389 records were identified, of which 12 full-text articles were reviewed. Three papers were from Japan, 7 were from China/Hong Kong Special Administrative Region, and 2 were from South Korea. None were from Southeast Asia. Four papers examined the effect of community intervention or health promotion on the incidence of cardiovascular events or mortality. Eight studies examined the cost-effectiveness of interventions. Conclusions: The literature review revealed that community intervention and health promotion programs for the control of NCDs are a cost-effective means of reducing cardiovascular events and mortality in East Asian countries.
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Affiliation(s)
- Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Kenichiro Nomoto
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Manabu Kokubo
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Noriyuki Suzuki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Hidenori Arai
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology
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Cheng J, Zhang Y, Zhong A, Tian M, Zou G, Chen X, Yu H, Song F, Zhou S. Quality of Health Economic Evaluations in Mainland China: A Comparison of Peer-Reviewed Articles in Chinese and in English. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:35-54. [PMID: 34322862 DOI: 10.1007/s40258-021-00674-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Our objective was to assess the incidence and quality of reporting of published health economic evaluations in mainland China and compare the quality of peer-reviewed articles in Chinese and English. METHODS A comprehensive search was conducted for economic evaluations pertaining to China published from 2006 to 2015 using the PubMed, CBM, CMCC, CNKI, VIP, and Wanfang databases. All studies in English that met the inclusion criteria were included. For studies in Chinese, 200 sampled studies were included according to the random seeds method, and the same number of the most-cited studies in Chinese as those in English were included according to the number of citations and journal grades. Researchers independently assessed the quality of the studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS After literature search and screening, a total of 310 studies were identified. The majority of these studies were cost-effectiveness studies (82.26%). Scores among different CHEERS items varied greatly. There was a gap between the average quality scores of the studies published in Chinese and those published in English (49.78 ± 9.31 vs. 82.48 ± 17.69) and between the average quality scores of the included most-cited studies in Chinese and English, which was slightly smaller (54.08 ± 10.27 vs. 82.48 ± 17.69). The methods, results, and discussion sections of studies published in Chinese were of low quality. CONCLUSION The quality of reporting of health economic evaluations in mainland China has developed slowly. Most of the included studies were incomplete in the presentation of content, making the results less reliable. It is important to standardize and improve the quality of Chinese health economic research.
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Affiliation(s)
- Jiehua Cheng
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Yu Zhang
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Ailin Zhong
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Miao Tian
- Dongfeng Stomatological Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Guanyang Zou
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China
| | - Xiaping Chen
- Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hongxing Yu
- Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Fujian Song
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Shangcheng Zhou
- School of Public Health and Management, Higher Education Mega Centre, Guangzhou University of Chinese Medicine, No. 232 Wai Huan Dong Road, Panyu District, Guangzhou, 510006, Guangdong, China.
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Kostova D, Spencer G, Moran AE, Cobb LK, Husain MJ, Datta BK, Matsushita K, Nugent R. The cost-effectiveness of hypertension management in low-income and middle-income countries: a review. BMJ Glob Health 2020; 5:e002213. [PMID: 32912853 PMCID: PMC7484861 DOI: 10.1136/bmjgh-2019-002213] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 01/11/2023] Open
Abstract
Hypertension in low-income and middle-income countries (LMICs) is largely undiagnosed and uncontrolled, representing an untapped opportunity for public health improvement. Implementation of hypertension control strategies in low-resource settings depends in large part on cost considerations. However, evidence on the cost-effectiveness of hypertension interventions in LMICs is varied across geographical, clinical and evaluation contexts. We conducted a comprehensive search for published economic evaluations of hypertension treatment programmes in LMICs. The search identified 71 articles assessing a wide range of hypertension intervention designs and cost components, of which 42 studies across 15 countries reported estimates of cost-effectiveness. Although comparability of results was limited due to heterogeneity in the interventions assessed, populations studied, costs and study quality score, most interventions that reported cost per averted disability-adjusted life-year (DALY) were cost-effective, with costs per averted DALY not exceeding national income thresholds. Programme elements that may reduce cost-effectiveness included screening for hypertension at younger ages, addressing prehypertension, or treating patients at lower cardiovascular disease risk. Cost-effectiveness analysis could provide the evidence base to guide the initiation and development of hypertension programmes.
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Affiliation(s)
- Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
| | - Andrew E Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York, United States
- Columbia University Irving Medical Center, New York, New York, United States
| | - Laura K Cobb
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York, United States
| | - Muhammad Jami Husain
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Biplab Kumar Datta
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
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Zhang X, Zhang X, Yang S. Total per-visit medical expenses incurred by outpatients with diabetes-Evidence from six provinces in eastern China. Int J Health Plann Manage 2019; 35:e156-e166. [PMID: 31709628 DOI: 10.1002/hpm.2952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Chronic diseases associated with diabetes threaten the health of Chinese people and contribute to poverty. METHODS Medical service utilization records of 78 124 visits by outpatients with diabetes to medical institutions in China's eastern region between 2013 and 2015 were randomly selected from the Medical Insurance Department (MID) database. One-way analysis of variance (ANOVA) was used to compare the average total per-visit, out-of-pocket (OOP), and medical insurance (MI) fund expenses between variables. Multiple linear regression analysis was performed to identify possible risk factors affecting total per-visit medical expenses. RESULTS Average total per-visit medical expenses were 244.59, 285.56, and 435.33 yuan in primary, secondary, and tertiary medical institutions, respectively. Significant differences were found for average total per-visit medical expenses by year of visit, age, type of medical insurance, and levels of medical institutions. No significant differences were found for average total per-visit medical expenses by gender. CONCLUSION The functions of medical networks at all levels should be clarified and the Urban Resident Basic Medical Insurance (URBMI) reimbursement ratio improved to ensure equal access to medical services irrespective of medical insurance type. Patients with chronic diseases should be encouraged to visit primary medical institutions to reduce medical expenses.
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Affiliation(s)
- Xiaoyan Zhang
- College of Politics & Law and Public Administration, Hubei University, Wuhan, China
| | - Xiaona Zhang
- College of Politics & Law and Public Administration, Hubei University, Wuhan, China
| | - Shiyu Yang
- College of Politics & Law and Public Administration, Hubei University, Wuhan, China
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A Community-Based Intervention for Improving Medication Adherence for Elderly Patients with Hypertension in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050721. [PMID: 30823383 PMCID: PMC6427311 DOI: 10.3390/ijerph16050721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based hypertension intervention intended to enhance patient adherence to prescribed medications. This study applied a non-equivalent control group design using the Korean National Health Insurance Big Data. Hongcheon County has been continuously implementing the intervention program since 2012. This study involved a cohort of patients with hypertension aged >65 and <85 years, among residents who lived in the study area for five years (between 2010 and 2014). The final number of subjects was 2685 in both the intervention and control region. The indirect indicators were analyzed as patients’ adherence and level of continuous treatment using the difference-in-difference regression. The proportion of hypertensive patients who continuously received insurance benefits for >240 days in 2014 was 81.0% in the intervention region and 79.7% in the control region. The number of dispensations per prescription and the dispensation days per hypertensive patient in the intervention region increased by approximately 10.88% and 2.2 days on average by month, respectively, compared to those in the control region. The intervention program encouraged elderly patients with hypertension to receive continuous care. Another research is needed to determine whether further improvement in the continuity of comprehensive care will prevent the progression of cardiovascular diseases.
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Analysis on Medical Expenses of Hypertensive Inpatients in Urban Areas from 2010 to 2013-Evidence from Two Provinces in South of China. Curr Med Sci 2018; 38:741-748. [PMID: 30128887 DOI: 10.1007/s11596-018-1939-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/20/2018] [Indexed: 02/04/2023]
Abstract
Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID), including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket (OOP) expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients (P>0.05). People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.
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Zhang D, Wang G, Joo H. A Systematic Review of Economic Evidence on Community Hypertension Interventions. Am J Prev Med 2017; 53:S121-S130. [PMID: 29153113 PMCID: PMC5819001 DOI: 10.1016/j.amepre.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/24/2017] [Accepted: 05/08/2017] [Indexed: 01/05/2023]
Abstract
CONTEXT Effective community-based interventions are available to control hypertension. It is important to determine the economics of these interventions. EVIDENCE ACQUISITION Peer-reviewed studies from January 1995 through December 2015 were screened. Interventions were categorized into educational interventions, self-monitoring interventions, and screening interventions. Incremental cost-effectiveness ratios were summarized by types of interventions. The review was conducted in 2016. EVIDENCE SYNTHESIS Thirty-four articles were included in the review (16 from the U.S., 18 from other countries), including 25 on educational interventions, three on self-monitoring interventions, and six on screening interventions. In the U.S., five (31.3%) studies on educational interventions were cost saving. Among the studies that found the interventions cost effective, the median incremental costs were $62 (range, $40-$114) for 1-mmHg reduction in systolic blood pressure (SBP) and $13,986 (range, $6,683-$58,610) for 1 life-year gained. Outside the U.S., educational interventions cost from $0.62 (China) to $29 (Pakistan) for 1-mmHg reduction in SBP. Self-monitoring interventions, evaluated in the U.S. only, cost $727 for 1-mmHg reduction in SBP and $41,927 for 1 life-year gained. For 1 quality-adjusted life-year, screening interventions cost from $21,734 to $56,750 in the U.S., $613 to $5,637 in Australia, and $7,000 to $18,000 in China. Intervention costs to reduce 1 mmHg blood pressure or 1 quality-adjusted life-year were higher in the U.S. than in other countries. CONCLUSIONS Most studies found that the three types of interventions were either cost effective or cost saving. Quality of economic studies should be improved to confirm the findings.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia.
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heesoo Joo
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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8
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Wang G, Grosse SD, Schooley MW. Conducting Research on the Economics of Hypertension to Improve Cardiovascular Health. Am J Prev Med 2017; 53:S115-S117. [PMID: 29153111 PMCID: PMC5808538 DOI: 10.1016/j.amepre.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/12/2017] [Accepted: 08/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael W Schooley
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Dainelli L, Xu T, Li M, Zimmermann D, Fang H, Wu Y, Detzel P. Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model. BMJ Open 2017; 7:e017136. [PMID: 28951410 PMCID: PMC5623478 DOI: 10.1136/bmjopen-2017-017136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To model the long-term cost-effectiveness of consuming milk powder fortified with potassium to decrease systolic blood pressure (SBP) and prevent cardiovascular events. DESIGN A best case scenario analysis using a Markov model was conducted. PARTICIPANTS 8.67% of 50-79 year olds who regularly consume milk in China, including individuals with and without a prior diagnosis of hypertension. INTERVENTION The model simulated the potential impact of a daily intake of two servings of milk powder fortified with potassium (+700 mg/day) vs the consumption of a milk powder without potassium fortification, assuming a market price equal to 0.99 international dollars (intl$; the consumption of a milk powder without potassium fortification, assuming a market price equal to intl$0.99 for the latter and to intl$1.12 for the first (+13.13%). Both deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results. MAIN OUTCOME MEASURES Estimates of the incidence of cardiovascular events and subsequent mortality in China were derived from the literature as well as the effect of increasing potassium intake on blood pressure. The incremental cost-effectiveness ratio (ICER) was used to determine the cost-effectiveness of a milk powder fortified with potassium taking into consideration the direct medical costs associated with the cardiovascular events, loss of working days and health utilities impact. RESULTS With an ICER equal to int$4711.56 per QALY (quality-adjusted life year) in the best case scenario and assuming 100% compliance, the daily consumption of a milk powder fortified with potassium shown to be a cost-effective approach to decrease SBP and reduce cardiovascular events in China. Healthcare savings due to prevention would amount to intl$8.41 billion. Sensitivity analyses showed the robustness of the results. CONCLUSION Together with other preventive interventions, the consumption of a milk powder fortified with potassium could represent a cost-effective strategy to attenuate the rapid rise in cardiovascular burden among the 50-79 year olds who regularly consume milk in China.
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Affiliation(s)
| | - Tingting Xu
- China Center for Health Development Studies, Peking University, Beijing, China
- Department of Health Policy and Administration, Peking University School of Public Health, Beijing, China
| | - Min Li
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yangfeng Wu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
- The George Institute for Global Health, Peking University Health Science Centre, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
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Brouwer ED, Watkins D, Olson Z, Goett J, Nugent R, Levin C. Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review. BMC Public Health 2015; 15:1183. [PMID: 26612044 PMCID: PMC4660724 DOI: 10.1186/s12889-015-2538-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 11/23/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) and CVD risk conditions is rapidly increasing in low- and middle-income countries, where health systems are generally ill-equipped to manage chronic disease. Policy makers need an understanding of the magnitude and drivers of the costs of cardiovascular disease related conditions to make decisions on how to allocate limited health resources. METHODS We undertook a systematic review of the published literature on provider-incurred costs of treatment for cardiovascular diseases and risk conditions in low- and middle-income countries. Total costs of treatment were inflated to 2012 US dollars for comparability across geographic settings and time periods. RESULTS This systematic review identified 60 articles and 143 unit costs for the following conditions: ischemic heart disease, non-ischemic heart diseases, stroke, heart failure, hypertension, diabetes, and chronic kidney disease. Cost data were most readily available in middle-income countries, especially China, India, Brazil, and South Africa. The most common conditions with cost studies were acute ischemic heart disease, type 2 diabetes mellitus, stroke, and hypertension. CONCLUSIONS Emerging economies are currently providing a base of cost evidence for NCD treatment that may prove useful to policy-makers in low-income countries. Initial steps to publicly finance disease interventions should take account of costs. The gaps and limitations in the current literature include a lack of standardized reporting as well as sparse evidence from low-income countries.
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Affiliation(s)
- Elizabeth D Brouwer
- Disease Control Priorities Network, Department of Global Health, University of Washington, 325 Ninth Avenue, Box 259931, Seattle, WA, 98104, USA.
| | - David Watkins
- Department of Medicine, University of Washington, 325 Ninth Ave, Box 359780, Seattle, WA, 98104, USA.
| | - Zachary Olson
- School of Public Health, University of California Berkeley, 50 University Hall, #7360, Berkeley, CA, 94720-7360, USA.
| | - Jane Goett
- PATH, 2201 Westlake Ave #200, Seattle, WA, 98121, USA.
| | - Rachel Nugent
- Disease Control Priorities Network, Department of Global Health, University of Washington, 325 Ninth Avenue, Box 259931, Seattle, WA, 98104, USA.
| | - Carol Levin
- Disease Control Priorities Network, Department of Global Health, University of Washington, 325 Ninth Avenue, Box 259931, Seattle, WA, 98104, USA.
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Gu D, He J, Coxson PG, Rasmussen PW, Huang C, Thanataveerat A, Tzong KY, Xiong J, Wang M, Zhao D, Goldman L, Moran AE. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study. PLoS Med 2015; 12:e1001860. [PMID: 26241895 PMCID: PMC4524696 DOI: 10.1371/journal.pmed.1001860] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 06/25/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs. METHODS AND FINDINGS The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs) gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention) and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg). Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015) were considered cost-effective. Treating hypertensive adults with prior cardiovascular disease for secondary prevention was projected to be cost saving in the main simulation and 100% of probabilistic simulation results. Treating all hypertension for primary and secondary prevention would prevent about 800,000 cardiovascular disease events annually (95% uncertainty interval, 0.6 to 1.0 million) and was borderline cost-effective incremental to treating only cardiovascular disease and stage two patients (2015 Int$13,000 per QALY gained [95% uncertainty interval, Int$10,000 to Int$18,000]). Of all one-way sensitivity analyses, assuming adherence to taking medications as low as 25%, high Shanghai drug costs, or low medication efficacy led to the most unfavorable results (treating all hypertension, about Int$47,000, Int$37,000, and Int$27,000 per QALY were gained, respectively). The strengths of this study were the use of a recent Chinese national health survey, vital statistics, health care costs, and cohort study outcomes data as model inputs and reliance on clinical-trial-based estimates of coronary heart disease and stroke risk reduction due to antihypertensive medication treatment. The limitations of the study were the use of several sources of data, limited clinical trial evidence for medication effectiveness and harms in the youngest and oldest age groups, lack of information about geographic and ethnic subgroups, lack of specific information about indirect costs borne by patients, and uncertainty about the future epidemiology of cardiovascular diseases in China. CONCLUSIONS Expanded hypertension treatment has the potential to prevent about 800,000 cardiovascular disease events annually and be borderline cost-effective in China, provided low-cost essential antihypertensive medicines programs can be implemented.
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Affiliation(s)
- Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Center for Cardiovascular Diseases, Beijing, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Pamela G. Coxson
- Division of General Medicine, University of California at San Francisco, San Francisco, California, United States of America
| | - Petra W. Rasmussen
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Chen Huang
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Center for Cardiovascular Diseases, Beijing, China
| | - Anusorn Thanataveerat
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Keane Y. Tzong
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Juyang Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Miao Wang
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Lee Goldman
- Columbia University College of Physicians and Surgeons, New York, New York, United States of America
| | - Andrew E. Moran
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
- Columbia University College of Physicians and Surgeons, New York, New York, United States of America
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Bowser D, Okunogbe A, Oliveras E, Subramanian L, Morrill T. A Cost-Effectiveness Analysis of Community Health Workers in Mozambique. J Prim Care Community Health 2015; 6:227-32. [PMID: 25858899 DOI: 10.1177/2150131915579653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Community health worker (CHW) programs are a key strategy for reducing mortality and morbidity. Despite this, there is a gap in the literature on the cost and cost-effectiveness of CHW programs, especially in developing countries. METHODS This study assessed the costs of a CHW program in Mozambique over the period 2010-2012. Incremental cost-effectiveness ratios, comparing the change in costs to the change in 3 output measures, as well as gains in efficiency were calculated over the periods 2010-2011 and 2010-2012. The results were reported both excluding and including salaries for CHWs. RESULTS The results of the study showed total costs of the CHW program increased from US$1.34 million in 2010 to US$1.67 million in 2012. The highest incremental cost-effectiveness ratio was for the cost per beneficiary covered including CHW salaries, estimated at US$47.12 for 2010-2011. The smallest incremental cost-effectiveness ratio was for the cost per household visit not including CHW salaries, estimated at US$0.09 for 2010-2012. Adding CHW salaries would not only have increased total program costs by 362% in 2012 but also led to the largest efficiency gains in program implementation; a 56% gain in cost per output in the long run as compared with the short run after including CHW salaries. CONCLUSIONS Our findings can be used to inform future CHW program policy both in Mozambique and in other countries, as well as provide a set of incremental cost per output measures to be used in benchmarking to other CHW costing analyses.
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