Building the health-economic case for scaling up the WHO-HEARTS hypertension control package in low- and middle-income countries

• Published in: Revista Panamericana de Salud Pública
• Main Authors: Andrew E. Moran, Margaret Farrell, Danielle Cazabon, Swagata Kumar Sahoo, Doris Mugrditchian, Anirudh Pidugu, Carlos Chivardi, Magdalena Walbaum, Senait Alemayehu, Wanrudee Isaranuwatchai, Chaisiri Ankurawaranon, Sohel R. Choudhury, Sarah J. Pickersgill, David A. Watkins, Muhammad Jami Husain, Krishna D. Rao, Kunihiro Matsushita, Matti Marklund, Brian Hutchinson, Rachel Nugent, Deliana Kostova, Renu Garg
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2022
• Subjects: health services accessibility; cost-benefit analysis; hypertension; cardiovascular diseases; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doi.org/10.26633/RPSP.2022.140; https://doaj.org/article/89b5da33858841ddaea86a960d8c608d

Generally, hypertension control programs are cost-effective, including in low- and middle-income countries, but country governments and civil society are not likely to support hypertension control programs unless value is demonstrated in terms of public health benefits, budget impact, and value-for-investment for the individual country context. The World Health Organization (WHO) and the Pan American Health Organization (PAHO) established a standard, simplified Global HEARTS approach to hypertension control, including preferred antihypertensive medicines and blood pressure measurement devices. The objective of this study is to report on health economic studies of HEARTS hypertension control package cost (especially medication costs), cost-effectiveness, and budget impact and describe mathematical models designed to translate hypertension control program data into the optimal approach to hypertension care service delivery and financing, especially in lowand middle-income countries. Early results suggest that HEARTS hypertension control interventions are either cost-saving or cost-effective, that the HEARTS package is affordable at between US$ 18-44 per person treated per year, and that antihypertensive medicines could be priced low enough to reach a global standard of an average <US$ 5 per patient per year in the public sector. This health economic evidence will make a compelling case for government ownership and financial support for national scale hypertension control programs.