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Moran AE, Farrell M, Cazabon D, Sahoo SK, Mugrditchian D, Pidugu A, Chivardi C, Walbaum M, Alemayehu S, Isaranuwatchai W, Ankurawaranon C, Choudhury SR, Pickersgill SJ, Watkins DA, Husain MJ, Rao KD, Matsushita K, Marklund M, Hutchinson B, Nugent R, Kostova D, Garg R. Building the health-economic case for scaling up the WHO-HEARTS hypertension control package in low- and middle-income countries. Rev Panam Salud Publica 2022; 46:e140. [PMID: 36071923 PMCID: PMC9440739 DOI: 10.26633/rpsp.2022.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
ABSTRACT
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 low- and 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.
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Affiliation(s)
- Andrew E. Moran
- Resolve to Save Lives, New York, United States of America
- Columbia University Irving Medical Center, New York, United States of America
| | | | | | | | | | - Anirudh Pidugu
- Columbia University Irving Medical Center, New York, United States of America
| | - Carlos Chivardi
- Center for Health Economics, University of York, York, United Kingdom
| | | | | | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health of Thailand, Bangkok, Thailand
| | | | | | | | | | - Muhammad Jami Husain
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Krishna D. Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Matti Marklund
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Brian Hutchinson
- Center for Global Noncommunicable Diseases, RTI International, Seattle, United States of America
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, United States of America
| | - Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Renu Garg
- Resolve to Save Lives, New York, United States of America
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Kaur P, Borah PK, Gaigaware P, Mohapatra PK, R Das NK, Uike PV, Tobgay KJ, Tushi A, Zorinsangi, Mazumdar G, Marak B, Pizi D, Chakma T, Sugunan AP, Vijayachari P, Bhardwaj RR, Arambam PC, Kutum T, Sharma A, Pal P, Shanmugapriya PC, Manivel P, Kaliyamoorthy N, Chakma J, Mathur P, Dhaliwal RS, Mahanta J, Mehendale SM. Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India. Indian J Med Res 2022; 156:260-268. [PMID: 36629185 PMCID: PMC10057372 DOI: 10.4103/ijmr.ijmr_3248_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background and objectives Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions. Results In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes.
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Affiliation(s)
- Prabhdeep Kaur
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P K Borah
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Pooja Gaigaware
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P K Mohapatra
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Nabajit K R Das
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Pankaj V Uike
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Karma Jigme Tobgay
- Department of Health Care, Human Services & Family Welfare, Government of Sikkim, Gangtok, Sikkim, India
| | - Aonungdok Tushi
- Department of Health & Family Welfare, Government of Nagaland, Mokokchung, Nagaland, India
| | - Zorinsangi
- Department of Health & Family Welfare, Government of Mizoram, Aizwal, Mizoram, India
| | | | - Bibha Marak
- Department of Health & Family Welfare, Government of Meghalaya, East Garo Hills, Meghalaya, India
| | - Dirang Pizi
- Department of Health & Family Welfare, Government of Arunachal Pradesh, East Kameng, Arunachal Pradesh, India
| | - Tapas Chakma
- Division of Non-communicable Diseases, ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - A P Sugunan
- ICMR-Regional Medical Research Centre, Port Blair, Andaman & Nicobar Islands, India
| | - P Vijayachari
- ICMR-Regional Medical Research Centre, Port Blair, Andaman & Nicobar Islands, India
| | - Rakesh R Bhardwaj
- Department of Health & Family Welfare, Government of Himachal Pradesh, Shimla, Himachal Pradesh, India
| | - Probin C Arambam
- Directorate of Health Services, Government of Manipur, Imphal, Manipur, India
| | - Tridip Kutum
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Anand Sharma
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Piyalee Pal
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P C Shanmugapriya
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Prathab Manivel
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Neelakandan Kaliyamoorthy
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Joy Chakma
- Indian Council of Medical Research, New Delhi, India
| | - Prashant Mathur
- ICMR-National Centre for Disease Informatics & Research, Bengaluru, Karnataka, India
| | - R S Dhaliwal
- Indian Council of Medical Research, New Delhi, India
| | - J Mahanta
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Sanjay M Mehendale
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Dalal JJ, Kerkar P, Guha S, Dasbiswas A, Sawhney JPS, Natarajan S, Maddury SR, Kumar AS, Chandra N, Suryaprakash G, Thomas JM, Juvale NI, Sathe S, Khan A, Bansal S, Kumar V, Reddi R. Therapeutic adherence in hypertension: Current evidence and expert opinion from India. Indian Heart J 2021; 73:667-673. [PMID: 34861979 PMCID: PMC8642659 DOI: 10.1016/j.ihj.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022] Open
Abstract
Hypertension (HTN) is a globally prevalent non-communicable disease contributing significantly to cardiovascular (CV) morbidity and mortality. In achieving control of HTN, therapeutic adherence plays a crucial role. Studies from India identify varying rates of adherence to antihypertensive medications. Multiple factors determine treatment adherence in HTN. In India, factors such as lower socioeconomic status, health literacy, asymptomatic nature of disease, forgetfulness, cost of medications, and duration of HTN determine the adherence. An excellent physician-patient relationship incorporating adequate counseling along with the use of other methods can identify poor adherence. Improving adherence necessitates incorporating a multipronged approach with strategies directed at physicians, patients, and health systems. With innovation in therapeutics, the pharmaceutical sector can contribute significantly to improve adherence. Furthermore, increasing adherence to lifestyle interventions can help achieve better HTN control and improve CV outcomes. In the Indian context, more emphasis is necessary on patient education, enhanced physician-patient relationship and communication, increased access to health care, and affordability in improving therapeutic adherence in HTN.
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Affiliation(s)
- Jamshed J Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
| | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital, Mumbai, Maharashtra, India.
| | | | - Arup Dasbiswas
- Department of Cardiology, NRS Medical College, Kolkata, West Bengal, India.
| | - J P S Sawhney
- Dept. of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | | | | | | | | | - Joy M Thomas
- Dr. Joy Thomas Heart Care, Bharathi Salai, Mugappair West, Chennai, India.
| | - N I Juvale
- Department of Cardiology, Saifee Hospital, Mumbai, India.
| | | | - Aziz Khan
- Crescent Hospital & Heart Centre, Dhantoli, Nagpur, Maharashtra, India.
| | - Sandeep Bansal
- Department of Cardiology, Safdarjung Medical College, Delhi, India.
| | | | - Rajshekhar Reddi
- Department of Neurology, Max Superspecialty Hospital, Saket, New Delhi, India.
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Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016-2018. Glob Heart 2021; 16:51. [PMID: 34381673 PMCID: PMC8344964 DOI: 10.5334/gh.999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background India has a high burden of hypertension. While the private sector provides 70% of out-patient care in the country, a significant proportion of patients seeking care from the public sector buy drugs from private markets. This study aimed to describe India's private sector antihypertensive drugs market at the national and state levels over 2016-2018. Methods Antihypertensive drugs sales in India from 2016-2018 were analysed using a large nationally representative dataset for the private pharmaceuticals market. In addition, data for five states (Punjab, Madhya Pradesh, Kerala, Telangana, and Maharashtra) that were the foci of a large hypertension control program were studied. Results The Indian hypertension drug market grew at a rate of 6.9% from 2016 to 2018 with a total of 21,066 million pills sales in 2018. Single-pill combinations (SPCs) contributed to 39.1% of total sale volumes. The market comprised of 182 different antihypertensive drugs including 134 SPCs. Total volume of sales covered a maximum of 26% of treatment need for the estimated population with hypertension. Two-drug SPCs had the highest market share (36%), followed by calcium channel blockers (18%), beta-blockers (16%) and angiotensin receptor blockers (14%). Among SPCs, amlodipine+atenolol had highest sales (9.8%). Twenty-five drugs, a mix of single drugs and SPCs, accounted for 80% of total sales. There were large state-to-state variations in sales per capita, preferred therapeutic classes and drugs. Conclusions Despite the large antihypertensive drugs market, there exists a high unmet need for treatment in India. Inter-state differences in product sales indicate variable treatment practices, underscoring the need for private sector engagement to improve hypertension care practices aligned with national and international guidelines. SPCs contributed to a large share of the private market and inclusion of select antihypertensive SPCs in the national list of essential medications should be considered for the public health system.
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Cohn J, Kostova D, Moran AE, Cobb LK, Pathni AK, Bisrat D. Blood from a stone: funding hypertension prevention, treatment, and care in low- and middle-income countries. J Hum Hypertens 2021; 35:1059-1062. [PMID: 34331004 PMCID: PMC8654676 DOI: 10.1038/s41371-021-00583-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jennifer Cohn
- Resolve to Save Lives, New York, NY, United States. .,Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA, United States.
| | - Deliana Kostova
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrew E Moran
- Resolve to Save Lives, New York, NY, United States.,Division of General Medicine, Department of Medicine, Columbia University, New York, NY, United States
| | - Laura K Cobb
- Resolve to Save Lives, New York, NY, United States
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