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Hollingworth SA, Leaupepe GA, Nonvignon J, Fenny AP, Odame EA, Ruiz F. Economic evaluations of non-communicable diseases conducted in Sub-Saharan Africa: a critical review of data sources. Cost Eff Resour Alloc 2023; 21:57. [PMID: 37641087 PMCID: PMC10463745 DOI: 10.1186/s12962-023-00471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Policymakers in sub-Saharan Africa (SSA) face challenging decisions regarding the allocation of health resources. Economic evaluations can help decision makers to determine which health interventions should be funded and or included in their benefits package. A major problem is whether the evaluations incorporated data from sources that are reliable and relevant to the country of interest. We aimed to review the quality of the data sources used in all published economic evaluations for cardiovascular disease and diabetes in SSA. METHODS We systematically searched selected databases for all published economic evaluations for CVD and diabetes in SSA. We modified a hierarchy of data sources and used a reference case to measure the adherence to reporting and methodological characteristics, and descriptively analysed author statements. RESULTS From 7,297 articles retrieved from the search, we selected 35 for study inclusion. Most were modelled evaluations and almost all focused on pharmacological interventions. The studies adhered to the reporting standards but were less adherent to the methodological standards. The quality of data sources varied. The quality level of evidence in the data domains of resource use and costs were generally considered of high quality, with studies often sourcing information from reliable databases within the same jurisdiction. The authors of most studies referred to data sources in the discussion section of the publications highlighting the challenges of obtaining good quality and locally relevant data. CONCLUSIONS The data sources in some domains are considered high quality but there remains a need to make substantial improvements in the methodological adherence and overall quality of data sources to provide evidence that is sufficiently robust to support decision making in SSA within the context of UHC and health benefits plans. Many SSA governments will need to strengthen and build their capacity to conduct economic evaluations of interventions and health technology assessment for improved priority setting. This capacity building includes enhancing local infrastructures for routine data production and management. If many of the policy makers are using economic evaluations to guide resource allocation, it is imperative that the evidence used is of the feasibly highest quality.
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Affiliation(s)
| | | | | | - Ama Pokuaa Fenny
- Institute of Social, Statistical and Economic Research, University of Ghana, Accra, Ghana
| | - Emmanuel A Odame
- Dept of Medical Affairs, Korle Bu Teaching Hospital, Accra, Ghana
| | - Francis Ruiz
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Chillo P, Mashili F, Kwesigabo G, Ruggajo P, Kamuhabwa A. Developing a Sustainable Cardiovascular Disease Research Strategy in Tanzania Through Training: Leveraging From the East African Centre of Excellence in Cardiovascular Sciences Project. Front Cardiovasc Med 2022; 9:849007. [PMID: 35402575 PMCID: PMC8990919 DOI: 10.3389/fcvm.2022.849007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) contribute the largest mortality burden globally, with most of the deaths (80% of all deaths) occurring in low and middle-income countries (LMICs), including Tanzania. Despite the increasing burden, to date, CVD research output is still limited in Tanzania, as it is for many sub-Saharan Africa (SSA) countries. This trend hinders the establishment of locally informed CVD management and policy changes. Here, we aim to review the existing gaps while highlighting the available opportunities for a sustainable CVD research strategy in Tanzania. Methods A rapid review of available literature on CVD research in SSA was conducted, with emphasis on the contribution of Tanzania in the world literature of CVD. Through available literature, we identify strategic CVD research priorities in Tanzania and highlight challenges and opportunities for sustainable CVD research output. Findings Shortage of skilled researchers, inadequate research infrastructure, limited funding, and lack of organized research strategies at different levels (regional, country, and institutional) are among the existing key bottlenecks contributing to the low output of CVD research in Tanzania. There is generally strong global, regional and local political will to address the CVD epidemic. The establishment of the East African Centre of Excellence in Cardiovascular Sciences (EACoECVS) offers a unique opportunity for setting strategies and coordinating CVD research and training for Tanzania and the East African region. Conclusion There is a light of hope for long-term sustainable CVD research output from Tanzania, taking advantage of the ongoing activities and plans for the evolving EACoECVS. The Tanzanian experience can be taken as a lesson for other SSA countries.
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Affiliation(s)
- Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Pilly Chillo, ;
| | - Fredirick Mashili
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Ruggajo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Appolinary Kamuhabwa
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Husain MJ, Spencer G, Nugent R, Kostova D, Richter P. The Cost-Effectiveness of Hyperlipidemia Medication in Low- and Middle-Income Countries: A Review. Glob Heart 2022; 17:18. [PMID: 35342693 PMCID: PMC8896253 DOI: 10.5334/gh.1097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 01/03/2023] Open
Abstract
Hyperlipidemia is a risk factor for cardiovascular disease - the leading cause of death globally. Increased understanding of the cost-effectiveness of hyperlipidemia treatment in low- and middle-income countries can guide approaches to hyperlipidemia management in resource-limited environments. We conducted a systematic review of the evidence on the cost-effectiveness of hyperlipidemia medication treatment in low- and middle-income countries using studies published between January 2010 and April 2020. We abstracted study details, including study design, treatment setting, intervention type, health metrics, costs standardized to constant 2019 US dollars, and cost-effectiveness measures including average and incremental cost-effectiveness ratios. Comparisons across studies suggested that treatment via polypill is generally more cost-effective than statin-only therapy, and that primary prevention is more cost-effective than secondary prevention. Treating hyperlipidemia at a threshold of 5.7 mmol/l comes at a higher cost per disability-adjusted life-years averted than at a threshold of 6.2 mmol/l. Most pharmacological treatment strategies for hyperlipidemia were found to be cost-effective in most of the examined low- and middle-income countries.
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Affiliation(s)
- Muhammad Jami Husain
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, US
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, US
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, US
| | - Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, US
| | - Patricia Richter
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, US
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Aminde LN, Cobiac L, Veerman JL. Cost-effectiveness analysis of population salt reduction interventions to prevent cardiovascular disease in Cameroon: mathematical modelling study. BMJ Open 2020; 10:e041346. [PMID: 33234652 PMCID: PMC7689085 DOI: 10.1136/bmjopen-2020-041346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Reducing dietary sodium (salt) intake has been proposed as a population-wide strategy to reduce blood pressure and cardiovascular disease (CVD). The cost-effectiveness of such strategies has hitherto not been investigated in Cameroon. METHODS A multicohort multistate life table Markov model was used to evaluate the cost-effectiveness of three population salt reduction strategies: mass media campaign, school-based salt education programme and low-sodium salt substitute. A healthcare system perspective was considered and adults alive in 2016 were simulated over the life course. Outcomes were changes in disease incidence, mortality, health-adjusted life years (HALYs), healthcare costs and incremental cost-effectiveness ratios (ICERs) over the lifetime. Probabilistic sensitivity analysis was used to quantify uncertainty. RESULTS Over the life span of the cohort of adults alive in Cameroon in 2016, substantial numbers of new CVD events could be prevented, with over 10 000, 79 000 and 84 000 CVD deaths that could be averted from mass media, school education programme and salt substitute interventions, respectively. Population health gains over the lifetime were 46 700 HALYs, 348 800 HALYs and 368 400 HALYs for the mass media, school education programme and salt substitute interventions, respectively. ICERs showed that all interventions were dominant, with probabilities of being cost-saving of 84% for the school education programme, 89% for the mass media campaign and 99% for the low sodium salt substitute. Results were largely robust in sensitivity analysis. CONCLUSION All the salt reduction strategies evaluated were highly cost-effective with very high probabilities of being cost-saving. Salt reduction in Cameroon has the potential to save many lives and offers good value for money.
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Affiliation(s)
| | - Linda Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - J Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Isaranuwatchai W, Teerawattananon Y, Archer RA, Luz A, Sharma M, Rattanavipapong W, Anothaisintawee T, Bacon RL, Bhatia T, Bump J, Chalkidou K, Elshaug AG, Kim DD, Reddiar SK, Nakamura R, Neumann PJ, Shichijo A, Smith PC, Culyer AJ. Prevention of non-communicable disease: best buys, wasted buys, and contestable buys. BMJ 2020; 368:m141. [PMID: 31992592 PMCID: PMC7190374 DOI: 10.1136/bmj.m141] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Wanrudee Isaranuwatchai and colleagues highlight the importance of local context in making decisions about implementing interventions for preventing non-communicable diseases
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
- University of Toronto, Toronto, Canada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
- National University of Singapore, Singapore
- National Health Foundation, Bangkok, Thailand
| | - Rachel A Archer
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
| | - Alia Luz
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
| | - Manushi Sharma
- Health Intervention and Technology Assessment Programme, Bangkok, Thailand
| | | | | | - Rachel L Bacon
- Tufts Medical Center, Boston, USA
- Boston University, Boston, USA
| | | | - Jesse Bump
- Harvard TH Chan School of Public Health, Boston, USA
| | - Kalipso Chalkidou
- Centre for Global Development, London, UK
- Imperial College London, London, UK
| | - Adam G Elshaug
- University of Sydney, Sydney, Australia
- Brookings Institution, Washington DC, USA
| | | | | | | | - Peter J Neumann
- Tufts Medical Center, Boston, USA
- Tufts University School of Medicine, Boston, USA
| | | | - Peter C Smith
- University of York, York, UK
- Imperial College Business School, London, UK
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Bekker LG, Alleyne G, Baral S, Cepeda J, Daskalakis D, Dowdy D, Dybul M, Eholie S, Esom K, Garnett G, Grimsrud A, Hakim J, Havlir D, Isbell MT, Johnson L, Kamarulzaman A, Kasaie P, Kazatchkine M, Kilonzo N, Klag M, Klein M, Lewin SR, Luo C, Makofane K, Martin NK, Mayer K, Millett G, Ntusi N, Pace L, Pike C, Piot P, Pozniak A, Quinn TC, Rockstroh J, Ratevosian J, Ryan O, Sippel S, Spire B, Soucat A, Starrs A, Strathdee SA, Thomson N, Vella S, Schechter M, Vickerman P, Weir B, Beyrer C. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission. Lancet 2018; 392:312-358. [PMID: 30032975 PMCID: PMC6323648 DOI: 10.1016/s0140-6736(18)31070-5] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Linda-Gail Bekker
- International AIDS Society, Geneva, Switzerland; Desmond Tutu HIV Centre, University of Cape Town, South Africa.
| | - George Alleyne
- NCD Alliance, Office of the Director, Pan American Health Organization, Washington, DC, USA
| | - Stefan Baral
- Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | | | - David Dowdy
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Dybul
- Centre for Global Health and Quality, Georgetown University School of Medicine, Washington, DC, USA
| | - Serge Eholie
- Department of Dermatology and Infectious Diseases, Medical School, Felix Houphouet Boigny Universty Abidjan, Cote d'Ivoire
| | - Kene Esom
- HIV, Health and Development Group, United Nations Development Programme, New York, NY, USA
| | - Geoff Garnett
- HIV Delivery, Bill & Melinda Gates Foundation, Washington, DC, USA
| | | | - James Hakim
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California-San Francisco, San Fransisco, CA, USA
| | | | - Leigh Johnson
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Parastu Kasaie
- Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Michel Kazatchkine
- UNAIDS and Global Health Center, Graduate Institute, Geneva, Switzerland
| | - Nduku Kilonzo
- National AIDS Control Council for Kenya, Nairobi, Kenya
| | - Michael Klag
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
| | - Marina Klein
- Division of Infectious Diseases, Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Chewe Luo
- HIV/AIDS Section, United Nations Children's Fund, New York City, NY, USA
| | - Keletso Makofane
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Kenneth Mayer
- The Fenway Institute, Harvard Medical School, Boston, MA, USA
| | | | - Ntobeko Ntusi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Loyce Pace
- Global Health Council, Washington, DC, USA
| | - Carey Pike
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anton Pozniak
- HIV Services, Chelsea and Westminster NHS Foundation Trust Hospital, London, UK
| | - Thomas C Quinn
- Centre for Global Health, Johns Hopkins University, Baltimore, MD, USA; International AIDS Society-National Institute for Drug Abuse, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, MD, USA
| | - Jurgen Rockstroh
- HIV Clinic, Department of Medicine, University Hospital Bonn, Bonn, Germany
| | - Jirair Ratevosian
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Owen Ryan
- International AIDS Society, Geneva, Switzerland
| | - Serra Sippel
- Center for Health and Gender Equity, Washington DC, USA
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Agnes Soucat
- Health Systems, Governance and Financing, World Health Organisation, Geneva, Switzerland
| | | | - Steffanie A Strathdee
- Global Health Sciences, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Nicholas Thomson
- Centre for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Stefano Vella
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Mauro Schechter
- Department of Preventative Medicine, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Brian Weir
- Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Chris Beyrer
- International AIDS Society, Geneva, Switzerland; Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Aminde LN, Takah NF, Zapata-Diomedi B, Veerman JL. Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations. Cost Eff Resour Alloc 2018; 16:22. [PMID: 29983644 PMCID: PMC6003072 DOI: 10.1186/s12962-018-0108-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. Methods In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond’s checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. Results From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. Conclusions This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation. Electronic supplementary material The online version of this article (10.1186/s12962-018-0108-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leopold Ndemnge Aminde
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,Non-communicable Diseases Unit, Clinical Research Education, Network & Consultancy, Douala, Cameroon
| | | | - Belen Zapata-Diomedi
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia
| | - J Lennert Veerman
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,4School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia.,5Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011 Australia
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Nugent R, Brower E, Cravioto A, Koehlmoos T. A cost-benefit analysis of a National Hypertension Treatment Program in Bangladesh. Prev Med 2017; 105S:S56-S61. [PMID: 28827074 DOI: 10.1016/j.ypmed.2017.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/15/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hypertension is one of the most common, yet manageable, risks for life-threatening events like stroke and myocardial infarction in the world. Bangladesh adults experience high rates of hypertension, with one in three women and one in five men meeting the condition's clinical definition. In the midst of an epidemiological transition, Bangladesh has the opportunity to slow the growth of hypertension prevalence through increased coverage of anti-hypertensive drugs for high-risk patients. METHODS Using economic cost-benefit analysis and a societal perspective, we model the return on investment of providing blood-pressure lowering drugs to 60% of hypertensive adults by 2021 and 2030. We stratify the projections on both gender and income quintile. RESULTS If the government of Bangladesh is proactive about hypertension management now, they could see a 12.7: 1 annual return on investment by 2021 and an 8.6: 1 annual return on investment by 2030. The return on investment is higher for providing medication for women than for men in both time horizons. CONCLUSION Bangladesh has a unique opportunity to address hypertension now in order to prevent thousands of premature deaths and to accrue substantial net economic benefits within 6years.
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Ngalesoni FN, Ruhago GM, Mori AT, Robberstad B, Norheim OF. Equity impact analysis of medical approaches to cardiovascular diseases prevention in Tanzania. Soc Sci Med 2016; 170:208-17. [PMID: 27590271 DOI: 10.1016/j.socscimed.2016.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 01/07/2023]
Abstract
Primary medical prevention of cardiovascular disease (CVD) has received low priority in Tanzania, despite evidence of the rising prevalence of CVD risk factors. Different guidelines have been proposed for medical CVD prevention, including the European Society of Cardiology (ESC) and the World Health Organization (WHO) guidelines, which recommend medical prevention for all individuals based on the consideration of single CVD risk thresholds. A third alternative is differentiated risk thresholds according to age. This paper compares the WHO and the differentiated risk threshold by age approaches against a baseline of no medical CVD prevention and a best scenario identical to the ESC approach in Tanzania. Assuming fixed budgets, we evaluate the guidelines according to three outcome measures, namely: efficiency, inequality and the combination of efficiency and inequality. We ran a Markov analysis for an estimated Tanzanian population at risk of CVD employing a 40 years time horizon to estimate the total expected costs and CVD deaths associated with provision of the different guidelines. The results were then used to calculate three outcomes: life expectancy at age 40 as a proxy for efficiency, the Gini coefficient (a measure of inequality), and the achievement index (which combines concerns of efficiency and inequality). Our results suggest that higher life expectancy (28.3 vs. 26.6 years) and more equally distributed health (Gini coefficient of 0.22 vs. 0.24) could be attained if medical CVD prevention was based on the differentiated risk threshold approach compared to the WHO single risk threshold, when the total cost of these approaches is the same. Preventing CVD based on differentiating risk thresholds by age seems to be the better alternative when concerns of both efficiency and inequality are considered important. However, further research on the country-specific distribution of CVD risk levels and budget impact analysis are important to assess the feasibility of its implementation.
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