Data from: Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: An individual-based modelling study

BackgroundCardiovascular disease (CVD) morbidity and mortality is
increasing in Africa, largely due to undiagnosed and untreated
hypertension. Approaches that leverage existing primary health systems
could improve hypertension treatment and reduce CVD, but
cost-effectiveness is unknown. We evaluated the cost-effectiveness of
population-level hypertension screening and implementation of chronic care
clinics across eastern, southern, central, and western Africa. Methods and
FindingsWe conducted a modelling study to simulate hypertension and CVD
across 3000 scenarios representing a range of settings across eastern,
southern, central, and western Africa. We evaluated two policies compared
to current hypertension treatment: 1) expansion of HIV primary care
clinics into chronic care clinics that provide hypertension treatment for
all persons regardless of HIV status (chronic care clinic or CCC policy),
and 2) CCC plus population-level hypertension screening of adults ≥40
years by community health workers (CHW policy). For our primary analysis,
we used a cost-effectiveness threshold of US $500 per disability-adjusted
life-year (DALY) averted, a 3% annual discount rate, and a 50-year time
horizon. A strategy was considered cost-effective if it led to the lowest
net DALYs, which is a measure of DALY burden that takes account of the
DALY implications of the cost for a given cost-effectiveness threshold.
Among adults 45-64 years, CCC implementation would improve
population-level hypertension control (the proportion of people with
hypertension whose blood pressure is controlled) from mean 4% (90% range
1-7%) to 14% (6-26%); additional CHW screening would improve control to
44% (35-54%). Among all adults, CCC implementation would reduce ischemic
heart disease (IHD) incidence by 10% (3-17%), strokes by 13% (5-23%), and
CVD mortality by 9% (3-15%). CCC plus CHW screening would reduce IHD by
28% (19-36%), strokes by 36% (25-47%), and CVD mortality by 25% (17-34%).
CHW screening was cost-effective in 62% of scenarios, CCC in 31%, and
neither policy was cost-effective in 7% of scenarios. Pooling across
setting-scenarios, incremental cost-effectiveness ratios were $69/DALY
averted for CCC and $389/DALY averted adding CHW screening to CCC.
ConclusionsLeveraging existing healthcare infrastructure to implement
population-level hypertension screening by CHWs and hypertension treatment
through integrated chronic care clinics is expected to reduce CVD
morbidity and mortality and is likely to be cost-effective in most
settings across Africa.