Cost-effectiveness Analysis of Interventions to Improve Control of High Blood Pressure in Low Resource Settings: The Case of Nigeria

Abstract

Objectives: Prevalence of hypertension is on the rise in most African countries while control remains poor. In the literature, there are effective interventions which could be implemented in hospitals of low resource setting such as Nigeria to improve control of blood pressure. This study aimed to evaluate the cost-effectiveness of three of such interventions namely: self-monitoring; health professional led care; and organization driven care interventions. Methods: A Markov model was used to represent a life cycle of Nigerian hypertensive female patients in low risk of having a cardiovascular event. Health care costs were obtained from existing databases and calibrated to Nigerian setting or derived through a cost analysis using a Nigerian hospital. Costs were presented in 2013 US dollars value. Uncertainties in the input parameters used in the analyses were captured using distributions appropriate for each parameter. Probabilistic cost-effectiveness analysis was performed using Markov Chain Monte Carlo simulation, and presented as cost-effectiveness acceptability frontiers. Population expected value of perfect information analysis was conducted. Results: Compared to null scenario (i.e. no intervention), professional led care intervention will require $190/QALY to emerge the most cost-effective option. The Population Expected Value of Perfect Information (EVPI) analysis showed that the opportunity cost surrounding the  choice of professional led care intervention as the most cost-effective option does not amount to very much. Conclusions: The result of this study shows that among the interventions compared health professional led care through a pharmaceutical care model or nurse led care is the most cost-effective option for ensuring that patients with high blood pressure are adequately followed for better control of blood pressure.