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The cost-effectiveness of hypertension management in low-income and middle-income countries: a review
  1. Deliana Kostova1,
  2. Garrison Spencer2,
  3. Andrew E Moran3,4,
  4. Laura K Cobb3,
  5. Muhammad Jami Husain1,
  6. Biplab Kumar Datta1,
  7. Kunihiro Matsushita5,
  8. Rachel Nugent2
  1. 1Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
  3. 3Resolve to Save Lives, an initiative of Vital Strategies, New York, New York, United States
  4. 4Columbia University Irving Medical Center, New York, New York, United States
  5. 5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Deliana Kostova; Kiv0{at}


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.

  • health economics
  • hypertension
  • review

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  • Handling editor Lei Si

  • Contributors GS conducted a comprehensive literature search. All authors contributed to the analysis, drafting and editing of the manuscript.

  • Funding GS and RN received support from the CDC Foundation with funds provided by Resolve to Save Lives, a division of Vital Strategies. Resolve to Save Lives is funded by grants from Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation. The funders had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data or decision to submit results.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request. As a review article, this article reports data from previously published studies.