Table 4

Cost per averted disability-adjusted life year (2017 US$D, unless indicated otherwise)

Country income groupCountryAuthorStudy typeSample sizeStudy designProviderIntervention detailsCost elementsIntervention subgroupCost (2017 US$)2017 country GDP per capita
BlendBlendBasuPharm only - modelledNot applicableHypothetical population-level modelNot specifiedA ‘treat-to-target’ (TTT) strategy in which BP therapy is titrated until blood pressures fall below a threshold, a ‘benefit-based, tailored’ (BBT) strategy in which BP therapy is initiated for patients with high estimated CVD risk, and a hybrid strategy that combines TTT and BBT.Drugs, costs of medical services - including patient-borne costsBBT - China220.908826
BBT - India290.611939
Hybrid - India371.581939
TTT - India412.851939
Hybrid - China449.258826
TTT - China450.808826
Lower middleGhanaGadPharm only – modelledNot applicableHypothetical population-level modelNot specifiedA core treatment model was used to estimate the long-term costs and health effects of the five main classes of antihypertensive drugs and a ‘no intervention” comparator: ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers (BB), calcium channel blockers (CCB), thiazide-like diureticsDrugs, cost medical visits not further disaggregatedDiuretics61.242025
CCB799.352025
ACEI1555.472025
ARB1808.722025
BB1462.902025
Lower middleVietnamHaPharm plus - modelledNot applicableHypothetical population-level modelDoctors, nursesComparison of a set of personal and non-personal prevention strategies to reduce CVD in Vietnam, including mass media campaigns for reducing consumption of salt and tobacco, drugs for lowering blood pressure or cholesterol, and combined pharmacotherapy for people at varying levels of absolute risk of a cardiovascular event.Drugs, laboratories, labour, travel/transportation/per diem and media costs.Education and individual treatment (beta-blocker and diuretic) for treatment of SBP >160.94.242343
Education and individual treatment (beta-blocker and diuretic) for treatment of SBP >140.268.832343
Upper middleThailandKhonputsaPharm only – modelledNot applicableHypothetical population-level modelDoctorsAnalysis of monotherapy and combination therapy of thiazide diuretics (D), CCB, BB, ACEI and ARB. Cost-effectiveness analysis includes cost-offsets, that is, the cost of disease treatments that are avoided by prevention. The study calculated cost-effectiveness figures using the lowest cost generic and the median cost medication shown in the Ministry of Health website. The figures reported in this table are based on the median cost.10-year CVD risk 5% to 9.9%, D+CCB+ACEI2077.346578
10-year CVD risk 5% to 9.9%, D692.456578
10-year CVD risk 5% to 9.9%, CCB1483.416578
10-year CVD risk 5% to 9.9%, ACEI2934.656578
10-year CVD risk 5% to 9.9%, BB6594.726578
10-year CVD risk 5% to 9.9%, ARB10 221.826578
10-year CVD risk 10% to 19.9%, D286.876578
10-year CVD risk 10% to 19.9%, CCB890.296578
10-year CVD risk 10% to 19.9%, ACEI1912.476578
10-year CVD risk 10% to 19.9%, BB5935.256578
10-year CVD risk 10% to 19.9%, ARB7583.936578
10-year CVD risk 20% and up, CCB309.956578
10-year CVD risk 20% and up, ACEI956.246578
10-year CVD risk 20% and up, BB3627.106578
10-year CVD risk 20% and up, ARB4616.316578
LowNepalKrishnanPharm plus – modelledNot applicableHypothetical population-level modelCommunity health workers provide blood pressure screening, lifestyle counselling, referrals and follow-up on adherence to antihypertensive medication via home visitsDrugs, labour, travel, training costs, administrative costsAdults aged 25 to 65 with hypertension568.16911
All adults aged 25 to 65401.23911
Upper middleSri LankaLungPharm only – modelledNot applicableHypothetical population-level modelDoctorsThe intervention group received the triple pill consisting of amlodipine, telmisartan and chlorthalidone (with discontinuation of current monotherapy, if applicable) as part of their usual hypertension clinic visits. There were scheduled clinic visits at 6, 12 and 24 weeks (end of study), which included blood pressure measurement, potential changes in medications in line with local guidelines at the discretion of the treating physician, and assessment of adverse events.Drugs, cost of outpatient and inpatient visits not further disaggregatedUsual care1323.464105
Intervention group1693.924105
BlendBlendMurray*Pharm plus - modelledNot applicableHypothetical population-level modelNot specifiedSeventeen non-personal and personal health-service interventions or combinations, including salt reduction through voluntary agreements with industry and salt intake legislation, health education campaigns and treatment and education for hypertension. Hypertension treatment for people with BP above two thresholds (140 and 160) was a standard regimen of beta blockers and diuretics. Treatment for people with absolute risk of cardiovascular event over next 10 years based on four thresholds (35%, 25%, 15% and 5%) with a statin, diuretic, beta blocker and aspirin.Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs, training costs and media costs.Eligibility: SBP above 160 (SE Asia)51.24*
PPP dollars
n/a
Eligibility: SBP above 160 (Latin America)115.30*
PPP dollars
n/a
Eligibility: SBP above 140 (SE Asia)128.11*
PPP dollars
n/a
Eligibility: SBP above 140 (Latin America)264.76*
PPP dollars
n/a
Eligibility: SBP above 160 (Europe)288.96*
PPP dollars
n/a
Eligibility: SBP above 140 (Europe)646.25*
PPP dollars
n/a
Treatment of risk above 35% (Latin America)37.26*
PPP dollars
n/a
Treatment of risk above 25% (Latin America)52.67*
PPP dollars
n/a
Treatment of risk above 15% (Latin America)76.87*
PPP dollars
n/a
Treatment of risk above 5% (Latin America)132.38*
PPP dollars
n/a
Treatment of risk above 25% (Europe)239.14*
PPP dollars
n/a
Treatment of risk above 15% (Europe)306.04*
PPP dollars
n/a
Treatment of risk above 5% (Europe)446.97*
PPP dollars
n/a
Treatment of risk above 25% (SE Asia)46.97*
PPP dollars
n/a
Treatment of risk above 15% (SE Asia)68.33*
PPP dollars
n/a
Treatment of risk above 5% (SE Asia)109.61*
PPP dollars
n/a
LowTanzaniaNgalesoniPharm only - modelledNot applicableHypothetical population-level modelNot specifiedPharmaceutical treatment with ACE inhibitors and diuretics modelled for four different risk levels. Very high risk is categorised as having SBP of 160 to 179 and being a smoker; high risk is having SBP of 160 to 179 and not being a smoker; moderate risk is having SBP of 140 to 159; and low risk is having SBP of 120 to 139.Drugs, costs of medical visit or screening - not further disaggregatedModerate risk2616.98936
High risk1761.58936
Very high risk1533.00936
Low risk1419.41936
BlendSub-Saharan Africa region and South East Asia regionOrtegonPharm plus – modelledNot applicableHypothetical population-level modelNot specifiedCost-effectiveness analysis of 123 single or combined prevention and treatment strategies for cardiovascular disease, diabetes and smoking. Relevant interventions were treatment with beta blockers and diuretics and along with patient education for two eligibility criteria (those with SBP above 140 and those above 160).Drugs, laboratories, cost of medical visit or screening not further disaggregated, intervention development cost, training cost, media cost, monitoring and evaluation cost, other unspecified costsSub-Saharan Africa, eligibility: SBP >160180.95*
PPP dollars
n/a
Sub-Saharan Africa, eligibility: SBP >140504.36* PPP dollarsn/a
South East Asia, eligibility: SBP >160182.24* PPP dollarsn/a
South East Asia, eligibility: SBP <140621.14* PPP dollarsn/a
Lower middleIndiaPraveenPharm only62 194Cross-sectional studyNot specifiedComparing the BP lowering effect of treatment eligibility standards compared with an untreated population. The different treatment standards were: (1) current practice (not further defined); (2) treating people with HTN using the 140/90 mm Hg threshold; (3) treatment according to the new Indian NPCDCS guidelines (drug therapy recommended in patients with CVD risk 20% to 30% and BP levels ≥140/90 mm Hg or CVD risk of ≥30% and BP level’s ≥130/80 mm Hg; (4) treating everyone in the intermediate and high risk categories (regardless of BP level); and (5) treating only those in the high risk category (regardless of BP level).Drugs, costs of medical visit or screening - not further disaggregatedTreatment of all at high risk213.721939
Treatment of all at intermediate and high risk241.031939
Treatment according to NPCDCS guidelines365.431939
Current practice (undefined)380.271939
Treatment of patients with BP greater than 140/90 mm Hg459.661939
Treatment of all above 55 years of age472.511939
Treatment of all above 45 years of age601.691939
LowTanzaniaRobberstadPharm only - modelledNot applicableHypothetical population-level modelNot specifiedFourteen pharmaceutical interventions of primary prevention of cardiovascular disease, four of which specifically target hypertension exclusively.Drugs, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs (utilities, maintenance, and so on), equipment costs and office suppliesDiuretics106.68936
Beta blockers412.93936
Calcium channel blockers1374.33936
Diuretics and beta blockers155.63936
Lower middleNigeriaRosendaalPharm plus - modelledNot applicableHypothetical population-level modelNot specifiedPopulation-level hypertension screening and subsequent antihypertensive treatment for high CVD risk individuals in the context of the KSHI programme. Two eligibility strategies: first was CVD risk and BP level, in which all individuals with HTN stage 1 combined with a 10-year CVD risk greater than 20% as well as all individuals with stage 2 HTN regardless of risk were treated. The second was CVD based only, in which all individuals with 10-year CVD risk greater than 20% were eligible. Three estimates of relative risk reduction, based on (1) Lawes, (2) Rapsomaniki and (3) Framingham.Labs, labour, cost of medical visit or screening - not further disaggregated, building overhead costs, and training costs.Treatment eligibility: Risk based. Risk reduction: Lawes et al3649.841968
Treatment eligibility: Risk + HTN. Risk reduction based: Lawes et al3998.391968
Treatment eligibility: Risk based. Risk reduction: Rapsomaniki et al11 553.361968
Treatment eligibility: Risk based. Risk reduction: Framingham score.13 616.781968
Treatment eligibility: Risk + HTN. Risk reduction: Rapsomaniki et al17 138.031968
Treatment eligibility: Risk + HTN. Risk reduction: Framingham score.21 268.821968
Upper middleArgentinaRubinstein*Pharm plus - modelledNot applicableHypothetical population-level modelNot specifiedPopulation and clinical interventions, including mass media campaigns to promote tobacco cessation, reduction of salt in bread, bupropion for tobacco cessation, high blood pressure treatment, high cholesterol treatment and polypill strategy for people with CVD risk greater than 20%.Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, trainings costs and media costs.Lifestyle change promotion and pharmacological therapy to achieve BP control.2596.9714 401
LowEthiopiaTollaPharm plus – modelledNot applicableHypothetical population-level modelNot specifiedAnalysis included cost-effectiveness analysis of 15 interventions; relevant interventions were antihypertensive treatment with 25 mg hydrochlorothiazide and 50 mg atenolol per day. Patients assumed to have four visits to a health centre for the first year followed by three visits per year for the remaining 9 years. Additionally, 20% will have 1.5 visit per year at primary hospital.Drugs, laboratories, cost of medical visit or screening not further disaggregated, intervention development cost, training cost, media cost, monitoring and evaluation cost, other unspecified costsEligibility: SBP >16080.18768
Eligibility: SBP >140166.86768
  • BP, blood pressure; CVD, cardiovascular disease; HTN, hypertension; KSHI, Kwara State Health Insurance; n/a, not available; NPCDCS, National Program on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke; PPP, purchasing-power-parity; SBP, systolic blood pressure; SE Asia, South East Asia; US$, US dollars.