Annual cost per hypertension patient (2017 US$)
| Country income group | Country | Author | Study type | Sample size | Study design | Provider | Intervention details | Cost elements | Intervention subgroup | Cost (2017 US$) |
| Upper middle | Mexico | Arredondo | Pharm only - modelled | Not applicable | Hypothetical population-level model | Not specified | Analysis of healthcare costs of changes in epidemiological profile in Mexico, using hypertension as one of four tracer diseases. | Drugs, laboratories, labour, equipment costs and office supplies | Total hospital and ambulatory costs per case of hypertension | 904.73 |
| Upper middle | Malaysia | Alefan | Pharm only | 600 | Observational | Doctors, nurses, pharmacists | Comparing different antihypertensive drug classes and combinations: Diuretics, BB, ACEIs, CCBs, prazosin, diuretics and ACEIs and other combinations | Drugs, laboratories, labour, and travel/transportation/per diem. | Diuretics | 522.32 |
| Diuretics + beta blockers | 614.41 | |||||||||
| Beta blockers | 626.32 | |||||||||
| ACE inhibitors | 651.69 | |||||||||
| Calcium channel blockers | 723.4 | |||||||||
| Prazosin | 753.06 | |||||||||
| Other combinations | 826.64 | |||||||||
| Lower middle | India | Anchala | Pharm plus | 1638 | Cluster randomised control trial | Doctor | Primary healthcare physicians received training to use decision support system (DSS) software for management of HTN or received chart-based support with HTN guidelines on a poster. | Drugs, laboratories, labour, travel/transportation/per diem, building overhead costs, depreciation, equipment costs and office supplies, training costs, intervention development costs, translation charges. | Chart-based support | 356.47 |
| Decision support system | 383.15 | |||||||||
| Upper middle | Argentina | Augustovski | Pharm plus | 1432 | Cluster randomised control trial | Community health workers, doctors | Multicomponent strategy that included community health worker home-based intervention, physician education and a text-messaging intervention. | Drugs, laboratories, labour, costs of medical visit or screening - not further disaggregated, equipment costs and office supplies, intervention development costs, training costs, health education/promotion/ media costs. | Intervention group | 202.85 |
| Control group | 102.49 | |||||||||
| Upper middle | China | Bai | Other | 818 | Observational study | Doctors, nurses, pharmacists, other | Community health centres that are part of a chronic disease control government programme. Components of intervention include classifying patients into four groups based on BP and risk; conduct lifestyle education sessions, supervision, and one-on-one sessions; standardise drug therapies according to 2005 Chinese national guidelines; conduct follow-up visits on a regular basis; provide other services, such as physician recommendations, if necessary. | Labour, building overhead costs, depreciation, equipment costs and office supplies, and health education/promotion costs. | Community health centre in Beijing | 6.19 |
| Community health centre in Chengdu | 6.35 | |||||||||
| Overall - all three community health centres | 8.19 | |||||||||
| Community health centre in Hangzhou | 13.38 | |||||||||
| Blend | Blend | Basu | Pharm only - modelled | Not applicable | Hypothetical population-level model | Not specified | A ‘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 costs | TTT - India | 48.88 |
| TTT - China | 57.41 | |||||||||
| BBT - India | 76.57 | |||||||||
| Hybrid - China | 87.69 | |||||||||
| Hybrid - India | 90.72 | |||||||||
| BBT - China | 99.14 | |||||||||
| Upper middle | Brazil | Bueno | Pharm only | 377 | Cross-sectional study | Not specified | Analysis of the association between physical activity level and healthcare costs among hypertensive non-institutionalised older people. | Drugs, cost of medical visit or screening - not further disaggregated | Activity level: active | 36.08 |
| Activity level: insufficiently active | 144.51 | |||||||||
| Activity level: sedentary | 158.81 | |||||||||
| Upper middle | Mexico | Calvo-Vargas | Pharm only | Not reported | Longitudinal study | Not specified | Analysis of the annual cost of antihypertensive medications with the cost of medical consultations and laboratory tests. | Drugs, laboratories, cost of medical visit or screening - not further disaggregated | Annual cost of treatment with diuretics | 90.3 |
| Annual cost of treatment with beta blockers | 176.54 | |||||||||
| Annual cost of treatment with calcium channel blockers | 451.65 | |||||||||
| Annual cost of treatment with ACE inhibitors | 701.3 | |||||||||
| Upper middle | Brazil | Cazarim | Pharm plus | 51 | Quasi-Experimental study | Doctors, pharmacists | Prior to intervention, the public health service did not offer pharmaceutical care for hypertension. Intervention involved blood pressure measurements and CV risk measures, analysis of medications and test results, education in health matters with guidelines on patient behaviours, adherence to treatment and, when necessary, interventions in pharmacotherapy | Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs, equipment costs and office supplies, and absenteeism or lost productivity. | Intervention period | 203.85 |
| Pre-intervention period | 205.15 | |||||||||
| Post-intervention period | 222.31 | |||||||||
| Upper middle | South Africa | Gaziano | Pharm plus - modelled | Not applicable | Hypothetical population-level model | Not specified | Intervention included screening for HTN and six different eligibility criteria for initiating pharmacological treatment (two BP-based criteria and four risk-based criteria) and a no treatment scenario in which individuals are screened but not treated. | Drugs and cost of medical visit or screening - not further disaggregated. | Screened - no treatment | 80.55 |
| Eligibility: absolute risk >40% | 80.66 | |||||||||
| Eligibility: absolute risk >30% | 81.3 | |||||||||
| Eligibility: absolute risk >20% | 84.57 | |||||||||
| Eligibility: absolute risk >15% | 87.9 | |||||||||
| Eligibility: 1995 South African guidelines - target level 160/95 | 88.83 | |||||||||
| Eligibility: Current guidelines - target level 140/90 | 93.22 | |||||||||
| Upper middle | Argentina | He | Pharm plus | 1357 | Cluster randomised control study | Community health workers, doctors | Intervention clinics implemented a community health worker-led home-based programme including health coaching, and BP monitoring. Physicians at the clinics received online education course on HTN management, and patients received individualised text messages. Control clinics maintained usual care: monthly visits after initiation of antihypertensive treatment and every 3 to 6 months for patients with controlled BP. | Drugs, laboratories, labour, costs of medical visits or screening not further disaggregated, equipment costs, intervention development costs, training costs, media costs | Intervention | 119.07 |
| Usual care | 45.07 | |||||||||
| Lower middle | Pakistan | Jafar | Other | 1044 | Cluster randomised control study | Community health workers, doctors | Family-based home health education by community health workers and special training of general practitioners on treatment and management of HTN. | Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, building overhead costs, training costs, health education/promotion/ absenteeism or lost productivity and fruits and vegetables. | Home health education only | 232.42 |
| Home health education and general practitioner training | 295.49 | |||||||||
| General practitioner training only | 317.89 | |||||||||
| Upper middle | China | Le | Pharm only | 9396 | Cross-sectional study | Not specified | Estimation of the economic burden of hypertension using cross-sectional health examination and questionnaire survey. Care includes outpatient visits, hospitalisation and medication. | Drugs, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem, absenteeism or lost productivity, other unspecified | Men | 609.38 |
| Women | 511.14 | |||||||||
| Age 19 to 44 years old | 326.33 | |||||||||
| Age 45 to 59 years old | 427.73 | |||||||||
| Age 60 years and older | 654.35 | |||||||||
| Overall | 547.78 | |||||||||
| Upper middle | South Africa | Makkink | Pharm only | 28 165 | Observational study | Not specified | ACE inhibitors compared with angiotensin receptor blockers (ARBs) in management of hypertension. Data analysed for 2 years, 2010 and 2011. | Drugs and other unspecified costs. | ACE inhibitor (year 2010) | 574.06 |
| ACE inhibitor (year 2011) | 625.06 | |||||||||
| ARB (year 2010) | 727.3 | |||||||||
| ARB (year 2011) | 866.27 | |||||||||
| Combined (year 2010) | 2019.93 | |||||||||
| Combined (year 2011) | 2417.85 | |||||||||
| Upper middle | Brazil | Obreli-Neto | Pharm plus | 200 | Randomised controlled clinical trial | Doctors, nurses, pharmacists | The control group received the usual care offered by the primary healthcare unit (medical and nurse consultations). The intervention group received the usual care plus a pharmaceutical care intervention. | Drugs, labour and cost of medical visit or screening - not further disaggregated. | Control group | 73.15 |
| Intervention group | 97.14 | |||||||||
| Lower middle | Kenya | Oyando | Pharm only | 212 | Cross-sectional study | Not specified | Examination of patient costs associated with obtaining care for HTN in public healthcare facilities. | Drugs, laboratories, cost of medical visit or screening - not further disaggregated, travel/transportation/per diem | Overall median annual hypertension care cost at a public facility | 282.7 |
| Overall mean annual hypertension care cost at a public facility | 476.5 | |||||||||
| Upper middle | Argentina | Perman | Pharm plus - modelled | Not applicable | Hypothetical population-level model | Doctors, medical students, health workers | Usual hypertension care (primary care physicians) compared with a new hypertension programme that added personal and telephone contact with patients by medical students; support with diet and activity; educational material; workshops; and, electronic health records. Programme was for middle-class patients 65 years or older. | Drugs, laboratories, labour, building overhead costs, equipment costs and office supplies, health education/promotion | Hypertension programme | 240.43 |
| Usual care | 196.50 | |||||||||
| Lower middle | India | Praveen | Pharm only | 62 194 | Cross-sectional study | Not specified | Comparing the BP lowering 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 levels ≥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 disaggregated | Treatment of all above 55 years of age | 34.92 |
| Treatment of all at high risk | 35.07 | |||||||||
| Treatment of all above 45 years of age | 35.08 | |||||||||
| Treatment according to NPCDCS guidelines | 35.13 | |||||||||
| Treatment of all at intermediate and high risk | 35.18 | |||||||||
| Current practice (undefined) | 35.23 | |||||||||
| Treatment of patients with BP greater than 140/90 mm Hg | 54.56 | |||||||||
| Lower middle | Kenya | Subramanian | Pharm only | Not reported | Observational study | Doctors and others | Analysis of payment data on CVD, diabetes, breast and cervical cancer and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital and the Kibera South Health Centre - a public outpatient facility, and private sector practitioners and hospitals. A treatment framework was developed using an itemisation cost approach to estimate payments. | Drugs, laboratories, labour, cost of medical visit or screening - not further disaggregated | Public facility - monotherapy - costs to patient | 25.64 |
| Public facility - two drug combination therapy - costs to patient | 67.25 | |||||||||
| Public facility - three drug combination treatment - costs to patient | 81.2 | |||||||||
| Public facility - four drug combination therapy - costs to patient | 110.33 | |||||||||
| Public facility - patients with resistant hypertension (high BP despite use of combination medications) - costs to patient | 159.36 | |||||||||
| Private facility - monotherapy - costs to patient | 418.2 | |||||||||
| Private facility - two drug combination therapy - costs per patient | 596.44 | |||||||||
| Private facility - three drug combination therapy - costs per patient | 948.06 | |||||||||
| Private facility - resistant hypertension (high BP despite the use of combination medications) - costs to patient | 987.17 | |||||||||
| Upper middle | China | Wang X | Pharm plus | 436 | Randomised controlled trial | Doctors | Provider training in guideline-oriented HTN management programme covering detection, evaluation, non-pharmaceutical and pharmaceutical treatment, follow-up and management, two-way referral, prevention and health education for hypertension. | Drugs, labour, travel/transportation/per diem, and training costs. | Rural intervention group - intention-to-treat analysis | 70.58 |
| Rural intervention group - per protocol analysis | 73.03 | |||||||||
| Rural control group - intention-to-treat analysis | 80.12 | |||||||||
| Rural control group - per protocol analysis | 86.52 | |||||||||
| Urban intervention group - intention-to-treat analysis | 108.05 | |||||||||
| Urban intervention group - per protocol analysis | 116.63 | |||||||||
| Urban control group - intention-to-treat analysis | 135.71 | |||||||||
| Urban control group - per protocol analysis | 155.87 | |||||||||
| Upper middle | China | Xie | Pharm only - modelled | Not applicable | Hypothetical population-level model | Not specified | A computer simulation model to project the consequences and cost-effectiveness of intensive hypertension control (reducing systolic/diastolic BP to 133/76 mm Hg) compared with standard hypertension control (based on the Chinese guidelines for the management of hypertension in 2011, involves the reduction of systolic/diastolic BP to 140/90 mm Hg). | Drugs, cost of medical visit or screening - not further disaggregated, monitoring costs | Standard - all men | 58.92 |
| Standard - all women | 63.27 | |||||||||
| Intensive - all men | 69.21 | |||||||||
| Standard - all men and all women | 70.96 | |||||||||
| Intensive - all men and all women | 70.96 | |||||||||
| Intensive - all women | 72.99 |
ACEIs, ACE inhibitors; BB, beta blockers; BP, blood pressure; CCBs, calcium channel blockers; CVD, cardiovascular disease; HTN, hypertension; NPCDCS, National Program on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke; US$, US dollars.