Table 1

Cost per mm Hg reduction in systolic and/or diastolic blood pressure (2017 US$)

Country income groupCountryAuthorStudy typeSample sizeStudy designProviderIntervention detailsTime periodCost elementsIntervention subgroupCost – systolic (2017 US$)Cost – diastolic (2017 US$)
Lower middleIndiaAnchalaPharm plus1638Cluster randomised control studyDoctorsPrimary 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.1 yearDrugs, laboratories, labour, travel/transportation/per diem, building overhead costs, depreciation, equipment costs and office supplies, training costs, intervention development costs, translation charges.Decision support system37.82
Chart-based support99.29
Upper middleSouth AfricaAnderson APharm only1473Meta-analysisNot specifiedComparison of the angiotensin receptor blockers (ARBs) currently available in South Africa: candesartan, losartan, irbesartan and valsartan.1 yearDrugsCandesartan4.6
Losartan5.47
Irbesartan6.11
Valsartan6.77
Upper middleArgentinaAugustovskiPharm plus1432Cluster randomised control studyCommunity health workers, doctorsMulticomponent strategy that included community health worker home-based intervention, physician education and a text-messaging intervention.1.5 yearsDrugs, 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.Control group15.3729.57
Intervention group19.5132.72
Upper middleChinaBaiPharm plus818Observational studyDoctors, nurses, pharmacists, otherCommunity 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 diet, exercise, smoking and drinking interventions consisting of educational sessions, supervision and face-to-face consultation as necessary; standardise drug therapies according to 2005 Chinese national guidelines for hypertension prevention and control; conduct follow-up visits on a regular basis; provide other services, such as physician recommendations, if necessary.1 yearLabour, building overhead costs, depreciation, equipment costs and office supplies, health education/promotion costs.Best case scenario - based on the lowest per capita cost and greatest blood pressure reduction of the community health centres0.350.75
Community health centre in Beijing0.611.05
Overall - all three community health centres0.671.33
Community health centre in Hangzhou0.751.61
Community health centre in Chengdu0.831.62
Worst case scenario - based on the highest per capita cost and smallest blood pressure reduction of the community health centres1.763.43
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.Simulation period: 10 yearsDrugs, costs of medical services - including patient-borne costsBBT - China0.12
Hybrid - China0.13
TTT - China0.14
BBT - India0.17
TTT - India0.2
Hybrid - India0.28
Upper middleArgentinaHePharm plus1357Cluster randomised control studyCommunity health workers, doctorsIntervention 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.18 monthsDrugs, laboratories, labour, costs of medical visits or screening not further disaggregated, equipment costs, intervention development costs, training costs, media costsUsual care5.5910.56
Intervention9.2514.06
Lower middlePakistanJafarOther1044Cluster randomised control studyCommunity health workers, doctorsFamily-based home health education by community health workers and special training of general practitioners on treatment and management of HTN.2 yearsDrugs, 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 and general practitioner training54.72
Home health education only83.01
General practitioner training only113.53
LowNepalKrishnanPharm plus –
modelled
Not applicableHypothetical population-level modelCommunity health workersCommunity health workers provide blood pressure screening, lifestyle counselling, referrals and follow-up on adherence to antihypertensive medication via home visits1 year Drugs, labour, travel, training costs, administrative costsAdults aged 25 to 65 with hypertension1.64
All adults aged 25 to 650.51
Upper middleBrazilObreli-NetoPharm plus200Randomised controlled clinical trialDoctors, nurses, pharmacistsThe 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.3 yearsDrugs, labour and cost of medical visit or screening - not further disaggregated.Intervention group (cost per patient divided by average change during study period)12.6719.69
Lower middleIndiaPatelPharm only60Observational studyNot specifiedComparing two beta blockers - nebivolol and metoprolol.2 monthsDrugsNebivolol 2.5 mg0.570.81
Nebivolol 5 mg0.641.02
Metoprolol 25 mg0.891.07
Metoprolol 50 mg1.071.31
Nebivolol 10 mg1.091.3
Metoprolol 100 mg1.131.29
Upper middleBrazilTsujiPharm only418Observational studyNot specifiedTraditional treatment (hydrochlorothiazide and atenolol) and current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension. For patients with grade 3 hypertension, a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment.1 yearDrugsTraditional: Grade 1 or 2 HTN44.6866.47
Traditional: Grade 3 HTN81.73107.88
Current: Grade 3 HTN82.82103.52
Current: Grade 1 or 2 HTN90.45130.77
Upper middleChinaWang XPharm plus436Randomised controlled trialDoctorsProvider training in guideline-oriented primary healthcare HTN management programme covering detection, evaluation, non-pharmaceutical and pharmaceutical treatment, follow-up and management, two-way referral, prevention and health education for hypertension.1 yearDrugs, labour, travel/transportation/per diem and training costs.PP analysis rural intervention3.735.99
ITT analysis rural intervention3.856.22
ITT analysis rural control4.89.1
ITT analysis urban intervention5.3215.22
PP analysis urban intervention5.3715.76
PP analysis rural control5.5511.09
ITT analysis urban control7.9434.8
PP analysis urban control9.0651.96
Upper middleChinaWang ZPharm only623Observational studyNot specifiedTreatment with nitrendipine with hydrochlorothiazide, or treatment with nitrendipine with metoprolol.6 monthsDrugs, cost of medical visit or screening - not further disaggregated, travel/transportation/per diemNitrendipine + hydrochlorothiazide. Women.1.473.05
Nitrendipine + hydrochlorothiazide. Men.1.472.95
Nitrendipine + hydrochlorothiazide. 65 years and older.1.472.95
Nitrendipine + hydrochlorothiazide. All patients.1.472.95
Nitrendipine + hydrochlorothiazide. Under 65 years old.1.583.37
Nitrendipine + metoprolol. Women.1.893.89
Nitrendipine + metoprolol.
65 years and older.
23.89
Nitrendipine + metoprolol.
All patients.
24
Nitrendipine + metoprolol.
Men.
2.14.1
Nitrendipine + metoprolol.
Under 65 years old.
2.314.52
  • ‘Pharm only’ indicates interventions or studies in which pharmacotherapy is the only form of treatment for hypertension. This includes testing various combinations of drugs and drug classes, different providers and delivery platforms. ‘Pharm plus’ indicates combination programmes that incorporated other forms of treatment for hypertension, such as patient education or lifestyle changes. ‘Other’ indicates a programme in which there was no pharmacological treatment.

  • BP, blood pressure; CVD, cardiovascular disease; HTN, hypertension; ITT, intention-to-treat; PP, per protocol; US$, US dollars.