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Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program

Author

Listed:
  • Nicole T A Rosendaal
  • Marleen E Hendriks
  • Mark D Verhagen
  • Oladimeji A Bolarinwa
  • Emmanuel O Sanya
  • Philip M Kolo
  • Peju Adenusi
  • Kayode Agbede
  • Diederik van Eck
  • Siok Swan Tan
  • Tanimola M Akande
  • William Redekop
  • Constance Schultsz
  • Gabriela B Gomez

Abstract

Background: High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA). We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria. Methods: A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD) within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY) averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1) presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy) and 2) presence of hypertension in combination with a CVD risk of >20% (risk based strategy). We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario. Results: Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$ 1,406 to US$ 7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment. Conclusions: Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities to finance CVD prevention care in SSA.

Suggested Citation

  • Nicole T A Rosendaal & Marleen E Hendriks & Mark D Verhagen & Oladimeji A Bolarinwa & Emmanuel O Sanya & Philip M Kolo & Peju Adenusi & Kayode Agbede & Diederik van Eck & Siok Swan Tan & Tanimola M Ak, 2016. "Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-20, June.
    • Handle: RePEc:plo:pone00:0157925
    DOI: 10.1371/journal.pone.0157925
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    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
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    1. Ciancio, Alberto & Kämpfen, Fabrice & Kohler, Hans-Peter & Kohler, Iliana V., 2021. "Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa," Journal of Health Economics, Elsevier, vol. 75(C).

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