Budget Impact and Investment Case for HEARTS Hypertension Control Programs in 4 Low- and Middle-Income Countries

Abstract

BACKGROUND. Hypertension (HTN) is a leading modifiable risk factor for cardiovascular disease, yet diagnosis, treatment, and control are suboptimal in many low- and middle-income countries. The World Health Organization HEARTS program is a standardized approach to improve HTN management in primary care.

OBJECTIVES. The purpose of this study was to model the program costs and health benefits of scaling up the HEARTS program over 2025-2040 in 4 low- and middle-income countries with HEARTS programs: Bangladesh, Ethiopia, Nigeria, and the Philippines.

METHODS. A cardiovascular disease simulation model estimated health benefits-averted deaths and disability-of increasing HEARTS HTN treatment coverage by 15 percentage points from 2025 to 2040 in the 4 countries. Program costs were obtained from the HEARTS programs including staff salaries, medications, diagnostics, and infrastructure in 2023 international dollars ($). Base and alternative cost scenarios projected HEARTS program budget impact, health benefits, cost-effectiveness over 2025 to 2040.

RESULTS. By 2040, cost of scaling up HEARTS treatment coverage is projected to be $2.9 billion in Bangladesh, $1.7 billion in Nigeria, $0.9 billion in the Philippines, and $0.5 billion in Ethiopia. Across the 4 countries, cost per primary care user ranged from $3 to 16 and cost per patient treated ranged from $27 to 67. HEARTS scale-up can prevent more than 300,000 deaths by 2040: 120,000 in Bangladesh, 77,500 in Nigeria, 47,200 in Ethiopia, and 82,000 in the Philippines. Alternative scenarios assuming lower-cost components identified ways to improve HEARTS affordability and economic returns.

CONCLUSIONS. Scale-up of HEARTS HTN control package may provide increased health gains and economic benefits over time.