The George Institute for Global Health, University of New South Wales, Level 5 1 King Street Newtown, Sydney, Australia.
UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK.
Health Policy Plan. 2021 May 17;36(4):435-443. doi: 10.1093/heapol/czab025.
Cardiovascular diseases (CVD) are the leading cause of death in Indonesia, and there are large disparities in access to recommended preventative treatments across the country, particularly in rural areas. Technology-enabled screening and management led by community health workers have been shown to be effective in better managing those at high risk of CVD in a rural Indonesian population; however, the economic impacts of implementing such an intervention are unknown. We conducted a modelled cost-effectiveness analysis of the SMARThealth intervention in rural villages of Malang district, Indonesia from the payer perspective over a 10-year period. A Markov model was designed and populated with epidemiological and cost data collected in a recent quasi-randomized trial, with nine health states representing a differing risk for experiencing a major CVD event. Disability-Adjusted Life Years (DALYs) were estimated for the intervention and usual care using disability weights from the literature for major CVD events. Annual treatment costs for CVD treatment and prevention were $US83 under current care and $US144 for those receiving the intervention. The intervention had an incremental cost-effectiveness ratio of $4288 per DALY averted and $3681 per major CVD event avoided relative to usual care. One-way and probabilistic sensitivity analyses demonstrated that the results were robust to plausible variations in model parameters and that the intervention is highly likely to be considered cost-effective by decision-makers across a range of potentially acceptable willingness to pay levels. Relative to current care, the intervention was a cost-effective means to improve the management of CVD in this rural Indonesian population. Further scale-up of the intervention offers the prospect of significant gains in population health and sustainable progress toward universal health coverage for the Indonesian population.
心血管疾病（CVD）是印度尼西亚的主要死因，该国在获得推荐的预防治疗方面存在巨大差异，尤其是在农村地区。事实证明，在印度尼西亚农村人口中，由社区卫生工作者主导的基于技术的筛查和管理，在更好地管理那些处于 CVD 高危人群方面非常有效；然而，实施这种干预措施的经济影响尚不清楚。我们从支付者的角度，对印度尼西亚马朗地区农村村庄的 SMARThealth 干预措施进行了 10 年的成本效益建模分析。设计了一个马尔可夫模型，并使用最近的一项准随机试验中收集的流行病学和成本数据进行填充，该模型有 9 个健康状态，代表发生主要 CVD 事件的不同风险。使用文献中的主要 CVD 事件残疾权重，对干预和常规护理的残疾调整生命年（DALY）进行了估计。根据目前的护理情况，CVD 治疗和预防的年度治疗费用为 83 美元/人，而接受干预的人的治疗费用为 144 美元/人。与常规护理相比，干预措施的增量成本效益比为每避免一个 DALY 增加 4288 美元，每避免一个主要 CVD 事件增加 3681 美元。单因素和概率敏感性分析表明，结果对模型参数的合理变化具有稳健性，并且决策者认为干预措施在一系列潜在可接受的支付意愿水平下极有可能具有成本效益。与目前的护理相比，该干预措施是改善该印度尼西亚农村人群 CVD 管理的一种具有成本效益的手段。进一步扩大该干预措施的规模，有望为印度尼西亚人口的健康带来重大改善，并朝着全民健康覆盖的目标取得可持续进展。
