Beshah Senait Alemayehu, Husain Muhammad Jami, Dessie Girma A, Worku Addisu, Negeri Mussie Gebremichael, Banigbe Bolanle, Moran Andrew E, Basu Soumava, Kostova Deliana
Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, USA.
Public Health Pract (Oxf). 2023 Aug 25;6:100423. doi: 10.1016/j.puhip.2023.100423. eCollection 2023 Dec.
In 2020, Ethiopia launched the Ethiopia Hypertension Control Initiative (EHCI) program to improve hypertension care using the approach described in the WHO HEARTS technical package.
To estimate the costs of implementing the HEARTS program for hypertension control and cardiovascular disease (CVD) prevention in the primary care setting in Ethiopia for adult primary care users in the catchment area of five examined facilities.
This study entails a program cost analysis using cross-sectional primary and secondary data.
Micro-costing facility surveys were used to assess activity costs related to training, counselling, screening, lab diagnosis, medications, monitoring, and start-up costs at five selected health facilities. Cost data were obtained from primary and secondary sources, and expert opinion. Annual costs from the health system perspective were estimated using the Excel-based HEARTS costing tool under two intervention scenarios - hypertension-only control and a CVD risk management program, which addresses diabetes and hypercholesterolemia in addition to hypertension.
The estimated cost per adult primary care user was USD 5.3 for hypertension control and USD 19.3 for integrated CVD risk management. The estimated medication cost per person treated for hypertension was USD 9.0, whereas treating diabetes and high cholesterol would cost USD 15.4 and USD 15.3 per person treated, respectively. Medications were the major cost driver, accounting for 37% of the total cost in the hypertension control program. In the CVD risk management scenario, the proportions of medication and lab diagnostics of total costs were 18% and 64%, respectively.
The results from this study can inform planning and budgeting for HEARTS scale-up to prevent CVD across Ethiopia.
2020年，埃塞俄比亚启动了埃塞俄比亚高血压控制倡议（EHCI）项目，采用世界卫生组织HEARTS技术包中描述的方法改善高血压护理。
估算在埃塞俄比亚五家被考察医疗机构服务范围内，针对成年初级保健使用者，在初级保健环境中实施HEARTS项目以控制高血压和预防心血管疾病（CVD）的成本。
本研究采用横断面的初级和二级数据进行项目成本分析。
通过微观成本核算机构调查来评估五家选定医疗机构在培训、咨询、筛查、实验室诊断、药物治疗、监测以及启动成本等方面的活动成本。成本数据来自初级和二级来源以及专家意见。从卫生系统角度出发，在两种干预情景下，即仅控制高血压和心血管疾病风险管理项目（除高血压外还涉及糖尿病和高胆固醇血症），使用基于Excel的HEARTS成本核算工具估算年度成本。
高血压控制方面，每位成年初级保健使用者的估计成本为5.3美元，综合心血管疾病风险管理的估计成本为19.3美元。高血压患者的人均药物治疗估计成本为9.0美元，而糖尿病和高胆固醇血症患者的人均治疗成本分别为15.4美元和15.3美元。药物是主要成本驱动因素，在高血压控制项目中占总成本的37%。在心血管疾病风险管理情景下，药物和实验室诊断在总成本中的占比分别为18%和64%。
本研究结果可为埃塞俄比亚扩大HEARTS项目以预防心血管疾病的规划和预算提供参考。
