Aramrat Piyachon, Aramrat Chanchanok, Kim Thomas Taeksung, Husain Muhammad Jami, Basu Soumava, Dabak Saudamini, Isaranuwatchai Wanrudee, Wiwatkunupakarn Nutchar, Sukonthasarn Apichard, Angkurawaranon Chaisiri, Kostova Deliana, Moran Andrew E
Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang , 50200, Chiang Mai, Thailand.
Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand.
BMC Prim Care. 2025 Apr 23;26(1):120. doi: 10.1186/s12875-025-02824-y.
In 2020, a pilot program for hypertension control was initiated in primary care facilities in Lampang Province, Thailand. The program followed the framework of the HEARTS program for standardized hypertension treatment, but the financial costs of the program are not well understood. This study evaluates the costs of the HEARTS approach compared to usual care to inform future scale-up efforts of the program.
Cost data were collected and analyzed using the HEARTS costing tool, a Microsoft Excel-based tool that supports activity-based costing of the HEARTS program from the health system perspective. Three scenarios were considered: usual care, the HEARTS regimen using standardized hypertension treatment with single-agent pills, and a sub-scenario of the HEARTS regimen using single-pill dual-drug combination pills. Costs are estimated as annual costs from the health system perspective in all Lampang primary care facilities.
For the usual care scenario, the HEARTS single-pill scenario, and the HEARTS combination-pill sub-scenario, the average annual medication cost per treated patient was USD 14.0 (THB 485), USD 13.8 (THB 479), and USD 14.3 (THB 497), respectively. Total program cost per primary care user was USD 13.6 (THB 472.7), THB USD 14.3 (494.5), and USD 14.4 (THB 499.9) across the three scenarios, respectively. The largest program cost driver (45-47% across the examined scenarios) was attributed to a comprehensive package of laboratory tests applied to all hypertension patients. Hypothetically, reducing test coverage from all hypertension patients (27% of primary care users) to 15% of primary care users (corresponding to the proportion of patients aged 65+) would reduce program cost per user from USD 14.3 to USD 12.0 in the HEARTS combination-pill scenario.
Compared to usual care, HEARTS implementation costs include additional costs for staff training, which are balanced by lower medication expenditures using the HEARTS standardized regimen with single-agent pills. The HEARTS regimen using dual-drug combination pills was estimated to be slightly more costly due to the higher price of combination pills. Optimizing coverage of diagnostic tests and lowering the purchasing prices of combination-pill medicines are key areas for cost reduction in future scale-up efforts.
2020年，泰国南邦府的基层医疗设施启动了一项高血压控制试点项目。该项目遵循了HEARTS标准化高血压治疗项目的框架，但该项目的财务成本尚不清楚。本研究评估了HEARTS方法与常规治疗相比的成本，以为该项目未来的扩大规模提供依据。
使用HEARTS成本核算工具收集和分析成本数据，该工具基于Microsoft Excel，从卫生系统角度支持HEARTS项目的作业成本核算。考虑了三种情况：常规治疗、使用单药片剂进行标准化高血压治疗的HEARTS方案，以及使用单片复方制剂的HEARTS方案的子情况。成本从南邦府所有基层医疗设施的卫生系统角度估计为年度成本。
对于常规治疗情况、HEARTS单片制剂情况和HEARTS复方制剂子情况，每位接受治疗的患者每年的平均药物成本分别为14.0美元（485泰铢）、13.8美元（479泰铢）和14.3美元（497泰铢）。三种情况下，每位基层医疗使用者的项目总成本分别为13.6美元（472.7泰铢）、14.3美元（494.5泰铢）和14.4美元（499.9泰铢）。最大的项目成本驱动因素（在所研究的情况下占45%-47%）归因于应用于所有高血压患者的一整套实验室检查。假设将检查覆盖范围从所有高血压患者（占基层医疗使用者的27%）减少到15%的基层医疗使用者（对应于65岁以上患者的比例），在HEARTS复方制剂情况下，每位使用者的项目成本将从14.3美元降至12.0美元。
与常规治疗相比，实施HEARTS的成本包括员工培训的额外成本，这些成本通过使用HEARTS单药标准化方案降低药物支出而得到平衡。由于复方制剂价格较高，使用复方制剂的HEARTS方案估计成本略高。优化诊断检查的覆盖范围和降低复方制剂药品的采购价格是未来扩大规模努力中降低成本的关键领域。
