Sambo Emmanuel Ndenor, Husain Muhammad Jami, Basu Soumava, Toma Malau Mangai, Eze Sunday Victor, Osi Kufor, Ogbureke Nanlop, Erojikwe Okeoma, Banigbe Bolanle, Moran Andrew E, Kostova Deliana
UKS Consulting, Abuja, Nigeria.
Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Cost Eff Resour Alloc. 2025 May 27;23(1):23. doi: 10.1186/s12962-025-00626-8.
The Nigeria Hypertension Control Initiative (NHCI) program, launched in 2020, integrates hypertension care into primary healthcare using the HEARTS technical package, which includes screening, health counselling, and standardized hypertension treatment protocols. This package has been piloted through NHCI in Kano and Ogun States and in the Federal Capital Territory (FCT) Abuja, as part of the Hypertension Treatment in Nigeria (HTN) project.
To assess the costs of scaling up the HEARTS hypertension control package and compare these costs with those of usual care.
Data on the costs of implementing the HEARTS program were collected from 15 purposively sampled primary health facilities in Kano, Ogun, and FCT Abuja between February and April 2024. Costs included training, medicines, provider time, and administrative expenses. We used the HEARTS costing tool, an Excel-based instrument, to collect and analyze the annual costs from a health system perspective, using an activity-based approach.
The estimated annual cost of implementing HEARTS was USD 16 per adult primary care user (PCU), with variations across the three locations: USD 21 in Abuja, USD 11 in Kano, and USD 16 in Ogun. Average annual medication costs per patient treated under HEARTS also varied by location, amounting to USD 28 in Abuja, USD 27 in Ogun, and USD 16 in Kano. Under usual care, annual medication costs per patient were estimated at USD 32 in Kano and USD 16 in Ogun (data for Abuja were unavailable). Major cost drivers for the HEARTS package included provider time (49%) and medication (47%), compared to usual care, where medication alone accounted for 80% of costs. Implementing HEARTS requires a full-time equivalent of 0.45 doctors, 1.59 nurses, and 5.21 community health workers per 10,000 primary care users.
In the Nigerian primary care setting, provider time costs and medication costs emerge as major considerations in scaling up hypertension services. Policy options could consider reducing follow-up visit frequency for well-controlled patients to decrease provider time costs. Additionally, medication costs may be reduced by prioritizing first-line treatments and volume-driven purchasing as program scale-up continues.
2020年启动的尼日利亚高血压控制倡议（NHCI）项目，利用包括筛查、健康咨询和标准化高血压治疗方案在内的HEARTS技术包，将高血压护理纳入初级医疗保健。作为尼日利亚高血压治疗（HTN）项目的一部分，该技术包已在卡诺州、奥贡州以及联邦首都地区（FCT）阿布贾通过NHCI进行了试点。
评估扩大HEARTS高血压控制技术包的成本，并将这些成本与常规护理的成本进行比较。
2024年2月至4月期间，从卡诺州、奥贡州和FCT阿布贾的15个经过 purposively 抽样的初级卫生设施收集了实施HEARTS项目的成本数据。成本包括培训、药品、医护人员时间和行政费用。我们使用HEARTS成本核算工具（一种基于Excel的工具），从卫生系统的角度，采用基于活动的方法收集和分析年度成本。
实施HEARTS的估计年度成本为每位成年初级保健用户（PCU）16美元，三个地点有所不同：阿布贾为21美元，卡诺为11美元，奥贡为16美元。在HEARTS项目下接受治疗的每位患者的平均年度药物成本也因地点而异，阿布贾为28美元，奥贡为27美元，卡诺为16美元。在常规护理下，卡诺州每位患者的年度药物成本估计为32美元，奥贡为16美元（阿布贾的数据不可用）。与常规护理相比，HEARTS技术包的主要成本驱动因素包括医护人员时间（49%）和药品（47%），而在常规护理中，仅药品就占成本的80%。每10000名初级保健用户实施HEARTS需要相当于0.45名全职医生、1.59名护士和5.21名社区卫生工作者。
在尼日利亚初级保健环境中，医护人员时间成本和药品成本是扩大高血压服务的主要考虑因素。政策选择可以考虑减少对病情控制良好患者的随访频率，以降低医护人员时间成本。此外，随着项目扩大，通过优先使用一线治疗药物和批量采购可以降低药品成本。
