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.