TY - JOUR
T1 - Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka
AU - COBRA-BPS study group
AU - Finkelstein, Eric A.
AU - Krishnan, Anirudh
AU - Naheed, Aliya
AU - Jehan, Imtiaz
AU - de Silva, H. Asita
AU - Gandhi, Mihir
AU - Lim, Ching Wee
AU - Chakma, Nantu
AU - Ediriweera, Dileepa S.
AU - Khan, Jehanzeb
AU - Kasturiratne, Anuradhani
AU - Hirani, Samina
AU - Solayman, A. K.M.
AU - Jafar, Tazeen H.
AU - de Silva, Asita
AU - Legido-Quigley, Helena
AU - Bilger, Marcel
AU - Feng, Liang
AU - Tavajoh, Saeideh
AU - Lintag, Cecille
AU - Assam, Pryseley Nkouibert
AU - Moorakanda, Rajesh Babu
AU - Lin, Xinyi
AU - Chan, Edwin
AU - Zheng, Yiheng
AU - Clemens, John D.
AU - Hasnat, Mohammad
AU - Nantu, Chakma
AU - Alam, Dewan
AU - Pervin, Sonia
AU - Siddiquee, Ali Tanweer
AU - Rajib, Rubhana
AU - Islam, Mohammad Tauhidul
AU - Khan, Aamir Hameed
AU - Senan, Sahar
AU - Farazdiq, Hamid
AU - Himani, Gulshan
AU - Nadeem, Syed Omair
AU - Shahab, Hunaina
AU - Khan, Ayesha
AU - Luke, Natasha
AU - de Silva, Chamini
AU - Perera, Manuja
AU - Ranasinha, Channa
AU - Ediriweera, Dileepa
AU - Ebrahim, Shah
AU - Turner, Elizabeth
AU - Perk, Joep
AU - Smith, Richard
AU - Mills, Anne
N1 - Funding Information:
The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, and Wellcome Trust funded the study (through grant number MR/N006178/1). We acknowledge the contribution of all investigators, coordinators, and staff of the COBRA-BPS study at the respective institutions including the International Centre for Diarrhoeal Disease Research, Bangladesh; Aga Khan University, Pakistan; Faculty of Medicine, University of Kelaniya, Sri Lanka; London School of Hygiene & Tropical Medicine, UK; and Duke-NUS Medical School, Singapore. A complete list of investigators, coordinators, and staff from all participating countries is provided in the appendix (p 3). We would like to thank all members of the Trial Steering Committee and the Data Safety and Monitoring Board. Their names are also listed in the appendix (p 3). The Trial Steering Committee met three times during the course to review the progress, and an independent Data Safety Monitoring Board met three times to assess quality and safety. Finally, we thank all the COBRA-BPS trial participants as the trial would not have been possible without their cooperation.
Funding Information:
The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, and Wellcome Trust funded the study (through grant number MR/N006178/1). We acknowledge the contribution of all investigators, coordinators, and staff of the COBRA-BPS study at the respective institutions including the International Centre for Diarrhoeal Disease Research, Bangladesh; Aga Khan University, Pakistan; Faculty of Medicine, University of Kelaniya, Sri Lanka; London School of Hygiene & Tropical Medicine, UK; and Duke-NUS Medical School, Singapore. A complete list of investigators, coordinators, and staff from all participating countries is provided in the appendix (p 3) . We would like to thank all members of the Trial Steering Committee and the Data Safety and Monitoring Board. Their names are also listed in the appendix (p 3) . The Trial Steering Committee met three times during the course to review the progress, and an independent Data Safety Monitoring Board met three times to assess quality and safety. Finally, we thank all the COBRA-BPS trial participants as the trial would not have been possible without their cooperation.
Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
PY - 2021/5
Y1 - 2021/5
N2 - Background: COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios. Methods: In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective. Findings: Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10·65 for Bangladesh, $10·25 for Pakistan, and $6·42 for Sri Lanka. Per-capita costs were $0·63 for Bangladesh, $0·29 for Pakistan, and $1·03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh, $2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79·3% in Bangladesh, 85·2% in Pakistan, and 99·8% in Sri Lanka. Interpretation: The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study. Funding: The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust.
AB - Background: COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios. Methods: In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective. Findings: Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10·65 for Bangladesh, $10·25 for Pakistan, and $6·42 for Sri Lanka. Per-capita costs were $0·63 for Bangladesh, $0·29 for Pakistan, and $1·03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh, $2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79·3% in Bangladesh, 85·2% in Pakistan, and 99·8% in Sri Lanka. Interpretation: The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study. Funding: The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust.
UR - http://www.scopus.com/inward/record.url?scp=85103971470&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(21)00033-4
DO - 10.1016/S2214-109X(21)00033-4
M3 - Article
C2 - 33751956
AN - SCOPUS:85103971470
SN - 2214-109X
VL - 9
SP - e660-e667
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 5
ER -
