COST-EFFECTIVENESS OF A HYPERTENSION CONTROL INTERVENTION IN THREE CHINESE COMMUNITY HEALTH CENTERS

Purpose:  To investigate the cost effectiveness of a hypertension control program in China.

Method:  We collected information on program costs (categorized into personnel, variable, and fixed costs) and health outcomes (changes in systolic and diastolic blood pressure [SBP and DBP]) by conducting face-to-face interviews and physical examinations in three community health centers in China's Beijing, Hezhou, and Chengdu cities during September 2008 to August 2009.  The intervention participants were comprised of 4902 hypertensive persons (SBP≥140mmHg and/or DBP≥90 mmHg) aged 18 and older who had no serious comorbidities, physical limitations, or mental disorders. The intervention included regular in-person visits, diet/physical activity/smoking/drinking-related behavioral monitoring and education, and checking on medication use, if applicable.  We examined the per capita costs and impact of the intervention on blood pressure, and derived cost-effectiveness measures.

Result: Overall, the total program costs were 240,772 Yuan (Chinese RMB) and the per capita costs were 49 Yuan.  After the one year program, on average the SBP decreased from 143 to 131 mmHg (p<0.001) and DBP decreased from 84 to 78 mmHg (p<0.001). The cost-effectiveness ratio was 4.0 Yuan per one mmHg SBP decrease and 0.5 mmHg DBP decrease.  Across the three centers, the annual per capita cost ranged from 36.9 to 79.8 Yuan, SBP decreases ranged from 7.6 to 17.8 mmHg and DBP decreases ranged from 3.9 to 8.3 mmHg.  The cost-effectiveness ratios ranged from 3.6 to 5.0 Yuan per person per mmHg SBP decrease and 0.5-0.6 mmHg DBP decrease.  There was a large variation in per capita program costs, and average SBP and DBP changes across communities.  However, the community with the highest per capita costs also had the best health outcomes improvement.  Thus, the cost-effectiveness ratios did not vary greatly across communities.  This may suggest 1) a positive correlation between the per capita costs and program impact; 2) differences in intervention levels; and 3) differences in health status such as baseline blood pressure measures.

Conclusion: The wide variation of per capita program costs and health outcomes across communities suggests a need to further investigate the relationship between program costs and health effects in hoping to improve cost-effectiveness of the intervention.  The costs and cost-effectiveness results could be helpful to policy makers in making informed resource allocation decisions.