Cost-Effectiveness of Individual- and Population-based Strategies to Lower Systolic Blood Pressure in China

BACKGROUND: Hypertension is a well known risk factor of cardiovascular disease (CVD), the leading cause of death and disability in China and worldwide. China currently spends more than $30 billion on CVD and $3 billion on the treatment of hypertension annually. This paper evaluates long-term costs and effectiveness of 8 selected individual- and population-based hypertension control intervention in China

METHODS: effect sizes of selected interventions on individual systolic blood pressure levels were derived from systematic reviews or meta-analyses. Health outcomes, quantified in terms of disability-adjusted life years (DALYs), were simulated for subpopulations differing in age and gender using PoPMoD, a life-table based disease model first developed by the World Health Organization CHOosing Interventions that are Cost-Effective (WHO-CHOICE) project.

RESULTS: population-based interventions, including community-based health education and nationwide use of low-sodium salt, are more cost-effective than traditional individual-based pharmacological therapies. Overall maximum health benefits are achieved when individual-based pharmacological therapies are combined with population-based interventions. Such combined interventions could potentially lower incidences of CVD by as much as 32% and avert 16.9 millions DALYs per year in China.

POLICY IMPLICATION: public policy should give more priority to population-based interventions that have been traditionally neglected in China. Future policy should also aim to improve pharmacological treatment rates and treatment adherence rates by expanding health insurance coverage, by offering free or low-cost hypertension screening programs and by improving public knowledge about the health consequences of hypertension.