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Adrianna Murphy, M.Sc .

Using Community Health Workers to Manage Hypertension in Urban India: A Cost-Effectiveness Analysis. Adrianna Murphy, M.Sc . London School of Hygiene and Tropical Medicine; Harvard School of Public Health Joshua Schulman-Marcus, M.D . Columbia University Medical School

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Adrianna Murphy, M.Sc .

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  1. Using Community Health Workers to Manage Hypertension in Urban India:A Cost-Effectiveness Analysis

  2. Adrianna Murphy, M.Sc. London School of Hygiene and Tropical Medicine; Harvard School of Public Health Joshua Schulman-Marcus, M.D. Columbia University Medical School DorairajPrabhakaran, M.D., M.P.H. Centre for Chronic Disease Control Tom Gaziano, M.D., PhD. Harvard Medical School; Harvard School of Public Health

  3. Burden of CVD in India Source: KS Reddy. 2007. ”India wakes up to the threat of cardiovascular diseases" Journal of the American College of Cardiology. Oct 2;50(14):1370-2

  4. A potential role for Community Health Workers ?

  5. The Evidence: Lin, T. et al; 2004 Yuchi, Taiwan 6 visits by CHWs 3.8 mm/Hg reduction for men 7.1 mm/Hg reduction for women

  6. The Evidence: Levin, et al.; 2003 Inner City Baltimore 1 visit from CHW 6.5 mm/Hg reduction

  7. To analyse cost-effectiveness: • Estimate risk of CVD events (fatal and non) • Estimate cost of CVD events • Design hypothetical CHW intervention • Estimate costs of CHW intervention

  8. Risk: Global Markov CVD Model Population estimates Adults ages 35-74 By age and sex UN Population Division Distribution of risk factors Region specific Global Burden of Disease Project Fatal or non-fatal CVD events  Ten-year risk of CVD events Framingham Risk Score Annual probability of non-CVD death Based on life tables WHO

  9. Costs: Global Markov CVD Model Likelihood of hospitalization or secondary treatment WHO PREMISE Cost of medications Management Sciences for Health  Cost of CVD Cost of clinic visits and hospitalizations WHO CHOICE

  10. CHW intervention: design + = 3 mm/Hg reduction in systolic blood pressure

  11. CHW intervention: costs • Cost estimates from WHO-CHOICE; expert opinion • CHW salary = 3,908 USD/year • Total cost of intervention for one year = $ 141, 904; $6.44/patient, $3.22/visit

  12. Results • $141,000 cost offset by $110,000 saved • 65 DALYs averted annually • $475/DALY averted

  13. Results: sensitivity analysis • +/-25% of overall program costs • $140-1600 per DALY averted • CHW salary below $1,400 or number of visits reduced = intervention cost-saving

  14. Results: sensitivity analysis • 3 to 7 mm/Hg decrease • At 5mm/Hg ICER = $180/DALY averted • Anything above 5.3 mm/Hg reduction = intervention cost-saving

  15. Conclusions A hypothetical intervention for which CHWs are paid $3900 annually, and achieve a 3 mm/Hg reduction in blood pressure is very cost-effective. At higher estimates of blood pressure reduction the intervention becomes cost-saving. CHW intervention may also lead to improvements in other CVD risk factors and reductions in CVD-related morbidity would likely lead to increases in work productivity.

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