National Health and Budget Impact of Implementing the WHO HEARTS Hypertension Control Program in Bangladesh

Anirudg Pidugu

Name: Anirudh Pidugu
School: College of Dental Medicine, Class of 2024
Mentor: Andrew Moran, MD, MPH
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To address the burden of hypertension in Bangladesh, the World Health Organization recommends implementing the HEARTS technical package. HEARTS recommends a practical approach to CVD prevention in primary care settings. The HEARTS program was implemented in four health complexes in Sylhet starting in 2019. We translated HEARTS effectiveness and costs into projections of national health and budget impact for nation-wide program scale-up. We used a mathematical model to project CVD deaths averted and obtain budget impact estimates. In addition, we explored alternative scenarios: 1) reducing medication costs, and/or 2) increasing team-based care. Improvement in hypertension control observed in the program was added to the 13% baseline national control rate resulting in projected improvement to 33% when HEARTS is scaled up nationally. Hypertension program costs were quantified with a HEARTS costing tool, deployed in the four health complexes. A 77% relative improvement to 33% hypertension control nationally would save 9,400 lives by 2030 and 17,600 lives by 2040 with a budget impact of 649 million US dollars by 2030 and 735 million US dollars by 2040. Reducing medication costs by 50% lowers the budget impact by 39.1% by 2030. Increasing team-based care lowers the budget impact by 2.2% by 2030. Combining these innovations lowers the projected budget impact by 41.3%. Experience suggests that implementing current HEARTS model in Bangladesh will improve hypertension control and save thousands of lives. Increased task sharing between healthcare workers and lower medication prices have potential to reduce costs and make reaching hypertension control goals more affordable and sustainable.