Cost-effectiveness of a mobile technology-enabled primary care intervention for cardiovascular disease risk management in rural Indonesia

被引:6
作者
Angell, Blake [1 ,2 ]
Lung, Thomas [1 ,3 ]
Praveen, Devarsetty [4 ,5 ,6 ]
Maharani, Asri [7 ]
Sujarwoto, Sujarwoto [8 ]
Palagyi, Anna [1 ]
Oceandy, Delvac [9 ,10 ]
Tampubolon, Gindo [11 ]
Patel, Anushka [1 ]
Jan, Stephen
机构
[1] Univ New South Wales, George Inst Global Hlth, Level 5 1 King St Newtown, Sydney, NSW, Australia
[2] UCL Univ Coll London, UCL Inst Global Hlth, 30 Guilford St, London WC1N 1EH, England
[3] Univ Sydney, Fac Med & Hlth, Sch Publ Hlth, Edward Ford Bldg A27, Sydney, NSW 2006, Australia
[4] George Inst Global Hlth, Jasola Dist Ctr, Primary Hlth Care Res, 308-309 Third Floor,Elegance Tower Plot 8, New Delhi 110025, India
[5] Univ New South Wales, Fac Med, Sydney, NSW 2052, Australia
[6] Manipal Acad Higher Educ, Prasanna Sch Publ Hlth, Manipal 576104, Karnataka, India
[7] Univ Manchester, Div Nursing Midwifery & Social Work, Oxford Rd, Manchester M13 9PL, Lancs, England
[8] Univ Brawijaya, Dept Publ Adm, Jl MT Haryono 163, Malang 65145, Jawa Timur, Indonesia
[9] Univ Manchester, Manchester Acad Hlth Sci Ctr, Div Cardiovasc Sci, Oxford Rd, Manchester M13 9PT, Lancs, England
[10] Univ Airlangga, Fac Med, Dept Biomed Sci, Jl Prof Dr Moestopo 47, Surabaya 60132, Indonesia
[11] Univ Manchester, Global Dev Inst, Arthur Lewis Bldg 2-025 Oxford Rd, Manchester M13 9PL, Lancs, England
基金
英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;
关键词
Cost-effectiveness analysis; Indonesia; digital health; cardiovascular diseases; primary care; MIDDLE;
D O I
10.1093/heapol/czab025
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Cardiovascular diseases (CVD) are the leading cause of death in Indonesia, and there are large disparities in access to recommended preventative treatments across the country, particularly in rural areas. Technology-enabled screening and management led by community health workers have been shown to be effective in better managing those at high risk of CVD in a rural Indonesian population; however, the economic impacts of implementing such an intervention are unknown. We conducted a modelled cost-effectiveness analysis of the SMARThealth intervention in rural villages of Malang district, Indonesia from the payer perspective over a 10-year period. A Markov model was designed and populated with epidemiological and cost data collected in a recent quasi-randomized trial, with nine health states representing a differing risk for experiencing a major CVD event. Disability-Adjusted Life Years (DALYs) were estimated for the intervention and usual care using disability weights from the literature for major CVD events. Annual treatment costs for CVD treatment and prevention were $US83 under current care and $US144 for those receiving the intervention. The intervention had an incremental cost-effectiveness ratio of $4288 per DALY averted and $3681 per major CVD event avoided relative to usual care. One-way and probabilistic sensitivity analyses demonstrated that the results were robust to plausible variations in model parameters and that the intervention is highly likely to be considered cost-effective by decision-makers across a range of potentially acceptable willingness to pay levels. Relative to current care, the intervention was a cost-effective means to improve the management of CVD in this rural Indonesian population. Further scale-up of the intervention offers the prospect of significant gains in population health and sustainable progress toward universal health coverage for the Indonesian population.
引用
收藏
页码:435 / 443
页数:9
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