Costing the Global Hearts Technical Package: Nepal Case Study

Background: The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are implementing a cardiovascular disease prevention and management program called the Global HEARTS Technical Package in up to 20 low- and middle-income countries. The Global HEARTS Technical Package represents a strategic and practical approach for reducing the number of premature deaths from CVD. The package will implement and bring to scale an evidence-based set of protocols for disease management and risk reduction at the primary care level.

Methods: To assist CDC, its partners, and in-country collaborators to conduct cost studies and economic evaluations of the programs, we created an Excel-based costing tool to accompany the Global HEARTS initiative to capture the incremental costs of instituting the Global HEARTS Technical Package. The perspective of the tool is from a District Health office. The tool estimates costs for each of the facets of the program as well as indirect costs of implementing it. The tool was used in a case study of Nepal to estimate the costs of medications for hypertension. All costs are USD.

Results: All patients in the case study were required go through three laboratory tests: urine test, blood glucose, and total cholesterol and they cost $0.39, $0.49 cents and $2.00 dollars respectively. On average the cost per patient was USD$11.49 and cost per capita was $1.00. Costs increased with CVD risk level, ranging from 0.09 for the lowest risk level and up to $37.35 for high risk patients.

Summary: The costing tool fills a knowledge gap for low- and middle-income countries that is inhibiting countries from implementing NCD programs. The tool can be used to perform multiple types of analysis, and also to guide future policies on implementing and scaling up the programs. These include: 1) Performing country-specific economic evaluations of program implementation, including cross country comparisons of the cost and effectiveness of Global HEARTS, and; 2) Identifying economies of scale that can be achieved if programs are scaled-up using information on fixed and variable costs.