A new article co-authored by Resolve to Save Lives dives into the cost of scaling up HEARTS hypertension services in Nigeria to help prevent and control high blood pressure, and outlines the next steps to lowering the cost of HEARTS implementation.
Abstract
Background
The Nigeria Hypertension Control Initiative (NHCI) program, launched in 2020, integrates hypertension care into primary healthcare using the HEARTS technical package, which includes screening, health counselling, and standardized hypertension treatment protocols. This package has been piloted through NHCI in Kano and Ogun States and in the Federal Capital Territory (FCT) Abuja, as part of the Hypertension Treatment in Nigeria (HTN) project.
Objective
To assess the costs of scaling up the HEARTS hypertension control package and compare these costs with those of usual care.
Methods
Data on the costs of implementing the HEARTS program were collected from 15 purposively sampled primary health facilities in Kano, Ogun, and FCT Abuja between February and April 2024. Costs included training, medicines, provider time, and administrative expenses. We used the HEARTS costing tool, an Excel-based instrument, to collect and analyze the annual costs from a health system perspective, using an activity-based approach.
Results
The estimated annual cost of implementing HEARTS was USD 16 per adult primary care user (PCU), with variations across the three locations: USD 21 in Abuja, USD 11 in Kano, and USD 16 in Ogun. Average annual medication costs per patient treated under HEARTS also varied by location, amounting to USD 28 in Abuja, USD 27 in Ogun, and USD 16 in Kano. Under usual care, annual medication costs per patient were estimated at USD 32 in Kano and USD 16 in Ogun (data for Abuja were unavailable). Major cost drivers for the HEARTS package included provider time (49%) and medication (47%), compared to usual care, where medication alone accounted for 80% of costs. Implementing HEARTS requires a full-time equivalent of 0.45 doctors, 1.59 nurses, and 5.21 community health workers per 10,000 primary care users.
Conclusions
HEARTS implementation in Nigeria appears not to be substantially more costly than usual care. Monitoring clinical outcomes of the Nigeria HEARTS programs—improvement in hypertension control and downstream averted cardiovascular disease outcomes–will be necessary for establishing the cost-effectiveness of HEARTS compared with usual care. In the meantime, lessons learned from this costing exercise point toward the next steps to lower the cost of HEARTS implementation in Nigeria, including visit spacing and multi-month prescriptions for stably controlled hypertension patients, tighter adherence to HEARTS protocol prescribing, and market-shaping measures to lower hypertension medication costs.