Estimated Cost for Risk Based Management of Cardiovascular Diseases in Primary Health Care in Nepal by Using Total Risk Approach

Abstract

Background: We estimated the direct medical cost of primary prevention of cardiovascular diseases (CVD) in the primary health care center (PHCC) using the GLOBAL HEARTS treatment protocols for risk based management of CVD. Method: We took the Ministry of Health’s perspective, and used a one-year time horizon. Cost for human resources and laboratory tests were estimated in the context of Nepal, while international drug prices obtained from Management Sciences of Health (MSH) and local prices for non study related drugs from Nepal’s Logistic Management division (LMD) were used in estimating local drug prices. The cost estimates are presented in both current Nepali rupees (NPR) and current US dollars (2017). Results: The estimated cost to provide CVD primary prevention for each patient was $3.05 for the first visit and an additional $0.09 for patients with risk <10%, $4.35 for patients with risk 10- 20% with high blood pressure (HBP), $25.46 for patients with risk 10-20% with high cholesterol, $33.04 for patients with risk 20-30%, $37.35 for patients with risk >30% and an additional $38.04 cost for management of those with diabetes. For a primary health care center with a population of 10,000, the estimated cost to screen and treat 50% of eligible patients was $12 per case and $1 per capita. The total annual cost varied from $5,000 at 25% coverage to as high as $15,000 at 75% coverage. Conclusion: Providing CVD prevention services at PHCCs is inexpensive. Along with the financial resources, health facilities will also need higher capacity for human resource, logistic management and laboratory services.