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

Bibliographic Data

ID16763116
AuthorsBlake Angell (0000-0002-7188-7740, The George Institute for Global Health, University of New South Wales, Level 5 1 King Street Newtown, Sydney, Australia, corresponding author), Thomas Lung (0000-0001-9978-6311, The George Institute for Global Health, University of New South Wales, Level 5 1 King Street Newtown, Sydney, Australia), Devarsetty Praveen (0000-0002-0973-943X, Primary health care research, George Institute for Global Health, 308-309, Third Floor, Elegance Tower Plot No. 8, Jasola District Centre, New Delhi 110025, India), Asri Maharani (0000-0002-5931-8692, Division of Nursing, Midwifery and Social Work University of Manchester, Oxford Road, Manchester, M13 9PL Lancashire, UK), Sujarwoto (0000-0003-4197-4592, University of Brawijaya), Sujarwoto Sujarwoto, Anna Palagyi (0000-0002-8127-9351, The George Institute for Global Health, University of New South Wales, Level 5 1 King Street Newtown, Sydney, Australia), Delvac Oceandy (0000-0002-6242-6491, Division of Cardiovascular Sciences, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PT, UK), Gindo Tampubolon (0000-0002-9081-2349, Global Development Institute, The University of Manchester, Arthur Lewis Building 2.025 Oxford Road, Manchester M13 9PL, UK), Anushka Patel (0000-0003-3825-4092, The George Institute for Global Health, University of New South Wales, Level 5 1 King Street Newtown, Sydney, Australia), Jan (0000-0003-2839-1405, The University of Sydney), Stephen Jan (The George Institute for Global Health, University of New South Wales, Level 5 1 King Street Newtown, Sydney, Australia)
Year2021
Volume36
Issue4
Pages435-443
Publication date2021-05-17
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czab025
PMID33712844
OpenAlexW3134953978
LanguageEN
Citations received5
References cited22

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

Cost effectiveness · Cost–benefit analysis · Economic growth · Environmental health · Health care · Intervention (counseling) · Population · Psychological intervention · Risk analysis (engineering) · Rural area · Cardiac Health and Mental Health · Healthcare Quality and Satisfaction · Healthcare Systems and Reforms · Medicine · Nursing

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