Table 1 Input parameters, costs, and cost assumptions (in Thailand THB and USD)
From: Costs of the HEARTS hypertension program in primary care in Lampang province, Thailand
Input Description | Units | Usual-care approach | HEARTS program scenario* | HEARTS sub-scenario** |
|---|---|---|---|---|
Adult population (35+) | Persons | 261,445 | 261,445 | 261,445 |
Primary healthcare attendance rate (annual) | Percent | 77.20% | 77.20% | 77.20% |
Adult population with risk factors | ||||
Use of tobacco products | Percent | 18.70% | 18.70% | 18.70% |
Hazardous or harmful use of alcohol | Percent | 6.00% | 6.00% | 6.00% |
Physical inactivity | Percent | 30.90% | 30.90% | 30.90% |
Hypertension (≥ 140/90mmHg) | Percent | 27.40% | 27.40% | 27.40% |
Low CVD risk (0 to < 10%) | Percent | 83.67% | 83.67% | 83.67% |
Medium CVD risk (10 to < 20%) | Percent | 14.78% | 14.78% | 14.78% |
High CVD risk (≥ 20%) | Percent | 1.54% | 1.54% | 1.54% |
Number of Healthcare Providers in Lampang | ||||
Doctors | 732 | 732 | 732 | |
Nurses | 1,594 | 1,594 | 1,594 | |
CHWs (Community Health Workers) | 18,200 | 18,200 | 18,200 | |
Annual wage (including benefits) | ||||
Doctors | THB (USD)/year | 287,160 (8,280) | 287,160 (8,280) | 287,160 (8,280) |
Nurses | THB (USD)/year | 215,760 (6,221) | 215,760 (6,221) | 215,760 (6,221) |
CHWs | THB (USD)/year | 7,200 (207) | 7,200 (207) | 7,200 (207) |
Training to counsel patients to change behavior (5 A’s) | ||||
Classroom size | Persons | 0 | 96 | 96 |
Hours of training needed | Persons | 0 | 8 | 8 |
Number of Trainers | ||||
Professional trainer(s) | Persons | 0 | 7 | 7 |
Administrative staff | Persons | 0 | 5 | 5 |
Input costs for training | ||||
Hourly wage | ||||
Professional trainer | THB (USD)/hour | 0 | 131.25 (3.78) | 131.25 (3.78) |
Administrative staff | THB (USD)/hour | 0 | 31.25 (0.90) | 31.25 (0.90) |
Per unit cost of materials | ||||
Guideline book | THB (USD)/book | 0 | 75 (2.16) | 75 (2.16) |
Treatment flow chart | THB (USD)/day | 0 | 2.5 (0.07) | 2.5 (0.07) |
Additional costs | ||||
Facility rental for training (one day) | THB (USD)/day | 0 | 18,125 (522.64) | 18,125 (522.64) |
Per diem for staff | THB (USD)/day | 0 | 647 (18.66) | 647 (18.66) |
Per diem and/or salary of trainees | THB (USD)/day | 0 | 300 (8.65) | 300 (8.65) |
Transportation stipend for staff | THB (USD)/day | 0 | 623 (17.97) | 623 (17.97) |
CVD Risk Screening and Diagnosis | ||||
Approximately how much time (in minutes) does a health provider spend to: | ||||
Screen patients for total CVD risk (ask about patients’ health history) | Minutes | 4 | 4 | 4 |
Counsel patients with behavioral risk factors to change their behavior (e.g., quit tobacco, cease using alcohol harmfully, increase physical activity) | Minutes | 5 | 5 | 5 |
Provide a physical exam (including relevant metabolic screenings) to assess patients’ total CVD risk | Minutes | 3 | 3 | 3 |
Assess patient risk using a CVD risk chart, counsel patient, and document results | Minutes | 2 | 2 | 2 |
What other resources are provided to individuals who receive brief interventions for behavioral risk factors? | ||||
# of ‘How to quit’ informational materials disseminated per person annually (print) | 0 | 0 | 0 | |
Cost (in LCU) of ‘How to quit’ informational materials, per unit (print materials) | 12 | 12 | 12 | |
# of ‘How to quit’ informational materials disseminated per person annually (digital) | 0 | 0 | 0 | |
Cost (in LCU) of ‘How to quit’ informational materials, per unit (digital materials) | 0 | 0 | 0 | |
Treatment for High CVD Risk | ||||
How many follow-up visits should a person with the following levels of CVD risk undertake annually? | ||||
Low CVD risk (≥ 0% to < 10%) | 1 | 1 | 1 | |
Medium CVD risk (≥ 10% to < 20%) | 2 | 2 | 2 | |
High CVD risk (≥ 20%) | 4 | 4 | 4 | |
Approximately how much time will the following health providers spend with a patient during a visit? | ||||
Generalists/primary care doctors | Minutes | 5 | 5 | 5 |
Nurses | Minutes | 15 | 15 | 15 |
Purchasing price of diagnostic tests | ||||
Fasting blood glucose (FPG) | THB (USD)/test | 40.94 (1.18) | 40.94 (1.18) | 40.94 (1.18) |
Cholesterol | THB (USD)/test | 40.94 (1.18) | 40.94 (1.18) | 40.94 (1.18) |
Triglyceride | THB (USD)/test | 68.24 (1.97) | 68.24 (1.97) | 68.24 (1.97) |
High-Density Lipoprotein (HDL) | THB (USD)/test | 75.06 (2.16) | 75.06 (2.16) | 75.06 (2.16) |
Low-density lipoprotein (LDL) | THB (USD)/test | 177.41 (5.12) | 177.41 (5.12) | 177.41 (5.12) |
Complete blood count (CBC) | THB (USD)/test | 88.71 (2.56) | 88.71 (2.56) | 88.71 (2.56) |
BUN + Creatinine + Urine microalbumin | THB (USD)/test | 266.12 (7.67) | 266.12 (7.67) | 266.12 (7.67) |
Electrocardiogram (ECG) *** | THB (USD)/test | 204.71 (5.90) | 204.71 (5.90) | 204.71 (5.90) |
Purchasing price of pharmaceutical drugs | ||||
Amlodipine 2.5 mg | THB (USD)/tablet | 0.45 (0.01) | 0.45 (0.01) | 0.45 (0.01) |
Amlodipine 5 mg | THB (USD)/tablet | 0.9 (0.03) | 0.9 (0.03) | |
Amlodipine 10 mg | THB (USD)/tablet | 1.31 (0.04) | ||
Losartan 50 mg | THB (USD)/tablet | 1.1 (0.03) | 1.1 (0.03) | |
hydrochlorothiazide 12.5 mg | THB (USD)/tablet | 0.09 (0.003) | 0.09 (0.003) | |
Enalapril 2.5 mg | THB (USD)/tablet | 0.25 (0.01) | ||
Enalapril 5 mg | THB (USD)/tablet | 0.5 (0.01) | ||
Amlodipine 2.5 mg + Losartan 50 mg | THB (USD)/tablet | 1.61 (0.05) | ||
Amlodipine 5 mg + Losartan 50 mg | THB (USD)/tablet | 2.11 (0.06) | ||
Amlodipine 5 mg + Losartan 50mg & hydrochlorothiazide 12.5 mg | THB (USD)/tablet | 2.11 + 0.09 (0.063) | ||
Pharmacological treatment for hypertension (1 per day, 365 days) | ||||
Hypertension Protocol Step #1 | Medicine (mg) | Amlodipine 5 mg | Amlodipine 2.5 mg | Amlodipine 2.5 mg |
% of all individuals with HBP with this regimen | Percent | 20% | 40% | 40% |
Hypertension Protocol Step #2 | Medicine (mg) | Amlodipine 10 mg | Amlodipine 2.5 mg Losartan 50 mg | Amlodipine 2.5 mg + Losartan 50 mg |
% of all individuals with HBP with this regimen | Percent | 8% | 38% | 38% |
Hypertension Protocol Step #3 | Medicine (mg) | Enalapril 2.5 mg | Amlodipine 5 mg Losartan 50 mg | Amlodipine 5 mg + Losartan 50 mg |
% of all individuals with HBP with this regimen | Percent | 6% | 23% | 23% |
Hypertension Protocol Step #4 | Medicine (mg) | Losartan 50 mg | Amlodipine 5 mg Losartan 50 mg Hydrochlorothiazide 12.5 mg | Amlodipine 5 mg + Losartan 50 mg & Hydrochlorothiazide 12.5 mg |
% of all individuals with HBP with this regimen | Percent | 5% | 0% | 0% |
Hypertension Protocol Step #5 | Medicine (mg) | Enalapril 5 mg | ||
% of all individuals with HBP with this regimen | Percent | 3% | ||
Hypertension Protocol Step #6 | Medicine (mg) | Other regimen | ||
% of all individuals with HBP with this regimen | Percent | 59% | ||
LCU to USD exchange rate | THB/USD | 37.92 | 37.92 | 37.92 |
“Safety stock” required to be on hand for medicines | Percent | 8.3 | 8.3 | 8.3 |