BACKGROUND: In 2016, Chile implemented a pilot project in two Santiago-area family health centers aimed at improving hypertension control using the HEARTS framework for cardiovascular disease (CVD) prevention. The core intervention replaced non-standardized, single-medication regimens with standardized treatment using fixed-dose combination pills. While prior studies demonstrate improved blood pressure control with fixed-dose combination pills, further evidence on cost-effectiveness is essential for scalability. METHODS: A 10-year outcomes-based Markov model was used to assess the benefits and costs of the HEARTS approach versus usual care from a societal perspective. Incremental program costs were estimated via activity-based costing, and incremental benefits from reductions in acute CVD events. The cost-effectiveness was quantified using incremental benefit-cost ratios (IBCR) and incremental cost per averted disability-adjusted life year (DALY). FINDINGS: While the HEARTS approach led to higher initial medication costs, averted CVD events generated net savings over time. The IBCR was estimated to exceed one by year 2 and reached 7.8 by year 10, showing that incremental benefits would exceed costs at an increasing rate over time. The cost per DALY averted in model year 10 was approximately $2,171, demonstrating high cost-effectiveness compared to the per-capita GDP threshold. INTERPRETATION: The HEARTS approach in Chile, which employs a standardized hypertension treatment protocol with fixed-dose combination pills, was estimated to be highly cost-effective compared to usual care. Over time, it progressively reduces the incidence of acute cardiovascular disease (CVD) events, resulting in substantial cost savings.

BACKGROUND: In 2020, a pilot program for hypertension control was initiated in primary care facilities in Lampang Province, Thailand. The program followed the framework of the HEARTS program for standardized hypertension treatment, but the financial costs of the program are not well understood. This study evaluates the costs of the HEARTS approach compared to usual care to inform future scale-up efforts of the program. METHODS: Cost data were collected and analyzed using the HEARTS costing tool, a Microsoft Excel-based tool that supports activity-based costing of the HEARTS program from the health system perspective. Three scenarios were considered: usual care, the HEARTS regimen using standardized hypertension treatment with single-agent pills, and a sub-scenario of the HEARTS regimen using single-pill dual-drug combination pills. Costs are estimated as annual costs from the health system perspective in all Lampang primary care facilities. RESULTS: For the usual care scenario, the HEARTS single-pill scenario, and the HEARTS combination-pill sub-scenario, the average annual medication cost per treated patient was USD 14.0 (THB 485), USD 13.8 (THB 479), and USD 14.3 (THB 497), respectively. Total program cost per primary care user was USD 13.6 (THB 472.7), THB USD 14.3 (494.5), and USD 14.4 (THB 499.9) across the three scenarios, respectively. The largest program cost driver (45-47% across the examined scenarios) was attributed to a comprehensive package of laboratory tests applied to all hypertension patients. Hypothetically, reducing test coverage from all hypertension patients (27% of primary care users) to 15% of primary care users (corresponding to the proportion of patients aged 65+) would reduce program cost per user from USD 14.3 to USD 12.0 in the HEARTS combination-pill scenario. CONCLUSIONS: Compared to usual care, HEARTS implementation costs include additional costs for staff training, which are balanced by lower medication expenditures using the HEARTS standardized regimen with single-agent pills. The HEARTS regimen using dual-drug combination pills was estimated to be slightly more costly due to the higher price of combination pills. Optimizing coverage of diagnostic tests and lowering the purchasing prices of combination-pill medicines are key areas for cost reduction in future scale-up efforts.