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 Trần Thị Mai Oanh, Hoàng Thị Phượng,  Nguyễn Khánh Phương,  Vương Lan Mai, Nguyễn Thị Thủy, Trần Văn Tiến

Place of publication: Health Strategy and Policy Institute
Year of publication: 2011
Hypertension is among the leading causes of disability and mortality globally, and has become a major public health problem in Vietnam and the world. Hypertension control is part of efforts to combat non-communicable diseases in Vietnam. Given the current resources constraints, valid evidence is needed on the cost-effectiveness of antihypertensive interventions to inform policymakers in effectively prioritizing resources allocation. This study was conducted under the auspices of the Health Strategy and Policy Institute, Queensland University, Australia and the National target program for Hypertension control, Vietnam Cardiovascular Hospital, Bach Mai Hospital. 
1. Estimate costs, effectiveness and cost-effectiveness of antihypertensive interventions on a national scale; 
2. Recommend highly cost – effectiveness of  interventions based on evidence from analyzing results.
This is a cost-effectiveness analysis (CEA) using modeling techniques and employing the WHO-CHOICE model for calculation of cost-effectiveness of interventions. Four interventions were included in the cost-effectiveness analysis, including (1) Mass media intervention on cutting down salt intake and voluntary salt intake reduction in preparing ready-to-eat foods (“salt intake reduction media intervention”); (2) media intervention for tobacco control; (3) drug-based intervention for Level 1 hypertensive patients; and (4) drug-based intervention for Levels 2-3 hypertensive patients. As the study bases itself on the government’s perspective, all costs and impacts are estimated using the government’s norms. The effectiveness of hypertensive control interventions is measured by the number of preventable disability-adjusted life years (DALY) by adopting the interventions. DALYs averted through the interventions are estimated by modeling methods and using variable population modeling (PopMod model) of WHO-CHOICE . The cost-effectiveness analysis duration is 10 years, with a discount rate of 3% for both costs and effectiveness of intervention. 

Intervention Costs: Levels 2-3 hypertension therapeutic drug-based interventions have the highest annual average cost ( 1,119,162 million VND), followed by Level 1 hypertension therapeutic drug-based intervention (98,787 million VND). Media interventions for salt intake reduction and tobacco control have the lowest and about the same costs (91,051 million VND).  
Effective intervention: Interventions delivered on individual patient levels are more effective than community-level media interventions. Level 1 antihypertensive drug-based interventions provide the highest 10-year effectiveness ( 2,633,396 DALYs  averted), followed by Levels 2-3 drug-based antihypertensive interventions (2,105,293 DALYs averted). The salt intake reduction media intervention is the third most effective strategy (481,368 DALYs averted). The least effective one is tobacco control media intervention (79,828 DALYs averted). 
Cost-effectiveness: All the four interventions (2 community-based interventions and 2  individual level interventions) are “very cost-effective” given the WHO threshold definition of < GDP per capita (i.e Incremental Cost-Effectiveness Ratio – ICER of all interventions were lower than VND 13.464.278 - GDP per capita of Vietnam in 2007). The salt intake reduction media intervention is the most cost - effective (1,891,505 VND/DALY), followed by Level 1 antihypertensive drug-based intervention (3,724,407VND/DALY). The third most effective intervention is Levels 2-3 antihypertensive drug-based intervention (5,315,945VND/DALY), while the tobacco control media intervention is the least cost-effective of all (11,405,900VND/DALY). 
All the four hypertensive control interventions achieve the “very cost-effective” given the WHO threshold definition of <GDP per capita. 
The salt intake reduction media intervention is the most cost-effectiveness, followed by Level 1, 2 and 3 antihypertensive drug-based interventions and tobacco control media intervention.
All these interventions can be incorporated as priorities in the Ministry of Health’s policy making and resources allocation agenda. Nevertheless, given the resources constraints, the highest priority should be given to salt intake reduction and drug-based cure for Level 1 hypertensive patients. When more resources are available, drug-based interventions for Levels 2 and 3 hypertensive patients can be introduced. 
A situational analysis on salt intake levels and the salt using habit of Vietnamese in different geological areas should be considered. 
 Further cost-effectiveness studies are also needed for other antihypertensive interventions.

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