Optimal scenario of antihypertension's cost-effectiveness in Prolanis hypertension patients: A case study of Pandeglang District, Indonesia

Abstract

Background: Since hypertension prevalence has increased, its economic burden has also increased in all regions, including Pandeglang District in Banten Province, Indonesia. In 2014, the government launched a chronic disease management programme (Prolanis) to optimise hypertension treatment in Primary Healthcare Centres (PHCs) through the Social Health Insurance Administration Body (BPJS Kesehatan). Pharmacists' counseling is important in this as it can increase the effectiveness of hypertension treatment.        Objective: To investigate the cost-effectiveness of pharmacists’ counselling for Prolanis hypertension patients at PHCs. Methods: An experimental study was conducted at 16 PHCs using a purposive sampling method. The total sample included 96 Prolanis hypertension patients divided into two groups of 48 participants (an intervention and control group). Incremental cost-effectiveness ratio (ICER) was applied by comparing the cost per quality-adjusted life-year (QALY) gained in both groups. A validated EuroQol-5 Dimension-5 Level (EQ-5D-5L) questionnaire and its Indonesian value set were employed to measure patient quality of life, and the local GDP per capita threshold for cost-effectiveness was used.          Results: Pharmacists' counseling intervention is cost-effective (ICER: IDR.2,000-28,307 per QALY-gained) within several scenarios with varying fees. Sensitivity analysis showed that the patient's utility score and the pharmacist`s counseling fee were the most influential parameters impacting the ICER.    Conclusion: Pharmacist`s counselling can be considered as a promising intervention to optimise Prolanis hypertension treatments at PHCs.