{
  "abstract": "Introduction The Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) programme is a community-based initiative for managing hypertension in rural South Asia. Previous analyses found the intervention more effective but too costly to be considered cost-effective, using a gross domestic product-based threshold cost-effectiveness threshold that overlooked Pakistan’s constrained healthcare resources. Additionally, key benefits, such as avoided cardiovascular events and associated cost savings, were not considered. This study evaluates the long-term cost-effectiveness of the COBRA-BPS programme compared with the standard of care (SoC) in Pakistan.Methods A Markov model was used to estimate long-term costs and health outcomes, measured in life years and disability-adjusted life years (DALYs). Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) and net monetary benefit statistics. Thresholds of US$183 (based on Pakistan’s marginal productivity of public health expenditure), US$500 and US$1000 per DALY averted were applied. Sensitivity analyses were conducted to assess robustness.Results Based on the pooled results, the COBRA-BPS programme incurred higher costs than SoC, with an incremental cost of US$105 and an incremental gain of 0.41 DALYs averted over individuals’ lifetimes, resulting in an ICER of US$252 per DALY averted.Conclusion COBRA-BPS effectively reduces cardiovascular events but has marginal cost-effectiveness when evaluated against the US$183 per DALY threshold. However, it becomes cost-effective at higher thresholds. Compared with previous analyses, our study found a significantly lower cost per DALY averted, driven by substantial downstream cost savings from avoided cardiovascular events.",
  "authors": [
    {
      "affiliations": [
        "Centre for Health Economics, University of York, York, UK"
      ],
      "name": "Carlos Chivardi"
    },
    {
      "affiliations": [
        "Medicine, Aga Khan University, Karachi, Pakistan",
        "Duke University, Durham, North Carolina, USA"
      ],
      "name": "Zainab Samad"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, England, UK"
      ],
      "name": "Tao Chen"
    },
    {
      "affiliations": [
        "Centre for Health Economics, University of York, York, UK"
      ],
      "name": "Simon Mark Walker"
    }
  ],
  "title": "Evaluating the long-term cost-effectiveness of the COBRA-BPS programme in Pakistan",
  "uid": "5803b515-2ac2-566e-add6-b96dae25e26d"
}