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Background <p>Few economic evaluations distinguish between the cost and impact of evidence-based interventions and the strategies used to improve their implementation. This distinction is essential for understanding whether a strategy is cost-effective, why it works, and the resources required to replicate its success. The Systems Analysis and Improvement Approach Hypertension (SAIA-HTN) trial evaluated an implementation strategy (“SAIA”) designed to improve hypertension care among people living with HIV (PLHIV) in Mozambique. We developed a mathematical model to estimate the cost-effectiveness of both the evidence-based intervention (including hypertension screening, pharmacological treatment and follow up, and lifestyle modifications such as diet and exercise) and the SAIA implementation strategy.</p> Methods <p>We constructed a decision-analytic, state-transition model that simulated cardiovascular risk, outcomes, and associated costs for PLHIV receiving hypertension care in Mozambique using a health systems perspective. Model inputs came from published epidemiological studies and primary data from the SAIA-HTN trial on intervention and implementation strategy effectiveness and costs. We estimated the incremental cost-effectiveness (willingness to pay $647/DALY averted, GDP per capita in Mozambique) of rolling out both components, compared to a “status quo” scenario where screening and treatment of hypertension remained at their current (very low) levels. Costs were reported in 2023 US dollars, and costs and outcomes were discounted at 3% over a ten-year time horizon.</p> Results <p>Scaling up screening and pharmacological treatment of hypertension in Mozambique would have an incremental cost-effectiveness ratio (ICER) of around $212 per disability-adjusted life year (DALY) averted and cost an additional $4.61 per person per year. Incremental to the intervention, the SAIA implementation strategy would have an ICER of $44 per DALY averted and cost an additional $0.79 per person per year. The average reduction in ten-year cardiovascular risk would be 29.3% for the intervention and 40.3% if the SAIA implementation strategy were co-introduced.</p> Conclusions <p>Our model is a tool for implementation scientists, policymakers, and researchers aiming to assess cardiovascular interventions and associated implementation strategies among PLHIV. Its application to SAIA-HTN suggests that this is a cost-effective strategy for improving hypertension care, but only in the presence of adequate blood pressure equipment, training, and medications. Our study shows how implementation strategies require a minimum threshold of health system readiness to generate meaningful health impact.</p> Trial registration <p>ClinicalTrials.gov (NCT04088656).</p>

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Mathematical modeling to assess health and economic impact of cardiovascular interventions and implementation strategies among people living with HIV: SAIA HTN

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月25日

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  • Akash Malhotra,
  • Ana Olga Mocumbi,
  • Maria Joana Coutinho,
  • Maxinel Jeremias Filipe Chidácua,
  • Amido Charama,
  • Onei A. Uetela,
  • Carmen Hazim,
  • Isaias Ramiro,
  • Kenneth Sherr,
  • Sarah Gimbel,
  • David Watkins

摘要

Background

Few economic evaluations distinguish between the cost and impact of evidence-based interventions and the strategies used to improve their implementation. This distinction is essential for understanding whether a strategy is cost-effective, why it works, and the resources required to replicate its success. The Systems Analysis and Improvement Approach Hypertension (SAIA-HTN) trial evaluated an implementation strategy (“SAIA”) designed to improve hypertension care among people living with HIV (PLHIV) in Mozambique. We developed a mathematical model to estimate the cost-effectiveness of both the evidence-based intervention (including hypertension screening, pharmacological treatment and follow up, and lifestyle modifications such as diet and exercise) and the SAIA implementation strategy.

Methods

We constructed a decision-analytic, state-transition model that simulated cardiovascular risk, outcomes, and associated costs for PLHIV receiving hypertension care in Mozambique using a health systems perspective. Model inputs came from published epidemiological studies and primary data from the SAIA-HTN trial on intervention and implementation strategy effectiveness and costs. We estimated the incremental cost-effectiveness (willingness to pay $647/DALY averted, GDP per capita in Mozambique) of rolling out both components, compared to a “status quo” scenario where screening and treatment of hypertension remained at their current (very low) levels. Costs were reported in 2023 US dollars, and costs and outcomes were discounted at 3% over a ten-year time horizon.

Results

Scaling up screening and pharmacological treatment of hypertension in Mozambique would have an incremental cost-effectiveness ratio (ICER) of around $212 per disability-adjusted life year (DALY) averted and cost an additional $4.61 per person per year. Incremental to the intervention, the SAIA implementation strategy would have an ICER of $44 per DALY averted and cost an additional $0.79 per person per year. The average reduction in ten-year cardiovascular risk would be 29.3% for the intervention and 40.3% if the SAIA implementation strategy were co-introduced.

Conclusions

Our model is a tool for implementation scientists, policymakers, and researchers aiming to assess cardiovascular interventions and associated implementation strategies among PLHIV. Its application to SAIA-HTN suggests that this is a cost-effective strategy for improving hypertension care, but only in the presence of adequate blood pressure equipment, training, and medications. Our study shows how implementation strategies require a minimum threshold of health system readiness to generate meaningful health impact.

Trial registration

ClinicalTrials.gov (NCT04088656).