title: Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam.
abstract: To inform development of guidelines for hypertension management in Vietnam, we evaluated the cost-effectiveness of different strategies on screening for hypertension in preventing cardiovascular disease (CVD).
  
  
  
  A decision tree was combined with a Markov model to measure incremental cost-effectiveness of different approaches to hypertension screening. Values used as input parameters for the model were taken from different sources. Various screening intervals (one-off, annually, biannually) and starting ages to screen (35, 45 or 55 years) and coverage of treatment were analysed. We ran both a ten-year and a lifetime horizon. Input parameters for the models were extracted from local and regional data. Probabilistic sensitivity analysis was used to evaluate parameter uncertainty. A threshold of three times GDP per capita was applied.
  
  
  
  Cost per quality adjusted life year (QALY) gained varied in different screening scenarios. In a ten-year horizon, the cost-effectiveness of screening for hypertension ranged from cost saving to Int$ 758,695 per QALY gained. For screening of men starting at 55 years, all screening scenarios gave a high probability of being cost-effective. For screening of females starting at 55 years, the probability of favourable cost-effectiveness was 90% with one-off screening. In a lifetime horizon, cost per QALY gained was lower than the threshold of Int$ 15,883 in all screening scenarios among males. Similar results were found in females when starting screening at 55 years. Starting screening in females at 45 years had a high probability of being cost-effective if screening biannually was combined with increasing coverage of treatment by 20% or even if sole biannual screening was considered.
  
  
  
  From a health economic perspective, integrating screening for hypertension into routine medical examination and related coverage by health insurance could be recommended. Screening for hypertension has a high probability of being cost-effective in preventing CVD. An adequate screening strategy can best be selected based on age, sex and screening interval.
authors.affiliation: University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.
authors.forename: Thi-Phuong-Lan
authors.initials: TP
authors.lastname: Nguyen
authors.affiliation: Medical Committee Netherlands-Vietnam, Amsterdam, The Netherlands.
authors.forename: E Pamela
authors.initials: EP
authors.lastname: Wright
authors.affiliation: Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam.
authors.forename: Thanh-Trung
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.
authors.forename: C C M
authors.initials: CC
authors.lastname: Schuiling-Veninga
authors.affiliation: University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bijlsma
authors.affiliation: Department of Health economic, Ha Noi University of Medicine, Ha Noi, Vietnam.
authors.forename: Thi-Bach-Yen
authors.initials: TB
authors.lastname: Nguyen
authors.affiliation: University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.|Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, The Netherland.|Department of Epidemiology, UMCG, Groningen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000628:therapy; D015994:Incidence; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D014744:Vietnam / Q000453:epidemiology