Evaluating the long-term cost-effectiveness of the COBRA-BPS programme in Pakistan

Authors

Carlos Chivardi, University of York
Zainab Samad, Aga Khan UniversityFollow
Tao Chen, Liverpool School of Tropical Medicine
Simon Mark Walker, University of York

Document Type

Article

Department

Medicine; Cardiology

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.

AKU Student

no

Publication (Name of Journal)

BMJ Public Health

DOI

10.1136/bmjph-2025-002981

Recommended Citation

Chivardi, C., Samad, Z., Chen, T., Walker, S. M. (2025). Evaluating the long-term cost-effectiveness of the COBRA-BPS programme in Pakistan. BMJ Public Health, 3(2), 1-8.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_cardiol/300