{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T16:37:34Z","timestamp":1793637454918,"version":"4.5.1"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,4,16]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The SingHypertension primary care clinic intervention, which consisted of clinician training in hypertension management, subsidized single\u2010pill combination medications, nurse\u2010delivered motivational conversations and telephone follow\u2010ups, improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care among patients with uncontrolled hypertension in Singapore. This study quantified the incremental cost\u2010effectiveness, in terms of incremental cost per unit reduction disability\u2010adjusted life years, of SingHypertension relative to usual care for patients with hypertension from the health system perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">We developed a Markov model to simulate CVD events and associated outcomes for a hypothetical cohort of patients over a 10\u2010year period. Costs were measured in US dollars, and effectiveness was measured in disability\u2010adjusted life years averted. We present base\u2010case results and conducted deterministic and probabilistic sensitivity analyses. Based on a willingness\u2010to\u2010pay threshold of US $55\u2009500 per DALY averted, SingHypertension was cost\u2010effective for patients with hypertension (incremental cost\u2010effectiveness ratio: US $24\u2009765 per disability\u2010adjusted life year averted) relative to usual care. This result held even if risk reduction was assumed to decline linearly to 0 over 10\u2009years but not sooner than 7\u2009years. Incremental cost\u2010effectiveness ratios were most sensitive to the magnitude of the reduction in CVD risk; at least a 0.13% to 0.16% point reduction in 10\u2010year CVD risk is required for cost\u2010effectiveness. Probabilistic sensitivity analysis indicates that SingHypertension has a 78% chance of being cost\u2010effective at the willingness\u2010to\u2010pay threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">SingHypertension represents good value for the money for reducing CVD incidence, morbidity, and mortality and should be considered for wide\u2010scale implementation in Singapore and possibly other countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration Information<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      REGISTRATION: URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02972619.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.033631","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T07:11:41Z","timestamp":1712905901000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Cost\u2010Effectiveness of a Multicomponent Primary Care Intervention for Hypertension"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3291-4523","authenticated-orcid":false,"given":"Junxing","family":"Chay","sequence":"first","affiliation":[{"name":"Program in Health Services &amp; Systems Research Duke\u2010NUS Medical School Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7454-8376","authenticated-orcid":false,"given":"Tazeen H.","family":"Jafar","sequence":"additional","affiliation":[{"name":"Program in Health Services &amp; Systems Research Duke\u2010NUS Medical School Singapore"},{"name":"Department of Renal Medicine Singapore General Hospital Singapore"},{"name":"Duke Global Health Institute Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1804-4277","authenticated-orcid":false,"given":"Rebecca J.","family":"Su","sequence":"additional","affiliation":[{"name":"Program in Health Services &amp; Systems Research Duke\u2010NUS Medical School Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-4430","authenticated-orcid":false,"given":"Rupesh M.","family":"Shirore","sequence":"additional","affiliation":[{"name":"Program in Health Services &amp; Systems Research Duke\u2010NUS Medical School Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5946-1149","authenticated-orcid":false,"given":"Ngiap Chuan","family":"Tan","sequence":"additional","affiliation":[{"name":"SingHealth Polyclinics Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6443-9686","authenticated-orcid":false,"given":"Eric A.","family":"Finkelstein","sequence":"additional","affiliation":[{"name":"Program in Health Services &amp; Systems Research Duke\u2010NUS Medical School Singapore"},{"name":"Duke Global Health Institute Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)32008-2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)01330-1"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwac285"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.5114\/aoms.2020.92689"},{"key":"e_1_3_2_6_2","unstructured":"Graden S. National estimate of cost of illness for hypertension and non\u2010persistence with drug therapy using the Medical Expenditure Panel Survey. In: Collge of Pharmarcy. The Ohio State University2003."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200106000-00008"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.115.018912"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)31145-6"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circresaha.118.313220"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.7326\/m17-1805"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004026"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j2099"},{"key":"e_1_3_2_14_2","unstructured":"Exchange rates. Monetary Authority of Singapore. 2023. Accessed November 7 2023. https:\/\/eservices.mas.gov.sg\/Statistics\/msb\/ExchangeRates.aspx"},{"key":"e_1_3_2_15_2","unstructured":"Agency for Care Effectiveness Singapore . Drug Evaluations Methods and Process Guide. Ministry of Health Singapore; 2019. Accessed May 26 2023. https:\/\/www.ace\u2010hta.gov.sg\/docs\/default\u2010source\/process\u2010methods\/ace\u2010methods\u2010and\u2010process\u2010guide\u2010for\u2010drug\u2010evaluation\u2010(20\u2010dec\u20102019).pdf."},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.05.003"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001860"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2019.09.2749"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002822"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-020-00937-z"},{"key":"e_1_3_2_21_2","unstructured":"National Registry of Diseases Office . Singapore Myocardial Infarction Registry Annual Report 2019. Health Promotion Board Ministry of Health Singapore; July 30 2021. Accessed May 26 2023. https:\/\/www.nrdo.gov.sg\/docs\/librariesprovider3\/default\u2010document\u2010library\/smir\u2010web\u2010report\u20102019.pdf?sfvrsn=a0d1988b_0."},{"key":"e_1_3_2_22_2","unstructured":"National Registry of Diseases Office . Singapore Stroke Registry Annual Report 2019. Health Promotion Board Ministry of Health Singapore; November 2023. Accessed December 26 2023. https:\/\/www.nrdo.gov.sg\/docs\/librariesprovider3\/default\u2010document\u2010library\/ssr\u2010annual\u2010report\u20102021_web.pdf?sfvrsn=7d63ee29_0."},{"key":"e_1_3_2_23_2","unstructured":"Department of Statistics Singapore . Complete Life Tables for Singapore Resident Population 2020\u20132021. Ministry of Trade and Industry Singapore; 2022. Accessed May 26 2023. https:\/\/www.singstat.gov.sg\/."},{"key":"e_1_3_2_24_2","unstructured":"Global Burden of Disease Collaborative Network . Global Burden of Disease Study 2019 (GBD 2019) Results. Institute of Health Metrics and Evaluation (IHME) 2020. Accessed May 26 2023. https:\/\/ghdx.healthdata.org\/gbd\u20102019."},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.5539\/gjhs.v8n1p165"},{"key":"e_1_3_2_26_2","unstructured":"Fee Benchmarks and Bill Amount Information. Ministry of Health (MOH) Singapore. Accessed May 22 2023. https:\/\/www.moh.gov.sg\/cost\u2010financing\/fee\u2010benchmarks\u2010and\u2010bill\u2010amount\u2010information"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-015-6584-7"},{"key":"e_1_3_2_28_2","unstructured":"Goods and Services Inflation Calculator. Monetary Authority of Singapore. Accessed July 27 2023. https:\/\/eservices.mas.gov.sg\/statistics\/calculator\/GoodsAndServices.aspx"},{"key":"e_1_3_2_29_2","unstructured":"Global Burden of Disease Collaborative Network . Global Burden of Disease Study 2019 (GBD 2019) Disability Weights. Institute for Health Metrics and Evaluation (IHME); 2020. Accessed May 26 2023. https:\/\/ghdx.healthdata.org\/gbd\u20102019."},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","unstructured":"Virtual ISPOR Asia Pacific. September 14\u201316 2020. Accessed May 26 2023. 10.1016\/j.vhri.2020.07.378.","DOI":"10.1016\/j.vhri.2020.07.378"},{"key":"e_1_3_2_31_2","unstructured":"National Population Health Survey 2021. Ministry of Health Singapore. Accessed May 26 2023. https:\/\/www.moh.gov.sg\/docs\/librariesprovider5\/resources\u2010statistics\/reports\/national\u2010population\u2010health\u2010survey\u20102021\u2010report.pdf?sfvrsn=769892c7_0."},{"key":"e_1_3_2_32_2","unstructured":"Department of Statistics Singapore . 2020 Census of Population. In: Demographic Characteristics Education Language and Religion. Ministry of Trade and Industry Singapore; 2020. Accessed August 16 2016. https:\/\/www.singstat.gov.sg\/."},{"key":"e_1_3_2_33_2","unstructured":"Agency for Care Effectiveness . Non\u2010vitamin K antagonist oral anti\u2010coagulation agents (NOACs) for preventing stroke and systemic embolism in non\u2010valvular atrial fibrillation. Ministry of Health Singapore; 2017. Accessed August 16 2016. https:\/\/www.ace\u2010hta.gov.sg\/docs\/default\u2010source\/drug\u2010guidances\/noacs_for\u2010preventing\u2010stroke\u2010and\u2010systemic\u2010embolism\u2010in\u2010nvaf\u2010(1\u2010jul\u201022).pdf."},{"key":"e_1_3_2_34_2","unstructured":"Agency for Care Effectiveness . Sodium\u2010glucose co\u2010transporter 2 (SGLT2) inhibitors for treating type 2 diabetes mellitus \u2013 technology guidance from the MOH Drug Advisory Committee. Ministry of Health Singapore; 2021. Accessed May 26 2023. https:\/\/www.ace\u2010hta.gov.sg\/docs\/default\u2010source\/drug\u2010guidances\/sodium\u2010glucose\u2010co\u2010transporter\u20102\u2010(sglt2)\u2010inhibitors\u2010for\u2010treating\u2010type\u20102\u2010diabetes\u2010mellitus\u2010(updated\u20101\u2010sept\u20102020).pdf."},{"key":"e_1_3_2_35_2","unstructured":"Agency for Care Effectiveness . Direct\u2010acting antiviral agents for treating genotype 1 chronic hepatitis C \u2013 Technology Guidance from the MOH Drug Advisory Committee. Ministry of Health Singapore; 2020. Accessed May 26 2023. https:\/\/www.ace\u2010hta.gov.sg\/docs\/default\u2010source\/drug\u2010guidances\/direct\u2010acting\u2010antiviral\u2010agents\u2010for\u2010treating\u2010genotype\u20101\u2010chronic\u2010hepatitis\u2010c\u2010(updated\u20101\u2010oct\u20102020).pdf."},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.122.20292"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487313501886"},{"key":"e_1_3_2_38_2","unstructured":"Walmart . Pharmacy $4 Prescriptions. Walmart; 2023. Accessed 11 October 2023. https:\/\/www.walmart.com\/cp\/4\u2010prescriptions\/1078664."},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(17)30411-4"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(19)30338-9"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.22559"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2023.100962"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1038\/hr.2011.187"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.033631","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T09:16:58Z","timestamp":1730798218000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.033631"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,16]]},"references-count":42,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,4,16]]}},"alternative-id":["10.1161\/JAHA.123.033631"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.033631","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,16]]},"assertion":[{"value":"2023-11-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e033631"}}