Description
Background
Hypertension—the main risk factor for cardiovascular diseases (CVDs)—remains underdiagnosed and poorly controlled in Kenya due to low screening, treatment uptake, and adherence. In 2019, Kenya piloted EMPOWER Health, a multicomponent, digital health-enabled intervention to improve hypertension screening and management. While clinically effective in reducing blood pressure, its long-term health and economic impacts are unclear. This study evaluates the cost-effectiveness of EMPOWER Health compared with usual care.
Methods
We developed an individual-level microsimulation model of 100,000 adults sampled from the 2015 Kenya STEPS survey. Individuals were simulated annually for 50 years, tracking cardiovascular risk, myocardial infarction (MI), stroke, and mortality. Intervention effects, defined as 12-month systolic blood pressure reductions, were estimated using inverse probability of treatment weighting. Annual risks of MI and stroke came from WHO CVD risk equations for Eastern Sub-Saharan Africa. Costs were assessed from a health system perspective and outcomes expressed in disability-adjusted life years (DALYs). Probabilistic sensitivity analysis (1,000 iterations) was conducted.
Results
Early findings indicate that over 50 years, EMPOWER Health averted 7,160 MIs, 10,060 strokes, and 9,333 deaths, versus 4,592 MIs, 7,178 strokes, and 6,186 deaths under usual care. Mean per-person costs were US$5,836 in the intervention arm and US$5,849 with usual care. EMPOWER Health yielded 0.34 DALYs averted per person compared with 0.23 for usual care. The incremental cost-effectiveness ratio (ICER) was –US$118.5 per DALY averted, indicating cost savings. Probabilistic analysis confirmed robustness, with a mean ICER of –US$124 and a 100% probability of cost-effectiveness at a US$1,000 per DALY threshold (≈50% of Kenya’s GDP per capita).
Conclusion
These preliminary findings suggest that EMPOWER Health is likely cost-saving and more effective than usual care for long-term hypertension management in Kenya, with high potential value for scale-up under accepted cost-effectiveness thresholds. Ongoing calibration, validation, and stakeholder engagement will refine these estimates.
| Country | Kenya |
|---|---|
| Organization | Academic Institution |
| Position | PhD Researcher |
| Received a Grant? | Yes |
| If yes, give grant details | Wellcome Trust [218462/Z/19/Z] |
