Cost-effectiveness of the simplified multicomponent primary care management of cardiovascular risk in Tibet, China: a within-trial and modeled economic evaluation

The Simplified Cardiovascular Management Program (SimCard), a cluster-randomized controlled trial conducted in Tibet, China, demonstrated significant reduction in systolic blood pressure (SBP) compared to usual care among people with or at high risk of developing cardiovascular diseases (CVD). This study conducted a comprehensive economic evaluation for within-trial incremental cost per mmHg reduction in SBP at 12 months and per Quality-Adjusted Life Year (QALY) gained over the 10-year timeframe through a Markov-based CVD model. We reported expenses in 2023 CNY, using China’s 2023 per-capita gross domestic product of CNY 89,358 as the cost-effectiveness threshold. We performed both one-way and probabilistic sensitivity analyses. During the trial period, the intervention group experienced a greater reduction in SBP, with a mean difference of 4.37 mmHg (95% CI: 1.32–7.42) compared to the usual care group. The Incremental Cost-Effectiveness Ratio (ICER) was CNY 101 (95% CI: 85–137) per mmHg reduction in SBP. In the 10-year modeled cost-effectiveness analysis, QALYs were higher in the intervention group by 0.11 (95% CI: 0.02–0.22) compared to the control group. The intervention had superior outcomes at similar costs (¥19,439 for the intervention group compared to ¥19,622 for the control group). This outcome remained robust across all sensitivity analyses The SimCard intervention was cost saving in preventing CVD among individuals at high risk in resource-constrained settings in China. Our findings highlight significant economic and health benefits of the intervention in Tibet, China, potentially generalizable to similar settings in other low- and middle-income countries.