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Budget Impact and Investment Case for HEARTS Hypertension Control Programs in 4 Low- and Middle-Income Countries

William Garcia1, Obehioye Amiosior2, Sohel Reza Choudhury3

  • 1Department of Global Health, University of Washington, Seattle, Washington, USA.

JACC. Advances
|December 10, 2025
PubMed

Insights

Scaling up the World Health Organization HEARTS program for hypertension (HTN) management in low- and middle-income countries is projected to prevent over 300,000 deaths by 2040, offering significant health and economic benefits.

Area of Science:

  • Public Health
  • Cardiovascular Disease Prevention
  • Health Economics

Background:

  • Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease, with suboptimal management in low- and middle-income countries.
  • The World Health Organization HEARTS program offers a standardized approach to improve HTN management in primary care settings.

Purpose of the Study:

  • To model the program costs and health benefits of scaling up the HEARTS program.
  • To analyze the impact of expanding HEARTS HTN treatment coverage in Bangladesh, Ethiopia, Nigeria, and the Philippines from 2025 to 2040.

Main Methods:

  • Utilized a cardiovascular disease simulation model to estimate averted deaths and disability from increased HTN treatment coverage.
  • Collected program cost data, including salaries, medications, diagnostics, and infrastructure, in international dollars ($).
  • Projected budget impact, health benefits, and cost-effectiveness under base and alternative cost scenarios.

Main Results:

  • Scaling up HEARTS is projected to cost $5.9 billion across the four countries by 2040, with costs per user ranging from $3 to $16.
  • Over 300,000 deaths can be prevented by 2040, with significant numbers in Bangladesh (120,000), Nigeria (77,500), the Philippines (82,000), and Ethiopia (47,200).
  • Alternative cost scenarios indicated potential improvements in HEARTS program affordability and economic returns.

Conclusions:

  • Scaling up the HEARTS hypertension control package is anticipated to yield substantial health gains.
  • The expansion of the HEARTS program is expected to generate significant economic benefits over time.
Abstract

Keywords:
HEARTSWorld Health Organizationbudget impactcosthypertension controlinvestment case

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