2025-26 Project (Murphy & Perel & Sadique)

Cost effectiveness and value of implementation of a hypertension management programme in Sub Saharan Africa

SUPERVISORY TEAM

Supervisor

Dr Adrianna Murphy at LSHTM
Email: adrianna.murphy@lshtm.ac.uk

Co-Supervisor

Prof Pablo Perel at LSHTM
Email: pablo.perel@lshtm.ac.uk

Co-Supervisor

Dr Zia Sadique at LSHTM
Email: zia.sadique@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

Sub-Saharan Africa (SSA) bears a disproportionate burden of hypertension-related premature mortality. There is a need to improve hypertension screening, diagnosis, and treatment. 

The IHCOR-Africa and IMPLEMENT-CVD projects have been working in Kilifi County, Kenya, and Kiang West, The Gambia to conduct a feasibility trial of a package of evidence-based approaches to hypertension diagnosis, risk stratification using (organ damage measures), and treatment (combination therapy).   

The aim of this PhD will be to inform resource allocation by evaluating the cost-effectiveness and value of implementation of individual components of the strategy as well as the overall strategy.    

The analysis will draw on cost data that are currently being collected, health and socioeconomic data from the Kilifi Demographic and Health Surveillance System and the Kiang West Longitudinal Population Study, and qualitative measures of acceptability and feasibility.   

Nested within the two closely linked ongoing projects, the PhD will benefit from existing infrastructure and team support.

Project Key Words

Economic evaluation, implementation research, sub-Saharan Africa

MRC LID Themes

  1. Translational and Implementation Research
  2. Global Health

Skills

MRC Core Skills

  1. Quantitative skills
  2. Interdisciplinary skills

Skills we expect a student to develop/acquire whilst pursuing this project

Developing a decision analytical model for predicting lifetime cost- effectiveness, analysis of parameter and decision uncertainty, value of implementation analysis, and sub group analysis using data driven machine learning.

Routes

Which route/s are available with this project?

  • 1+4 = No
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • Not applicable

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? No

Location & Travel

Students funded through MRC LID are expected to work on site at their primary institution, meeting – at the minimum – the institutional research degree regulations and expectations. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training (for research degree study). Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Primary location for duration of this research degree: LSHTM, London

Travel requirements for this project: One visit to each of Kilifi, Kenya, and Kiang West, The Gambia for maximum two weeks (can be adapted to personal circumstances).

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • Minimum LSHTM institutional eligibility criteria for doctoral study.
  • MSc in Health Economics with training in basic cost-effectiveness analysis.

Other useful information

  • Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

Sub-Saharan Africa (SSA) has a high burden of hypertension-related premature mortality. There is a need to improve hypertension screening, diagnosis, and treatment.   

The IHCOR-Africa and IMPLEMENT-CVD projects have been working in Kilifi County, Kenya, and Kiang West, The Gambia to develop and conduct a feasibility trial of a package of three evidence-based approaches to hypertension diagnosis (comparing three different diagnostic strategies), risk stratification using point-of-care devices to measure hypertension-mediated organ damage), and treatment (fixed-dose combination therapy). To inform resource allocation for this strategy we need to understand its cost- effectiveness and value of implementation.   

Aim:   
Evaluate the cost-effectiveness and value of implementation for a strategy for hypertension screening, risk stratification, and treatment in SSA.   

Techniques:   
1. Cost-effectiveness analysis:  The PhD will model the comparative cost- effectiveness of the approaches to diagnosis, screening, and treatment for different levels of risk and compared to current standards of care. The analysis will take a societal perspective and an ingredients approach to measure and value both health system costs of diagnosis and treatment (medicines, diagnostics, staff time), and patient costs (direct and indirect). The outcome measure will be disability-adjusted life year (DALY) and the incremental cost per DALY averted will be reported. The PhD will also examine subgroup heterogeneity in cost-effectiveness results using data driven machine learning approaches. An appropriate decision analytical model will be developed for the decision and disease context, and parametrised using the costs and outcome data collected in the study areas and published literature to predict lifetime cost-effectiveness of alternative strategies.   

Data required:   
i) Primary data on patient costs (out-of-pocket costs for services, transport, opportunity cost of time spent seeking care, and missing productive activity (currently being collected)   
ii) Primary data on costs of delivering the interventions (fixed/capital costs and variable costs) to health workers and facilities (currently being collected)   
iii) DALYs modelled from the defined health states associated with a hypertension diagnosis derived from external data (already in public domain).   

2. Value of Implementation analysis: Interventions that are deemed cost- effective do not immediately get implemented due to a number of constraints. Decision-makers need to know the value of investing in implementation and increasing utilisation. Value of implementation analysis is a new area that recognises implementation activities compete for resources and encounter bottlenecks. This analysis will evaluate the expected value of perfect and specific implementation. The analysis will estimate the maximum that can be gained from achieving full/specific implementation which represents the maximum the decision maker can invest in implementation activities. A subgroup analysis will evaluate whether there is differential value in increasing utilization in specific subsets of patients (socio-economic status, CVD risk), accounting for variation in the cost- effectiveness of the intervention, subgroup size, and costs and effects of the implementation activity itself.   

Data required:  
i)) Socio-demographic and health data for subgroup analysis (Kenya Demographic and Health Surveillance System & Kiang West Longitudinal Population Study, to which supervisors have access)  
ii)) Accessibility, acceptability, and estimated uptake/utilisation of the interventions by patients and providers (currently being collected).   
v) Costs of implementation (scale-up costs and maintenance costs) (to be collected early 2025).   

Risks are likely to be low. Almost all data required are either already collected or are being collected as part of the larger ICVD and IHCOR projects.

Further reading

Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier)

Additional information from the supervisory team

The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.

Murphy-Perel-Sadique recording

MRC LID LINKS

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