Table 5

Annual cost of implementing risk-based hypertension, diabetes and high cholesterol management programme in four subdistricts

	Golapganj		Fenchuganj		Beanibazar		Bishwanath		Total
	BDT	USD	BDT	USD	BDT	USD	BDT	USD	BDT	USD
H: Healthy lifestyles counselling	13 335 339	157 071	4 765 107	56 126	10 800 324	127 212	9 947 252	117 164	38 848 022	457 574
H1: Training costs	418 990	4935	418 990	4935	418 990	4935	418 990	4935	1 675 960	19 740
H1.1: Facility rental (% of H1)	18 000	212	18 000	212	18 000	212	18 000	212	72 000	848
H1.2: Human resources	20 000	236	20 000	236	20 000	236	20 000	236	80 000	942
H1.3: Instructive handbooks	35 000	412	35 000	412	35 000	412	35 000	412	140 000	1649
H1.4: Per diem/transportation	339 990	4005	339 990	4005	339 990	4005	339 990	4005	1 359 960	16 018
H1.5: Refreshments	6000	71	6000	71	6000	71	6000	71	24 000	283
H2: Brief counselling costs	12 816 349	150 958	4 246 117	50 013	10 281 334	121 099	9 428 262	111 051	36 772 062	433 122
H2.1: Tobacco	9 272 756	109 220	3 072 108	36 185	7 438 647	87 617	6 821 441	80 347	26 604 952	313 368
Provider time to administer 5A’s	3 807 374	44 845	1 261 401	14 857	3 054 293	35 975	2 800 870	32 990	10 923 938	128 668
Informational materials (print)	5 465 382	64 374	1 810 707	21 328	4 384 354	51 641	4 020 572	47 357	1,5681,014	184 700
H2.2: Alcohol	933 641	10 997	309 320	3643	748 971	8822	686 827	8090	2 678 759	31 552
Provider time to administer 5A’s	383 351	4515	127 006	1496	307 526	3622	282 010	3322	1 099 893	12 955
Informational materials (print)	550 290	6482	182 314	2147	441 445	5200	404 817	4768	1 578 866	18 597
H2.3: Physical inactivity	2 609 952	30 741	864 689	10 185	2 093 715	24 661	1 919 994	22 615	7 488 350	88 202
Provider time to administer 5A’s	1 071 641	12 622	355 040	4182	859 675	10 126	788 345	9286	3 074 701	36 216
Informational materials (print)	1 538 311	18 119	509 650	6003	1 234 040	14 535	1 131 648	13 329	4 413 649	51 986
H3: Other programme costs	100 000	1178	100 000	1178	100 000	1178	100 000	1178	400 000	4711
Community awareness meetings	50 000	589	50 000	589	50 000	589	50 000	589	200 000	2356
Community health workers training	50 000	589	50 000	589	50 000	589	50 000	589	200 000	2356
E: Evidence-based treatment protocols	56 155 264	661 428	18 604 504	219 134	45 048 007	530 601	41 310 245	486 575	161 118 020	1 897 739
E1: Ask about patient history—provider time	5 317 334	62 631	1 761 658	20 750	4 265 589	50 243	3 911 661	46 074	15 256 241	179 697
E2: Assess via physical exam and diagnostic tests——provider time	25 513 182	300 509	8 452 638	99 560	20 466 790	241 069	18 768 602	221 067	73 201 212	862 205
E3: Return visits - Counsel and treat per protocol—provider time	25 324 748	298 289	8 390 209	98 825	20 315 628	239 289	18 629 982	219 434	72 660 567	855 837
A: Access to Essential Medicines and tech.	347 102 943	4 088 374	115 109 353	1 355 823	278 480 835	3 280 104	255 388 440	3 008 109	996 081 571	11 732 410
A1: Diagnostic tests	170 039 655	2 002 823	56 334 940	663 545	136 406 582	1 606 674	125 088 536	1 473 363	487 869 714	5 746 404
Complete blood count (panel)	51 527 168	606 916	17 071 194	201 074	41 335 328	486 871	37 905 617	446 474	147 839 307	1 741 335
Blood lipid panel	103 054 336	1 213 832	34 142 388	402 148	82 670 656	973 742	75 811 234	892 947	295 678 614	3 482 669
Fasting blood glucose	15 458 150	182 075	5 121 358	60 322	12 400 598	146 061	11 371 685	133 942	44 351 792	522 400
A2: Hypertension medications	40 028 765	471 481	13 261 719	156 204	32 111 257	378 224	29 446 893	346 842	114 848 633	1 352 752
Amlodipine 5 mg	9 873 894	116 300	3 271 268	38 531	7 920 882	93 297	7 263 664	85 556	28 329 707	333 683
Losartan 50 mg	30 016 637	353 553	9 944 653	117 134	24 079 482	283 622	22 081 538	260 089	86 122 310	1 014 397
Hydrochlorothiazide 12.5 mg	138 235	1628	45 798	539	110 892	1306	101 691	1198	396 616	4672
A3: Diabetes medications	25 366 503	298 781	8 404 042	98 988	20 349 124	239 683	18 660 698	219 796	72 780 367	857 248
Metformin 500 mg	11 707 617	137 899	3 878 789	45 687	9 391 903	110 623	8 612 630	101 444	33 590 939	395 653
Metformin 1000 mg	12 292 998	144 794	4 072 728	47 971	9 861 498	116 154	9 043 262	106 517	35 270 486	415 436
Gliclazide	1 365 889	16 088	452 525	5330	1 095 722	12 906	1 004 807	11 835	3 918 943	46 160
A4: Cholesterol medications	111 499 768	1 313 307	36 940 399	435 105	89 445 620	1 053 541	82 024 060	966 126	319 909 847	3 768 078
Simvastatin 10 mg	79 451 930	935 830	26 322 800	310 045	63 736 699	750 727	58 448 282	688 437	227 959 711	2 685 038
Atorvastatin 20 mg	13 353 266	157 282	4 424 000	52 108	10 712 050	126 173	9 823 241	115 704	38 312 556	451 267
Atorvastatin 40 mg	18 694 572	220 195	6 193 600	72 952	14 996 870	176 642	13 752 537	161 985	53 637 579	631 774
A5: Diagnostic tech. machines and supplies	168 253	1982	168 253	1982	168 253	1982	168 253	1982	673 010	7927
R: Risk-based management	5 489 668	64 660	1 933 992	22 780	4 437 923	52 272	4 083 995	48 104	15 945 577	187 816
R1: Training costs	172 334	2030	172 334	2030	172 334	2030	172 334	2030	689 336	8119
R2: Estimate risk using risk charts	5 317 334	62 631	1 761 658	20 750	4 265 589	50 243	3 911 661	46 074	15 256 241	179 697
T: Team-based care: Savings from training nurses and CHWs to do tasks customarily performed by doctors	25 600 367	301 536	8 481 523	99 900	20 536 731	241 893	18 832 739	221 823	73 451 360	865 151
T1: Savings from training nurses	23 761 458	279 876	7 872 283	92 724	19 061 549	224 518	17 479 958	205 889	68 175 248	803 006
Savings from counselling to change behaviour	1 355 873	15 970	449 207	5291	1 087 688	12 811	997 439	11 748	3 890 208	45 821
Savings from screening for—and assess—CVD risk	15 152 559	178 475	5 020 114	59 130	12 155 452	143 174	11 146 879	131 294	43 475 005	512 073
Savings from treating CVD risk	7 253 025	85 430	2 402 961	28 303	5 818 410	68 533	5 335 639	62 846	20 810 036	245 112
T2: Savings from training CHWs	1 838 909	21 660	609 239	7176	1 475 181	17 376	1 352 781	15 934	5 276 112	62 145
Savings from counselling to change behaviour	1 838 909	21 660	609 239	7176	1 475 181	17 376	1 352 781	15 934	5 276 112	62 145
S: Systems for monitoring	3 114 636	36 686	3 114 636	36 686	3 114 636	36 686	3 114 636	36 686	12 458 546	146 744
S1: Human resources	2 969 636	34 978	2 969 636	34 978	2 969 636	34 978	2 969 636	34 978	11 878 546	139 912
S2: Technology	110 000	1296	110 000	1296	110 000	1296	110 000	1296	440 000	5183
S3: Supplies	10 000	118	10 000	118	10 000	118	10 000	118	40 000	471
S4: Training	25 000	294	25 000	294	25 000	294	25 000	294	100 000	1178
Total programme cost (H+E+A+R+T+S)	425 197 850	5 008 220	143 527 592	1 690 549	341 881 725	4 026 875	313 844 568	3 696 638	1,224,451,735	14 422 282

5 A’s, Assess, Advise, Agree, Assist, Arrange; BDT, Bangladesh Taka; CHW, community health worker; CVD, cardiovascular disease.