Cost-Effectiveness of Population Level and Individual Level Interventions to Combat Non-communicable Disease in Eastern Sub-Saharan Africa and South East Asia: A WHO-CHOICE Analysis

Document Type : Original Article

Authors

1 Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland

2 Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

3 Department of Prevention of Non-Communicable Diseases, World Health Organization, Geneva, Switzerland

4 Department of Management of Non Communicable Diseases, Violence and Injury, World Health Organization, Geneva, Switzerland

Abstract

Background 
To determine the health system costs and health-related benefits of interventions for the prevention and control of non-communicable diseases (NCDs), including mental health disorders, for the purpose of identifying the most cost-effective intervention options in support of global normative guidance on the best-buy interventions for NCDs. In addition, tools are developed to allow country contextualisation of the analyses to support local priority setting exercises.
 
Methods 
This analysis follows the standard WHO-CHOICE (World Health Organization-Choosing Interventions that are Cost-Effective) approach to generalized cost-effectiveness analysis applied to two regions, Eastern sub-Saharan Africa and South-East Asia. The scope of the analysis is all NCD and mental health interventions included in WHO guidelines or guidance documents for which the health impact of the intervention is able to be identified and attributed. Costs are measured in 2010 international dollars, and benefits modelled beginning in 2010, both for a period of 100 years.
 
Results 
There are many interventions for NCD prevention and management that are highly cost-effective, generating one year of healthy life for less than Int. $100. These interventions include tobacco and alcohol control policies such as taxation, voluntary and legislative actions to reduce sodium intake, mass media campaigns for reducing physical activity, and treatment options for cardiovascular disease (CVD), cervical cancer and epilepsy. In addition a number of interventions fall just outside this range, including breast cancer, depression and chronic lung disease treatment.
 
Conclusion 
Interventions that represent good value for money, are technically feasible and are delivered for a low per-capita cost, are available to address the rapid rise in NCDs in low- and middle-income countries. This paper also describes a tool to support countries in developing NCD action plans.

Keywords


 

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  1. World Health Organization. Global Health Observatory. http://www.who.int/gho/ncd/mortality_morbidity/en/. Accessed July 18, 2017.
  2. World Health Organization. Global Health Observatory. http://gamapserver.who.int/gho/interactive_charts/mbd/life_expectancy/atlas.html.
  3. World Economic Forum, Harvard School of Public Health. The global economic burden of non-communicable diseases. Geneva: World Economic Forum; 2011.
  4. Goal 3: Ensure healthy lives and promote well-being for all at all ages. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Metadata. https://unstats.un.org/sdgs/metadata/files/Metadata-03-04-01.pdf.  Accessed November 20, 2017. 
  5. Sustainable Development Knowledge Platform. https://sustainabledevelopment.un.org/sdg3. Accessed November 20, 2017.
  6. Dieleman JL, Schneider MT, Haakenstad A, et al. Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet. 2016;387(10037):2536-2544. doi:10.1016/s0140-6736(16)30168-4
  7. Addis Ababa Action Agenda. Third International Conference on Financing for Development; Addis Ababa; 2015.
  8. World Health Organization (WHO). Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2015 global survey. In: Riley L, Cowan M, eds. Geneva, Switzerland: WHO; 2016.
  9. World Health Organization (WHO), Calouste Gulbenkian Foundation. Integrating the response to mental disorders and other chronic diseases in health care systems. In: Chisholm D, Epping-Jordan J, eds. Geneva, Switzerland: WHO; 2014.
  10. World Health Organization (WHO). mhGAP Intervention Guide - Version 2.0. World Health Organization; 2017.
  11. World Health Organization (WHO). Package of Essential Non-Communicable Disease Interventions for Primary Health Care in Low Resource Settings. WHO; 2010.
  12. World Health Organization (WHO). Global Action Plan for the Prevention and Control of NCDs 2013-2020 (in IRIS). WHO; 2013.
  13. Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: pros and cons. Bull World Health Organ. 2016;94(12):925-930. doi:10.2471/blt.15.164418
  14. Ortegón M, Lim S, Chisholm D, Mendis S. Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e607. doi:10.1136/bmj.e607
  15. Chisholm D, Saxena S. Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e609. doi:10.1136/bmj.e609
  16. Ginsberg GM, Lauer JA, Zelle S, Baeten S, Baltussen R. Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e614. doi:10.1136/bmj.e614
  17. Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8. doi:10.1186/1478-7547-1-8
  18. Bertram MY, Lauer JA, Stenberg K, Edejer TTT. Methods for the economic evaluation of health care interventions for priority setting in the health system: an update from WHO CHOICE. Int J Health Policy Manag. 2021. doi:10.34172/ijhpm.2020.244
  19. Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2129-2143. doi:10.1016/s0140-6736(12)61680-8
  20. Bertram MY, Stenberg K, Brindley C, et al. Disease control programme support costs: an update of WHO-CHOICE methodology, price databases and quantity assumptions. Cost Eff Resour Alloc. 2017;15:21. doi:10.1186/s12962-017-0083-6
  21. Johns B, Torres TT. Costs of scaling up health interventions: a systematic review. Health Policy Plan. 2005;20(1):1-13. doi:10.1093/heapol/czi001
  22. Stanciole AE, Ortegón M, Chisholm D, Lauer JA. Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ. 2012;344:e608. doi:10.1136/bmj.e608
  23. Zelle SG, Vidaurre T, Abugattas JE, et al. Cost-effectiveness analysis of breast cancer control interventions in Peru. PLoS One. 2013;8(12):e82575. doi:10.1371/journal.pone.0082575
  24. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-2223. doi:10.1016/s0140-6736(12)61689-4
  25. World Health Organization (WHO). Comprehensive Cervical Cancer Control: A Guide to Essential Practice. WHO; 2014.
  26. World Health Organization (WHO). WHO Report on the Global Tobacco Epidemic, 2008. WHO; 2011. https://www.who.int/tobacco/mpower/2008/en/.
  27. World Health Organization (WHO). WHO Framework Convention on Tobacco Control. WHO; 2003.
  28. World Health Organization (WHO). SHAKE the Salt Habit. WHO; 2017. https://apps.who.int/iris/handle/10665/250134.
  29. World Health Organization (WHO). Fiscal Policies for Diet and the Prevention of Noncommunicable Diseases. WHO; 2016. https://www.who.int/docs/default-source/obesity/fiscal-policies-for-diet-and-the-prevention-of-noncommunicable-diseases-0.pdf?sfvrsn=84ee20c_2
  30.   World Health Organization (WHO). Governance: Development of a Draft Global Action Plan to Promote Physical Activity. WHO; https://apps.who.int/iris/bitstream/handle/10665/272722/9789241514187-eng.pdf.
  31. World Health Organization (WHO). ‘Best Buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Updated (2017)  Appendix 3 of the Global Action Plan for the prevention and control of noncommunicable diseases 2013-2020. WHO; 2017.
  32. Stenberg K, Hanssen O, Edejer TT, et al. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. Lancet Glob Health. 2017;5(9):e875-e887. doi:10.1016/s2214-109x(17)30263-2