How Much Health Will a Million Dollars Buy?| Service or intervention | Cost per DALY (US$) | Estimated DALYs averted per million US$ spent |
| Reducing under-five mortality |
| Improving care of children under 28 days old (including resuscitation of newborns) | 10-400 | 2,500-100,000 |
| Expanding immunization coverage with standard child vaccines | 2-20 | 50,000-500,000 |
| Adding vaccines against additional diseases to the standard child immunization program (particularly Hib and HepB) | 40-250 | 4,000-24,000 |
| Switching to the use of combination drugs (ACTs) against malaria where resistance exists to current inexpensive and previously highly effective drugs (Sub-Saharan Africa) | 8-20 | 50,000-125,000 |
| Preventing and treating HIV/AIDS |
| Preventing mother-to-child transmission (antiretroviral-nevirapine prophylaxis of the mother; breastfeeding substitutes) | 50-200 | 5,000-20,000 |
| Treating STIs to interrupt HIV transmission | 10-100 | 10,000-100,000 |
| Using antiretroviral therapy that achieves high adherence for a large percentage of patients | 350-500 | 2,000-3,000 |
| Using antiretroviral therapy that achieves high adherence for only a small percentage of patients | | Because of very limited gains by individual patients and the potential for adverse changes in population behavior, it is possible that more life years would be lost than saved. |
| Preventing and treating noncommunicable disease |
| Taxing tobacco products | 3-50 | 24,000-330,000 |
| Treating AMI (heart attacks) with an inexpensive set of drugs | 10-25 | 40,000-100,000 |
| Treating AMI with inexpensive drugs plus streptokinase (costs and DALYs for this intervention are in addition to what would have occurred with inexpensive drugs only) | 600-750 | 1,300-1,600 |
| Treating heart attack and stroke survivors for life with a daily polypill combining four or five off-patent preventive medications | 700-1,000 | 1,000-1,400 |
| Performing coronary artery bypass grafting (bypass surgery) in specific identifiable high-risk cases—for example, disease of the left main coronary artery (incremental to treatment with polypill) | >25,000 | <40 |
| Using bypass surgery for less severe coronary artery disease (incremental to treatment with polypill) | Very high | Very small |
| Other |
| Detecting and treating cervical cancer | 15-50 | 20,000-60,000 |
| Operating a basic surgical ward at the district hospital level that focuses on trauma, high-risk pregnancy, and other common surgically treatable conditions | 70-250 | 4,000-15,000 |
Source: Authors.
AMI = acute myocardial infarction.
