2. Intervention Cost–Effectiveness: Overview of Main Messages

Abstract

Setting intervention priorities efficiently can make limited resources go farther in improving health and can substantively increase available resources in low– and middle–income countries (LMICs). Intervention cost–effectiveness is one among a few important criteria on the basis of which intervention strategies can be formulated. Using the analysis of cost–effective interventions provided here for all major diseases, it is possible to identify which interventions are most suitable for local application based on disease prevalence and health system capacity.

Specific diseases and interventions discussed include tuberculosis, HIV/AIDS, childhood illnesses and mortality affecting children under the age of five, malaria and tropical diseases, maternal and neonatal health conditions, cancer, neurological and mental disorders, and cardiovascular disease. In addition, it is found that certain behaviors and lifestyle choices that result in injuries and illness can be changed by educational campaigns, taxes, and legislation.

Costs are analyzed in terms of service levels for emergency and hospital care, surgery, and integrated management of childhood illnesses. Intervention quality is an important determinant of cost–effectiveness, and improving quality can be an efficient way to use resources.

It is concluded that (1) interventions to treat communicable diseases have been highly cost–effective in the past and remain so; (2) many interventions have been developed for noncommunicable diseases, and LMICs need to implement them as their use becomes more feasible as a result of falling costs; and (3) technological progress requires the willingness and ability to fund and deploy interventions effectively, especially when certain diseases threaten developing countries and fail to motivate the developed world to seek cures. The lack of reliable data on costs and effectiveness is an important obstacle to efficient priority setting. Further challenges come from lack of knowledge about the costs, extent of coverage, and institutional capacity requirements of interventions in developing countries.