Annex 2.C: Summary of Other Interventions
Table 2.C.1 summarizes personal interventions for which cost-effectiveness is evaluated using a measure other than $/DALY averted. A summary of population-based interventions evaluated using measures other than DALYs is shown in table 2.C.2.
[Table .]
[Table .]
Notes
1. Few other cost-effectiveness studies have covered a similarly extensive set of health interventions (Dixon and Welch 1991; Jamison and others 1993; Tengs and others 1995), and only one of those studies makes these comparisons on a global scale (Jamison and others 1993). The current World Health Organization project CHOICE (Choosing Interventions That Are Cost-Effective) is a parallel effort to make such global comparisons (Murray and others 2000; http://www.who.int/evidence/cea).
2. Of these 319 cost-effectiveness estimates, 257 were in terms of U.S. dollars per DALY and therefore comparable. Interventions with cost-effectiveness in terms of dollars per DALY were grouped into 121 intervention clusters to facilitate analyses and presentation.
3. Health system capacity is often used to describe both the level of care (primary, secondary, and tertiary) and the institutional and organizational capacities. We use the term to refer to the latter.
4. Chapter 15 presents a fuller discussion of these methods. Note that not all chapters have used these standardized costs. Furthermore, the analyses have used U.S. dollars rather than purchasing-power parity dollars (which provide a better measure of input resource intensity and are less susceptible to exchange rate fluctuations) in order to provide a monetary estimate that may be more useful to policy makers and donors.
5. Noneconomic reasons for maintaining certain interventions can include retaining key technical skills that may be required in the future and may lead to the development of new methods that may be more cost-effective (see chapter 66 on referral hospitals for a more in-depth discussion).
6. Some interventions with high potential to reduce the burden of disease may have been excluded due to the way their cost-effectiveness ratios were calculated. For example, nutrition-related interventions are excluded from the table because those evaluated in the volume address either vitamin A deficiency or iodine deficiency both of which are associated with low avertable burden. Also, only the burden of children age 0 to 4 was considered, further lowering the avertable burden. Another example is of the integrated management of infant and childhood illness, which is evaluated for Sub-Saharan Africa but not for the South Asia Region.
7. The second and third observations speak more generally to the global public goods nature of health research (see chapter 4 for an in-depth discussion). In relation to both HIV/AIDS and noncommunicable diseases, the responsiveness of the medical research system to threats to populations in developed countries has the potential to bring great benefits to people living in LMICs.
