Neglected Low-Cost Opportunities and High-Cost Interventions in South Asia and Sub-Saharan Africa| Neglected low-cost opportunities in South Asia | Cost per DALY averteda (US$) | Thousands of DALYs averteda,b per 20% increase in coverage | Burden of target diseasesa (millions of DALYs) |
| CHILDHOOD IMMUNIZATION |
| Additional coverage of traditional Expanded Program on Immunization (tuberculosis, diphtheria-pertussis-tetanus, polio, measles) | 8 | n.e. | 28.4 |
| HIV AND AIDS |
| Voluntary counseling and testing | | | |
| Peer-based programs targeting at-risk groups (e.g., commercial sex workers) to disseminate information and teach specific skills | 9-126 | n.e. | 7.4 |
| School-based interventions that disseminate information to students | | | |
| Prevention of mother-to-child-transmission with antiretroviral therapy | | | |
| SURGICAL SERVICES AND EMERGENCY CARE |
| Surgical ward in a district hospital, primarily for obstetrics, trauma and injury | 6-212 | at least 1.8 | 48.0-146.3 |
| Staffed community ambulance | | | |
| Training of lay first responders and volunteer paramedics | | | |
| TUBERCULOSIS |
| Childhood vaccination against endemic TB | | | |
| Directly observed short-course chemotherapy | 8-263 | n.e. | 13.9 |
| Isoniazid treatment of epidemic TB | | | |
| Management of drug resistance | | | |
| LOWER ACUTE RESPIRATORY ILLNESSES OF CHILDREN UNDER FIVE |
| Community- or facility-based case management of non-severe cases | | | |
| Case management package including community- and facility-based care for non-severe cases and hospital-based care for severe cases | 28-264 | 0.7-1.8 | 9.7-26.4 |
| CARDIOVASCULAR DISEASES |
| Management of acute myocardial infarction with aspirin and beta-blocker | | | |
| Primary prevention of coronary artery disease with legislation substituting 2% of trans fat with polyunsaturated fat, at $0.50 per adult | | | |
| Secondary prevention of congestive heart failure with angiotensin-converting enzyme inhibitors and beta-blockers incremental to diuretics | 9-304 | at least 0.1 | 25.9-39.1 |
| Secondary prevention of myocardial infarction and stroke with polypill containing aspirin, beta-blocker, thiazide diuretic, angiotensin-converting enzyme inhibitor, and statin | | | |
| TOBACCO USE AND ADDICTION |
| Tax policy to increase price of cigarettes by 33 percent | | | |
| Non-price interventions such as advertising bans, health information dissemination, tobacco supply reductions, and smoking restrictions | 14-374 | at least 2.5 | 15.7 |
| Nicotine replacement therapy | | | |
| MATERNAL AND NEONATAL CARE |
| Increased primary care coverage | | | |
| Improved quality of comprehensive emergency obstetric care | 127-394 | at least 1.3 | 37.7-47.8 |
| Improved overall quality and coverage of care | | | |
| Neonatal packages targeted to families, communities, and clinics | | | |
| Neglected low-cost opportunities in Sub-Saharan Africa | Cost per DALY averteda (US$) | Thousands of DALYs averteda,b per 20% increase in coverage | Burden of target diseasesa (millions of DALYs) |
| CHILDHOOD IMMUNIZATION |
| Second opportunity measles vaccinationc | | | |
| Additional coverage of traditional Expanded Program on Immunization (tuberculosis, diphtheria-pertussis-tetanus, polio, measles) | 1-5 | n.e. | 13.5-31.3 |
| TRAFFIC ACCIDENTS |
| Increased speeding penalties, media, and law enforcement | 2-12 | n.e. | 6.4 |
| Speed bumps at the most dangerous traffic intersections | | | |
| MALARIA |
| Insecticide-treated bed netsc | | | |
| Residual household sprayingc | 2-24 | 20.8-37.6 | 35.4 |
| Intermittent preventive treatment during pregnancyc | | | |
| SURGICAL SERVICES AND EMERGENCY CARE |
| Surgical ward in a district hospital, primarily for obstetrics, trauma and injury | | | |
| Staffed community ambulance | | | |
| Training of lay first responders and volunteer paramedics | | | |
| CHILDHOOD ILLNESSES |
| Integrated management of childhood illnessesc | | | |
| Case management of non-severe lower acute respiratory illnesses at the community or facility level | | | |
| Case management package including community- or facility-based care for non-severe cases and hospital-based care for severe lower acute respiratory illnesses | 9-218 | at least 1.2 | 9.6-45.1 |
| Breastfeeding support to prevent underweight childrenc | | | |
| CARDIOVASCULAR DISEASE |
| Management of acute myocardial infarction with aspirin and beta-blocker | | | |
| Primary prevention of coronary artery disease with legislation substituting 2% of trans fat with polyunsaturated fat, at $0.50 per adult | | | |
| Secondary prevention of congestive heart failure with angiotensin- converting enzyme inhibitors and beta-blockers incremental to diuretics | 9-273 | at least 0.04 | 4.6 |
| Secondary prevention of myocardial infarction and stroke with polypill containing aspirin, beta-blocker, thiazide diuretic, angiotensin-converting enzyme inhibitor, and statin | | | |
| HIV AND AIDS |
| Peer-based programs targeting at-risk groups (e.g., commercial sex workers) to disseminate information and teach specific skills | | | |
| Voluntary counseling and testing | | | |
| Diagnosis and treatment of sexually-transmitted diseasesc | 6-377 | n.e. | 56.8 |
| Condom promotion and distributionc | | | |
| Prevention and treatment of tuberculosis co-infectionc | | | |
| Blood and needle safety programsc | | | |
| Prevention of mother-to-child transmission with antiretroviral therapy | | | |
| MATERNAL AND NEONATAL CARE |
| Increased primary care coverage | | | |
| Improved quality of comprehensive emergency obstetric care | 82-409 | at least 2.8 | 29.8-37.7 |
| Improved overall quality and coverage of care | | | |
| Neonatal packages targeted to families, communities, and clinics | | | |
| High-cost interventions in South Asia | Cost per DALY averteda (US$) | Thousands of DALYs averteda,b per 20% increase in coverage | Burden of target diseasesa (millions of DALYs) |
| DEPRESSION |
| Episodic treatment with newer antidepressant drug (selective serotonin reuptake inhibitors) | 1,003-1,449 | 0.4-0.8 | 14.6 |
| Episodic or maintenance psychosocial treatment plus treatment with newer antidepressant drug (selective serotonin reuptake inhibitors) | | | |
| HIGH BLOOD PRESSURE AND CHOLESTEROL |
| Primary prevention of stroke and ischemic and hypertensive heart disease with aspirin, beta-blocker, and statin, incremental to policy-induced behavior change, at 15 percent risk of CVD event over 10 years | 1,120-1,932 | at least 6.7 | 48.6 |
| Primary prevention of stroke and ischemic and hypertensive heart disease with a polypill, containing aspirin, beta-blocker, thiazide diuretic, angiotensin-converting enzyme inhibitor, and statin, at 15 percent risk of CVD event over 10 years | | | |
| LIFESTYLE DISEASES |
| Primary prevention of diabetes, ischemic heart disease, and stroke through policy that replaces saturated fat with monounsaturated fat in manufactured foods, accompanied by a public education campaign | 1,325-1,865 | 1.3-1.8 | 39.5 |
| Primary prevention of diabetes, ischemic heart disease, and stroke through legislation that reduces salt content plus public education | | | |
| STROKE (ISCHEMIC) |
| Acute management with recombinant tissue plasminogen activator with 48 hours of onset | | | |
| Acute management with heparin within 48 hours of onset | 1,630-2,967 | 0.03-0.4 | 2.2-9.2 |
| Secondary prevention with carotid endarterectomy | | | |
| DIARRHEAL DISEASES |
| Oral rehydration therapy if the package cost is greater than US$2.30 per child per episode | 500-6,390 | 0.02-2.5 | 22.3 |
| Rotavirus or cholera immunization | | | |
| TUBERCULOSIS |
| Isoniazid treatment for latent endemic TB in patients uninfected with HIV | 5,588-9,189 | n.e. | 13.9 |
| SCHIZOPHRENIA AND BIOPOLAR DISORDER |
| Antipsychotic medication and psychosocial treatment for schizophrenia | 1,743-17,702 | 0.02-0.12 | 2.2-2.9 |
| Valproate and psychosocial treatment for bipolar disorder | | | |
| CARDIOVASCULAR DISEASES |
| Management of acute myocardial infarction with streptokinase or tissue plasminogen activator, incremental to aspirin and beta-blocker | | | |
| Secondary prevention of ischemic heart disease with statin, incremental to aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor | 638-24,040 | 0.04-0.3 | 25.9 |
| Secondary prevention of ischemic heart disease with coronary artery bypass graft | | | |
| High-cost interventions in Sub-Saharan Africa | Cost per DALY averteda (US$) | Thousands of DALYs averteda,b per 20% increase in coverage | Burden of target diseasesa (millions of DALYs) |
| DIARRHEAL DISEASES |
| Oral rehydration therapy if the cost per episode is greater than US$2.80 per child | 500-1,658 | 0.1-4.6 | 22 |
| Rotavirus or cholera immunization | | | |
| HIV AND AIDS |
| Home care treatmentc | 673-1,494 | n.e. | 56.8 |
| Antiretroviral therapy in populations with low adherencec | | | |
| TRAFFIC ACCIDENTS |
| Random driver breath tests | | | |
| Enforcement of seatbelt laws | 973-2,146 | at least 0.05 | 6.2-6.4 |
| Child restraint promotion | | | |
| HIGH BLOOD PRESSURE AND CHOLESTEROL |
| Primary prevention of stroke and ischemic and hypertensive heart disease with aspirin, beta-blocker, and statin, incremental to policy-induced behavior change, at 15 percent risk of CVD event over 10 years | 1,920 | n.e. | 10.6 |
| LIFESTYLE DISEASES |
| Primary prevention of diabetes, ischemic heart disease, and stroke through policy that replaces saturated fat with monounsaturated fat in manufactured foods, accompanied by a public education campaign | 1,766-2,356 | 1.4-1.8 | 9.6 |
| Primary prevention of diabetes, ischemic heart disease, and stroke through legislation that reduces salt content plus public education | | | |
| STROKE (ISCHEMIC) |
| Acute management with recombinant tissue plasminogen activator within 48 hours of onset | | | |
| Acute management with heparin within 48 hours of onset | | | |
| Secondary prevention with carotid endarterectomy | | | |
| TUBERCULOSIS |
| Isoniazid treatment for latent endemic TB in patients uninfected with HIV | 4,129-5,506 | n.e. | 8.1 |
| CARDIOVASCULAR DISEASES |
| Management of acute myocardial infarction with streptokinase or tissue plasminogen activator, incremental to aspirin and beta-blocker | | | |
| Secondary prevention of ischemic heart disease with statin, incremental to aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor | 634-26,813 | 0.03-0.2 | 4.6 |
| Secondary prevention of ischemic heart disease with coronary artery bypass graft | | | |
