The risk factors and disease conditions covered in this volume of Disease Control Priorities constitute the majority of the health burden facing middle- and high-income countries (MICs and HICs, respectively) today and are fast approaching a majority of the burden in low-income countries (LICs). Previous editions of Disease Control Priorities, published in 1993 and 2006, acknowledged the importance of cardiovascular and related diseases (CVRDs) to the future health and economic well-being of populations in low- and middle-income countries (LMICs) and singled out tobacco taxes and treatment of heart disease with low-cost generics as high-priority, cost-effective interventions. With some exceptions, most of the conclusions about cost-effectiveness were extrapolated from analyses done in HICs (Rodgers and others 2006) and from modeling, because of the paucity of economic analysis of interventions for CVRDs using LMIC data. In 2012, the World Health Organization (WHO) reviewed the cost-effectiveness of noncommunicable disease (NCD) interventions, based on a limited number of modeled studies. The results were used to develop the WHO Best Buys for interventions recommended in the NCD Global Action Plan (WHO 2011).
By 2016, when the WHO updated its review of cost-effectiveness evidence, considerably more LMIC data were available. This chapter also benefits from a larger universe of economic analyses on the conditions and risk factors covered in the chapters in this volume—both from models and from experience. Some recent systematic reviews have examined evidence on the cost-effectiveness of interventions to tackle CVRDs in LMICs (for example, Shroufi and others 2013; Suhrcke, Boluarte, and Niessen 2012; Wiseman and others 2016). These reviews found modest, but growing, evidence of the cost-effectiveness of CVRD interventions in these settings and noted a bias in favor of research on personal medical interventions over population-level interventions.
The chapter catalogues the results of dozens of high-quality, cost-effectiveness analyses for cardiovascular disease (CVD), diabetes, respiratory, and kidney-related conditions and risk factors (hereafter termed CVRDs)—much of it with country-specific data. It begins by summarizing the available literature on population-level health and intersectoral policies to address the major risks in LMICs and discusses some methodological issues in these analyses. It then assesses and discusses the cost-effectiveness of personal services delivered through various levels of the health system. It is intended to complement the reviews of effective policies and interventions in other chapters with cost-effectiveness results useful for informing decisions about policies, packages, and delivery platforms. The methodology used for the review is described in online annex 19A, along with the detailed results.
© 2017 International Bank for Reconstruction and Development / The World Bank.