Affordability of Non-Communicable Disease (NCD) prevention

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Helpdesk Query:

Produce a report looking at evidence about the affordability of managing NCDs either through primary or secondary prevention in low income countries.

Summary:

This helpdesk reviews key studies on multiple primary and secondary prevention strategies, cardio-vascular disease (CVD) prevention drugs, and cancer prevention and early detection, in order to determine what the evidence says about the affordability of managing NCDs in low income countries. One key document reviewed the WHO Global action plan for the prevention and control of non-communicable diseases, 2013-2020. This outlines a combination of population-wide and individual interventions for prevention and control of Non-Communicable Diseases (NCDs) deemed to be ‘very cost-effective’. They estimate the cost of this, in terms of current health spending, to be 4% in low-income countries and 2% in lower middle-income countries. Highlighted as affordable are:

  • Tobacco: increasing pricing, creating smoke-free laws, health warnings/media campaigns, banning advertising.
  • Alcohol: regulating availability, restricting advertising, taxation.
  • Health, diet and activity: reducing salt, replacing trans fats with unsaturated fats, public awareness programmes.
  • CVD and diabetes prevention: Drug therapy (including glycaemic control for diabetes mellitus and control of hypertension using a total risk approach) and counselling for high-risk individuals.
  • Cancer prevention: Hepatitis B immunisation, cervical cancer screening.

 

Some cost estimates for specific interventions are identified in the literature. For example:

  • Reduced salt intake intervention and the four WHO tobacco control provisions could be implemented for less than USD $0.40 per person per year in Low and Middle Income Countries (LMICs)
  • Monthly costs from a 2013 price guide: Aspirin for CVD prevention ($0.084), Simvastatin for stroke prevention ($0.705), Atenolol to prevent cardiac complications ($0.354).
  • Population-based demand reduction measures for tobacco control, US$ 0.11 per head of population for low- and middle income countries; for reducing harmful alchohol use in Africa, US$ 0.14 per person; and for health diet and exercise in Africa, less than US$ 0.10 per person.
  • A one-month supply of standard generic CVD secondary prevention drugs cost 1.5 days’ wages of the lowest-level government worker in Sri Lanka; more than 5 days’ wages in Brazil, Nepal, and Pakistan; and more than 18 days’ wages in Malawi. Prices could be reduced by improving purchasing efficiency, eliminating taxes and regulating mark-ups. Combination drugs such as polypills could improve affordability.
  • The Gavi Alliance is supporting the introduction of vaccines to reduce human papillomavirus (HPV), the leading cause of cervical cancer, US$ 4.50 per dose.
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