Benefits and Costs of the Health Targets for the Post-2015 Development Agenda

Authors: Prabhat Jha, Ryan Hum, Keely Jordan, Cindy Gauvreau

Highlights: 

Objectives:

• Develop a plausible estimate for a benefit-to-cost ratio (BCR) for a global reduction of 40% of all-cause deaths before age 70 years by 2030
• Comment on the health-related proposed Sustainable Development Goal and sub-goals, particularly where they are likely to be poor in terms of BCR (and relate to the overall goal of reducing mortality by 40% by 2030)

Summary:

• We quantify the BCR for a new proposed over-arching health goal that is achievable and quantitatively measurable: avoidance of 40% of the premature deaths (deaths before age 70) in each country.

Sub-goals include: (i) avoid 2/3 of child and maternal deaths; (ii) avoid 2/3 of TB, HIV and malaria deaths; (iii) avoid 1/3 of premature deaths from noncommunicable diseases; and (iv) avoid 1/3 of remaining causes at ages 5-69 years.

• The overarching goal has a population weighted BCR of 9 to 1 in low-income and lowermiddle income countries combined when each Disability Adjusted Life Year (DALY) was valued at $5000. Sensitivity analyses suggest that these favourable ratios persist even with higher costs but, are sensitive to fluctuations in the valuation of the benefits.
• In the year 2030, a 40% reduction in premature deaths before age 70 in low-income and lower middle-income countries would avoid 3.5 million and 7.2 million deaths, respectively or 2.2 million and 4.5 million, respectively if compared to 2030 United Nations projected totals (with cumulative reductions over a 20-year period being 22 million and 45 million, respectively).
•  We also identified BCRs for interventions proposed in the Open Working Group health related SDGs and related these to specific goals for 2035 established for the Lancet Commission on Investing in Health proposed goals. These confirm specific high-priority interventions already well described as being highly cost-beneficial (such as immunization, subsidies for effective malaria treatment, tobacco taxation, and reproductive health II services). These specific interventions can be delivered as priorities within an overall commitment to reduce premature deaths by 40% by 2030.
• The 40% reduction in premature deaths goal is adaptable to low, middle and high-income countries, inclusive across ages and diseases and is consistent with targets currently in development. Moreover, these BCRs allow individual countries to customize their intervention approach based on their demographic and health profile.