We know of two large-scale, systematic projects devoted to rating the cost-effectiveness of different health interventions. Both use an approach centered on disability-adjusted life-years (DALYs), which is not the only measure of cost-effectiveness we intend to use, but they’re a start.
One is the Disease Control Priorites report. We are currently in the process of constructing a full summary of the interventions and cost-effectiveness estimates discussed in the report, as the summary provided by the report itself appears incomplete. From looking at the average cost-per-DALY-averted of the existing list, however, it appears that three of the five most cost-effective interventions (including the top two) fall under what we call straightforward interventions: vaccination campaigns and mass drug administration (deworming).
The other is the 2008 Copenhagen Consensus, which explicitly ranks interventions by the desirability of funding them. Four of the top six (including #1) fit within our straightforward interventions: vitamin supplementation, vitamin fortification, vaccination campaigns and mass drug administration (deworming).
From our scan of the Disease Control Priorites Report, we also believe that our straightforward interventions will prove top candidates for cost effectiveness by other criteria. In particular, we noted vaccination campaigns as having the lowest “cost per death averted” (#4) in the report, which likely corresponds to the lowest “cost per life-year saved” (#3) as well since most deaths averted are infant deaths. We also feel that surgery may be the strongest intervention we’ve seen in terms of averting extreme suffering.
We therefore consider the “straightforward interventions” to be priority interventions, and are planning on looking into them actively. They will not necessarily be the only priority interventions we name, but they stand out given what we know.
Again, these interventions are:
- Vaccination campaigns.
- Mass drug administration programs, including albendazole for treating helminths (i.e., deworming).
- Vitamin supplementation programs, with nutrients that need be taken only infrequently (particularly vitamin A).
- Vitamin fortification programs, such as the iodization of salt.
- One-time surgery programs, along the lines of Interplast’s surgical team trips.