title: Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis.
abstract: OBJECTIVE
  To inform decision making regarding intervention strategies against non-communicable diseases in Mexico, in the context of health reform.
  
  
  METHODS
  Cost effectiveness analysis based on epidemiological modelling.
  
  
  METHODS
  101 intervention strategies relating to nine major clusters of non-communicable disease: depression, heavy alcohol use, tobacco use, cataracts, breast cancer, cervical cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes.
  
  
  METHODS
  Mexican data sources were used for most key input parameters, including administrative registries; disease burden and population estimates; household surveys; and drug price databases. These sources were supplemented as needed with estimates for Mexico from the WHO-CHOICE unit cost database or with estimates extrapolated from the published literature.
  
  
  METHODS
  Population health outcomes, measured in disability adjusted life years (DALYs); costs in 2005 international dollars ($Int); and costs per DALY.
  
  
  RESULTS
  Across 101 intervention strategies examined in this study, average yearly costs at the population level would range from around ≤$Int1m (such as for cataract surgeries) to >$Int1bn for certain strategies for primary prevention in cardiovascular disease. Wide variation also appeared in total population health benefits, from <1000 DALYs averted a year (for some components of cancer treatments or aspirin for acute ischaemic stroke) to >300,000 averted DALYs (for aggressive combinations of interventions to deal with alcohol use or cardiovascular risks). Interventions in this study spanned a wide range of average cost effectiveness ratios, differing by more than three orders of magnitude between the lowest and highest ratios. Overall, community and public health interventions such as non-personal interventions for alcohol use, tobacco use, and cardiovascular risks tended to have lower cost effectiveness ratios than many clinical interventions (of varying complexity). Even within the community and public health interventions, however, there was a 200-fold difference between the most and least cost effective strategies examined. Likewise, several clinical interventions appeared among the strategies with the lowest average cost effectiveness ratios-for example, cataract surgeries.
  
  
  CONCLUSIONS
  Wide variations in costs and effects exist within and across intervention categories. For every major disease area examined, at least some strategies provided excellent value for money, including both population based and personal interventions.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. jsalomon@hsph.harvard.edu
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.forename: Natalie
authors.initials: N
authors.lastname: Carvalho
authors.forename: Cristina
authors.initials: C
authors.lastname: Gutiérrez-Delgado
authors.forename: Ricardo
authors.initials: R
authors.lastname: Orozco
authors.forename: Anna
authors.initials: A
authors.lastname: Mancuso
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Hogan
authors.forename: Diana
authors.initials: D
authors.lastname: Lee
authors.forename: Yuki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Sridharan
authors.forename: María Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.forename: Eduardo
authors.initials: E
authors.lastname: González-Pier
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D011322:Primary Prevention / Q000191:economics*