title: Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries.
abstract: OBJECTIVE
  This study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases.
  
  
  METHODS
  We constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer's perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars.
  
  
  METHODS
  The primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted.
  
  
  RESULTS
  Implementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness.
  
  
  CONCLUSIONS
  IPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC can be an important new approach for enhancing global health.
authors: Health Strategies International, Oakland, California, USA.
authors: Elliot
authors: E
authors: Marseille
authors: Health Strategies International, Arlington, Virginia, USA.
authors: Aliya
authors: A
authors: Jiwani
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: Abhishek
authors: A
authors: Raut
authors: Department of Global Health, University of Washington, Seattle, Washington, USA.
authors: Stéphane
authors: S
authors: Verguet
authors: Departments of Global Health, Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, Washington, USA.
authors: Judd
authors: J
authors: Walson
authors: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA Global Health Sciences, University of California, San Francisco, California, USA.
authors: James G
authors: JG
authors: Kahn
mesh_terms: D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003967:Diarrhea / Q000517:prevention & control*; D014943:Global Health / Q000191:economics*; D015658:HIV Infections / Q000517:prevention & control*; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D038622:Internationality; D008288:Malaria / Q000517:prevention & control*; D012680:Sensitivity and Specificity
keywords: Health Economics