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Cost effectiveness of strategies to combat chronic obstructive pulmonary disease and asthma in sub-Saharan Africa and South East Asia: mathematical modelling study

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e608 (Published 02 March 2012) Cite this as: BMJ 2012;344:e608
  1. Anderson E Stanciole, economist1,
  2. Mónica Ortegón, researcher2,
  3. Dan Chisholm, health economist3,
  4. Jeremy A Lauer, economist3
  1. 1Health, Nutrition and Population, World Bank, Washington DC, USA
  2. 2Medical and Health Sciences School, Universidad del Rosario, Bogota, Colombia
  3. 3Department of Health Systems Financing, World Health Organization, Geneva, Switzerland
  1. Correspondence to: A E Stanciole astanciole{at}worldbank.org
  • Accepted 26 October 2011

Abstract

Objectives To determine the population level costs, effects, and cost effectiveness of selected, individual based interventions to combat chronic obstructive pulmonary disease (COPD) and asthma in the context of low and middle income countries.

Design Sectoral cost effectiveness analysis using a lifetime population model.

Setting Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD).

Data sources Disease rates and profiles were taken from the WHO Global Burden of Disease study; estimates of intervention effects and resource needs were drawn from clinical trials, observational studies, and treatment guidelines. Unit costs were taken from a WHO price database.

Main outcome measures Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005.

Results In both regions low dose inhaled corticosteroids for mild persistent asthma was considered the most cost effective intervention, with average cost per DALY averted about $Int2500. The next best value strategies were influenza vaccine for COPD in Sear-D (incremental cost $Int4950 per DALY averted) and low dose inhaled corticosteroids plus long acting β agonists for moderate persistent asthma in Afr-E (incremental cost $Int9112 per DALY averted).

Conclusions COPD is irreversible and progressive, and current treatment options produce relatively little gains relative to the cost. The treatment options available for asthma, however, generally decrease chronic respiratory disease burden at a relatively low cost.

Footnotes

  • doi: 10.1136/bmj.e586
  • , doi: 10.1136/bmj.e615
  • , doi: 10.1136/bmj.e609
  • , doi: 10.1136/bmj.e612
  • , doi: 10.1136/bmj.e607
  • , doi: 10.1136/bmj.e355
  • , doi: 10.1136/bmj.e614
  • We thank Dan Hogan (Department of Health Policy and Management, Harvard University) for providing a version of the WHO-CHOICE COPD tool that served as basis for the model used in this paper. We thank Michele Sechi-Gatta (Erasmus University, Rotterdam) for research assistance and Dr Shanthi Mendis (Department of Chronic Diseases and Health Promotion, WHO) for comments and feedback on an earlier draft.

  • Contributors: All authors contributed to the conception, design, and interpretation of data. AES and MO performed the technical analysis and drafted the manuscript. All authors have read, commented on, and approved the submitted manuscript. AES was based at the WHO when this work was undertaken and is guarantor of the study.

  • Funding: None

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • AES is a staff member of the World Bank; DC and JL are staff members of the WHO. The authors alone are responsible for the views expressed in this publication, and these do not necessarily represent the decisions, policy, or views of the organisations they work for.

  • Ethical approval: Not required

  • Data sharing: No additional data available.

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