Saturday, May 18, 2013

What is and isn't worth paying for in public health

Bill Gates on which public health interventions are most worthwhile in developing countries:
BG: The way that this is talked about is, what’s a year of life worth? They call it a disability-adjusted life year (DALY). When you’re running a poor country health-care system, you can’t treat a year of life as being worth more than, say, $200, $300 or else you’ll bankrupt your health system immediately. So, with very few exceptions, you do nothing for cancer. If you get cancer, you’re going to die. And so none of the stuff that’s going on in the U.S. about $300,000 a year chemotherapy drugs is relevant.
Even simple things don’t pass the test. We’re on the verge of saying that Africa should do blood pressure medicine because it’s become generic and so cheap and that’s such a common issue in terms of heart attack death, the so-called polypill is so cheap that it’s one of the few non-infectious disease things that meets the dollars per DALY threshold to actually go into a poor healthcare system and say this is worth it given the extremely finite not only financial resources, but personnel resources, that you have.     
But here’s the good news for these countries. If you spend the less than 2 percent of what the rich countries spend, but you spend it on vaccinations and antibiotics, you get over half of all that healthcare does to extend life. So you spend 2 percent and you get 50 percent. If you spend another 80 percent you’re at over 90 percent.

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