The economic value of changing mortality risk in low- and middle-income countries: a systematic breakdown by cause of death

Abstract

Background: We develop a framework for quantifying monetary values associated with changes in disease-specific mortality risk in low- and middle-income countries to help quantify trade-offs involved in investing in mortality reduction due to one disease versus another. Methods: We monetized the changes in mortality risk for communicable and non-communicable diseases (CD and NCD, respectively) between 2017 and 2030 for low-income, lower-middle-income, and upper-middle-income countries (LICs, LMICs, and UMICs, respectively). We modeled three mortality trajectories (“base-case”, “high-performance”, and “low-performance”) using Global Burden of Disease study forecasts and estimated disease-specific mortality risk changes relative to the base-case. We assigned monetary values to changes in mortality risk using value of a statistical life (VSL) methods and conducted multiple sensitivity analyses. Results: In terms of NCDs, the absolute monetary value associated with changing mortality risk was highest for cardiovascular diseases in older age groups. For example, being on the low-performance trajectory relative to the base-case in 2030 was valued at $9100 (95% uncertainty range $6800; $11,400), $28,300 ($24,200; $32,400), and $30,300 ($27,200; $33,300) for females aged 70–74 years in LICs, LMICs, and UMICs, respectively. Changing the mortality rate from the base-case to the high-performance trajectory was associated with high monetary value for CDs as well, especially among younger age groups. Estimates were sensitive to assumptions made in calculating VSL. Conclusions: Our framework provides a priority setting paradigm to best allocate investments toward the health sector and enables intersectoral comparisons of returns on investments from health interventions.