Best Investments in Chronic, Noncommunicable Disease Prevention and Control in Low- and Lower-Middle-Income Countries

Abstract

The world remains off-track for the sustainable development goal (SDG) target 3.4, which calls for a one-third reduction in noncommunicable diseases (NCDs) mortality by 2030. This paper presents benefit-cost analyses of various NCD interventions in low-income (LICs) and lower-middle-income (LMCs) countries. We looked at 30 interventions recommended by the Disease Control Priorities Project, including six intersectoral policies (e.g., taxes) and 24 clinical services. We used a previously published model to estimate intervention costs and benefits through 2030, discounted at 8%. We focused on interventions with benefit-cost ratios (BCRs) > 15 and their contribution toward achieving the SDG target. We found that intersectoral policies often provided great value for money, with BCRs ranging from 40 (trans-fat bans) to 100 (tobacco excise taxes). However, seven clinical interventions (e.g., basic treatment of cardiovascular disease or breast cancer) also had BCRs > 15. The overall population impact of clinical interventions over the 2023-2030 period would be much higher than that of the intersectoral policies, which can take many years to reach their peak effects. Fully implementing the best-investment interventions would accelerate progress toward SDG 3.4 everywhere, but only one in 10 countries would achieve the target. This strategy would require an additional US$ 2.4 billion annually across all LICs and LMCs. We conclude that there are several cost-beneficial opportunities to tackle NCDs in LICs and LMCs. In countries with very limited resources, the best-investment interventions could begin to address the major NCD risk factors and build greater health system capacity, with benefits continuing to accrue beyond 2030.