8. The Cost-Effectiveness of Interventions and Policies for Noncommunicable Diseases and Their Risk Factors in the Latin America and Caribbean Region: A Systematic Literature Review

DAVID WATKINS; POGGIO ROSANA; ADOLFO RUBINSTEIN

Economic Dimensions of Noncommunicable Diseases in Latin America and the Caribbean

Pan American Health Organization

Año: 2016; p. 87 - 109

Noncommunicable diseases (NCDs) are the leadingcause of death in the Americas, with cardiovasculardisease (CVD) responsible for 45 percent of thosedeaths (Hospedales, Barcelo, Luciani, and others 2012).In the Latin America and Caribbean (LAC) region, it isestimated that from 1990 until 2020, death from CVD,including coronary heart disease (CHD), will increase byapproximately 145 percent for both men and women. Thatcompares with an increase of 28 percent for women andan increase of 50 percent for men in developed countriesduring the same period (Yusuf, Hawken, Ounpuu, andothers 2004).The countries and territories of LAC have pioneereda strong and multisectoral response to NCD preventionand control, spearheaded by the leadership of theCaribbean countries in the 2011 United Nations High-Level Meeting on NCDs, and continuing with the recentcreation of the Healthy Latin America Coalition, whichadvocates for health promotion and NCD prevention.The Pan American Health Organization (PAHO) haspromoted and facilitated member countries? activitiesin surveillance, policy development, and guidelines forNCD prevention. The PAHO Regional Strategy and Planof Action for the Prevention and Control of ChronicDiseases was adopted in 2012, with explicit attention tothe development and economic importance of NCDs, andto the need for multisectoral involvement (PAHO 2012).In this environment, it is unsurprising that a largenumber of economic studies about NCDs have beenproduced in the LAC region. This article reviewsthe literature from LAC on the cost-effectiveness ofinterventions and policies to control and prevent NCDs.Many LAC countries use the World Health Organization(WHO) threshold to define an intervention as being costeffective,that is, whether the cost of a disability-adjustedlife year (DALY) or quality-adjusted life year (QALY) is lessthan one times the country?s gross domestic product (GDP)per capita per life year. Most GDPs per capita in LAC rangebetween U$S4,000 and US$12,000 (Sachs 2001).The literature on this issue reflects severalcharacteristics unique to the LAC region: the relativelyrobust availability of health condition and risk factordata; a strong political and advocacy environmentfor population policy implementation; and an activeresearch network on economic and public health issues,particularly on cost-effectiveness methods. As a result,this review identified a large number of relevant articles,which enables interesting comparisons across time andgeography.