This document analyzes the cost-effectiveness and cost-benefit of three interventions to address non-communicable diseases in Haiti: a cervical cancer vaccination program in primary schools, a hypertension screening and treatment campaign, and improving diagnosis and insulin supply for type 1 diabetes patients. It finds that each intervention would save hundreds of lives annually, have benefit-cost ratios above 2, and cost-effectiveness ratios classifying each as highly cost-effective. Combined, the three interventions could save over 2,500 lives each year with an investment return of $2.53 for every $1 spent.

1. HAITI & NON-COMMUNICABLE DISEASE
COST-EFFECTIVENESS AND COST-BENEFIT ANALYSIS
RYAN K MCBAIN, PHD MPH | PARTNERS IN HEALTH | BOSTON, MA, USA | RMCBAIN@MAIL.HARVARD.EDU

2. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
OVERVIEW

3. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
1 40HAITIAN GIRLS
Will develop cervical cancer.
The vast majority are avoidable.
HAITIAN CONTEXT
IN
4,000HAITIAN CHILDREN
Have Type-1 Diabetes,
treatable with insulin.
2,300HAITIAN ADULTS
Die each year from heart
attacks and strokes

4. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
WHAT WE CAN DO
Cervical Cancer
vaccination program
at primary schools
throughout Haiti
Hypertension
screening campaign
and systematic
treatment for those
who are hypertensive
Type-1 Diabetes
insulin supply and
improved diagnostic
tools

5. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
CERVICAL CANCER
INTERVENTION | COSTS | BENEFITS

6. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
70%OF MORTALITIES
from cervical cancer can be
averted through vaccinations.
Current coverage in Haiti is less
than 5%. School-based vaccine
programs are highly cost-
effective. We evaluate this
delivery mode for 10 year-old
girls enrolled in primary school,
aiming to achieve 67% coverage
throughout Haiti.
CERVICAL CANCER PROPOSAL

7. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
COST: $US 2.033M / YEAR
At the patient-level, cost per vaccine dose--when subsidized
by GAVI--is $4.50. Each individual receives 3 doses.
The estimated cost of delivery at schools is $2.99 per
person as a capital cost, and $4.17 per person as a recurrent
cost for administering each dose.
CERVICAL CANCER PROPOSAL

8. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
1,046 LIVES SAVED
EACH YEAR
Assuming two-thirds coverage is achieved at primary
schools throughout Haiti, 93,336 girls would be
vaccinated each year. This would avert 1,494 cases of
cervical cancer and 15,163 disability-adjusted life years.
These benefits are likely to materialize 40 years later.
CERVICAL CANCER PROPOSAL

9. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
BENEFIT-COST RATIO: 2.72 TO 1
CERVICAL CANCER PROPOSAL
$2.03M invested will result in a
$5.52M return, assuming the value of
a health year of life as the equivalent
of 3x GDP per capita and a 5%
discount rate.
From a cost-effectiveness
standpoint, the cost is only $134 per
DALY averted, which should be
considered highly cost-effective
This investment would constitute
less than 1% of the annual budget of
the Ministries of Health and
Education.

10. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
HEART DISEASE
INTERVENTION | COSTS | BENEFITS

11. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
1 IN 5DEATHS EACH YEAR
in Haiti are due to hypertension,
leading to heart attacks and strokes.
Much of this is due to lack of
knowledge about the condition, and
an absence of screening and
treatment. We propose an mass-
media campaign and systematic
treatment of those with SBP > 160.
HEART DISEASE PROPOSAL

12. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
COST: $US 9.89M / YEAR
About 500K for national mass media campaign
3.69M to screen 490,000 self-presenters
5.72M to treat those with SBP>160, including medicines
(amlodipine & hydrochlorothiazide) and four annual clinic visits
HEART DISEASE PROPOSAL

13. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
1,299 LIVES SAVED
EACH YEAR
2,567 strokes avoided and 975 related deaths
851 heart attacks and 323 related deaths
This assumes a population-wide effect of lowering SBP by
a modest 1.83 mmHg due to improved knowledge and
awareness through the education campaign, and one-
third reduction between baseline SBP and 115 mmHg
among those enrolled in treatment.
HEART DISEASE PROPOSAL

14. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
BENEFIT-COST RATIO: 2.02 TO 1
HEART DISEASE PROPOSAL
$9.89M invested will result in a
$19.96M return, assuming the value
of a healthy year of life as the
equivalent of 3x GDP per capita and a
5% discount rate.
From a cost-effectiveness
standpoint, the cost is only $872 per
DALY averted, which is considered
cost-effective
This investment would constitute
less than <5% of the annual budget of
the Ministries of Health and
Education.
CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE

15. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
TYPE-1 DIABETES
INTERVENTION | COSTS | BENEFITS

16. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
>90%OF CHILDREN WITH TYPE-1
DIABETES WILL DIE
if not provided with an adequate
insulin supply. Presently, families
arrive for care too late, diagnostic
tests are weak and insulin supply is
absent. We propose enhancement of
diagnostic and treatment tools,
including insulin, at health facilities.
TYPE-1 DIABETES PROPOSAL

17. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
COST: $US 4.40M / YEAR
Insulin supply costs $77 per year per patient
4 clinical visits cost $30 per year per patient
Clinical supplies cost $469 per year per patient:
This includes glucometer, test strips and syringes
We assume mean dx is at age 9, and that life expectancy of
those on continuous treatment is 37 years
TYPE-1 DIABETES PROPOSAL

18. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
522 LIVES SAVED
FOR EACH NEW COHORT OF CHILDREN
This assumes 0.1% of Haitian children have Type-1
diabetes, an estimated 3,952 children. We expect 80% to
self-present with uncontrolled symptoms of diabetes, and
that 33% of them will be correctly diagnosed. We
estimate an increase in treatment from 25% to 75% of
these individuals.
TYPE-1 DIABETES PROPOSAL

19. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
BENEFIT-COST RATIO: 3.59 TO 1
TYPE-1 DIABETES PROPOSAL
$4.40M invested will result in a
$15.79M return, assuming the value
of a healthy year of life as the
equivalent of 3x GDP per capita and a
5% discount rate.
From a cost-effectiveness
standpoint, the cost is $316 per
DALY averted, which is considered
cost-effective
This investment would constitute
less than <3% of the annual budget of
the Ministries of Health and
Education.
CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE

20. CEA & CBA OF THREE INTERVENTIONS TO ADDRESS NON-COMMUNICABLE DISEASE
2500LIVES SAVED EVERY YEAR
Overall: Every $1 invested yields $2.53 in return.
These investments would build a foundation for addressing
the majority of death and disease in Haiti, and accounts for
less than 10% of the MOH budget.
CONCLUSION