Cost-effectiveness analysis of humanitarian relief interventions: visceral leishmaniasis treatment in the Sudan

Abstract

Spending by aid agencies on emergencies has quadrupled over the last decade, to over US$6 billion. To date, cost-effectiveness has seldom been considered in the prioritization and evaluation of emergency interventions. The sheer volume of resources spent on humanitarian aid and the chronicity of many humanitarian interventions call for more attention to be paid to the issue of 'value for money'. In this paper we present data from a major humanitarian crisis, an epidemic of visceral leishmaniasis (VL) in war-torn Sudan. The special circumstances provided us, in retrospect, with unusually accurate data on excess mortality, costs of the intervention and its effects, thus allowing us to express cost-effectiveness as the cost per Disability Adjusted Life Year (DALY) averted. The cost-effectiveness ratio, of US$18.40 per DALY (uncertainty range between US$13.53 and US$27.63), places the treatment of VL in Sudan among health interventions considered 'very good value for money' (interventions of less than US$25 per DALY). We discuss the usefulness of this analysis to the internal management of the VL programme, the procurement of funds for the programme, and more generally, to priority setting in humanitarian relief interventions. We feel that in evaluations of emergency interventions attempts could be made more often to perform cost-effectiveness analyses, including the use of DALYs, provided that the outcomes of these analyses are seen in the broad context of the emergency situation and its consequences on the affected population. This paper provides a first contribution to what is hoped to become an international database of cost-effectiveness studies of health interventions during relief operations, which use a comparable measure of health outcome such as the DALY.

PIP: With spending by official aid agencies upon emergencies quadrupling over the past decade to more than US$6 billion, greater attention needs to be paid to the cost-effectiveness of the humanitarian interventions funded by such agencies. Data are presented from an epidemic of visceral leishmaniasis (VL) in civil war-torn Sudan, in a study of how such data could have been used in planning relevant health interventions. Data are available on the impact of a VL treatment program for 3067 patients between August 1990 and July 1991. Calculations made with the available data and relevant assumptions yielded a cost-effectiveness ratio of US$18.40 per Disability Adjusted Life Year (DALY), with an uncertainty range of US$13.53-27.63, a highly cost-effective health intervention. The applicability of the analysis to the internal management of the VL program, the procurement of funds for the program, and to priority setting in humanitarian relief interventions are discussed. When evaluating emergency interventions, efforts could be made more often to perform cost-effectiveness analyses, including the use of DALYs, provided that the outcomes of the analyses are seen in the broad context of the emergency situation and its consequences upon the affected population.