Health Affairs
July 2015; Volume 34, Issue 7
http://content.healthaffairs.org/content/current
Focus: Medicaid’s Evolving Delivery Systems

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Health Aid Is Allocated Efficiently, But Not Optimally: Insights From A Review Of Cost-Effectiveness Studies
Eran Bendavid1,*, Andrew Duong2, Charlotte Sagan3 and Gillian Raikes4
Author Affiliations
1Eran Bendavid (ebd@stanford.edu) is an assistant professor in the Department of Medicine at Stanford University, in California.
2Andrew Duong is a research assistant in the Program of Human Biology at Stanford University.
3Charlotte Sagan is a research assistant in the School of Medicine at Stanford University.
4Gillian Raikes is a research assistant in the Program of Human Biology at Stanford University.
*Corresponding author
Abstract
Development assistance from high-income countries to the health sectors of low- and middle-income countries (health aid) is an important source of funding for health in low- and middle-income countries. However, the relationship between health aid and the expected health improvements from those expenditures—the cost-effectiveness of targeted interventions—remains unknown. We reviewed the literature for cost-effectiveness of interventions targeting five disease categories: HIV; malaria; tuberculosis; noncommunicable diseases; and maternal, newborn, and child health. We measured the alignment between health aid and cost-effectiveness, and we examined the possibility of better alignment by simulating health aid reallocation. The relationship between health aid and incremental cost-effectiveness ratios is negative and significant: More health aid is going to disease categories with more cost-effective interventions. Changing the allocation of health aid earmarked funding could lead to greater health gains even without expanding overall disbursements. The greatest improvements in the alignment would be achieved by reallocating some aid from HIV or maternal, newborn, and child health to malaria or TB. We conclude that health aid is generally aligned with cost-effectiveness considerations, but in some countries this alignment could be improved.

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Simulations Show Diagnostic Testing For Malaria In Young African Children Can Be Cost-Saving Or Cost-Effective
Victoria Phillips1,*, Joseph Njau2, Shang Li3 and Patrick Kachur4
Author Affiliations
1Victoria Phillips (vphil01@sph.emory.edu) is an associate professor in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University, in Atlanta, Georgia.
2Joseph Njau is a prevention effectiveness fellow in the Global Immunization Division in the Center for Global Health, Centers for Disease Control and Prevention (CDC), in Atlanta.
3Shang Li is a health care analyst at Analysis Group, in New York City.
4Patrick Kachur is a medical epidemiologist and chief of the Malaria Branch, Division of Parasitic Disease and Malaria, Center for Global Health, CDC.
*Corresponding author
Abstract
Malaria imposes a substantial global disease burden. It disproportionately affects sub-Saharan Africans, particularly young children. In an effort to improve disease management, the World Health Organization (WHO) recommended in 2010 that countries test children younger than age five who present with suspected malaria fever to confirm the diagnosis instead of treating them presumptively with antimalarial drugs. Costs and concerns about the overall health impact of such diagnostic testing for malaria in children remain barriers to full implementation. Using data from national Malaria Indicator Surveys, we estimated two-stage microsimulation models for Angola, Tanzania, and Uganda to assess the policy’s cost-effectiveness. We found that diagnostic testing for malaria in children younger than five is cost-saving in Angola. In Tanzania and Uganda the cost per life-year gained is $5.54 and $94.28, respectively. The costs projected for Tanzania and Uganda are less than the WHO standard of $150 per life-year gained. Our results were robust under varying assumptions about cost, prevalence of malaria, and behavior, and they strongly suggest the pursuit of policies that facilitate full implementation of testing for malaria in children younger than five.