The second initiative is using low-cost drugs to avert heart attacks. Jha argues that systemwide efforts to achieve high rates of appropriate drug use administered within hours of an acute heart attack should be a high priority. Up to 300,000 heart-attack deaths could be prevented each year at the cost of $200 million. Jha calculates that, in economic terms, each dollar spent would generate $25 of benefits.
Another approach to the same problem is to create a “generic risk pill.”. In the absence of any drug therapy, adults with previous stroke, heart attack, diabetes, or any other evidence of some serious vascular disease have about a 7 percent annual risk of either dying or being rehospitalized with a recurrence. If they take an aspirin a day, that risk drops to 5 percent; if they add two more drugs to reduce blood pressure and blood lipids, it drops to 2 percent. The exact sequence of drugs matters little, but being on three or four drugs (aspirin, a blood pressure pill or two, and a statin drug to lower cholesterol) daily versus being on no drugs means a greatly reduced 10-year risk of rehospitalization: 16 percent for those receiving treatment as compared with 50 percent for those on no drugs. All of these drugs are low-cost and thus could be easily packaged into “polypills” or generic risk pills for widespread use, similar to the way many countries treat tuberculosis with several drugs.
This “generic risk pill” would prevent 1.6 million deaths annually. If the cost per adult patient per year were $100, the total cost would then be $32 billion per year. The higher cost is reflected in a lower “benefit-cost ratio”: Each dollar spent on this initiative would see about $4 worth of benefits. Still, this remains an attractive investment.
Next, Jha proposes efforts to reduce salt consumption, which is a significant cause of heart diseases and strokes. This can be done in food processing or at the cooking or eating stages. The former approach is being tried in Latin America where Brazil, Argentina, and Chile are among the countries with industry agreements to reduce salt in processing.
Experience in the United Sates and other developed countries suggest that substantial reduction from current levels is feasible with only some consumer resistance. Argentina and South Africa are focusing on salt reduction in bread. The main limitation in salt reduction strategies is the unproven impact on changing behavior when salt is mostly added at the table as a condiment. The researchers propose a population-level intervention to reduce salt intake through voluntary manufacturing changes, behavior change using mass media and other awareness raising campaigns. An annual expenditure of $1 billion would save more than 1.3 million lives a year from heart disease and strokes, meaning that the benefits are 20 times higher than the costs.
Finally, Hepatitis B is a viral infection that attacks the liver and is the major cause of liver cancer worldwide. Yet the Hepatitis B vaccine can prevent 90 percent ofiver cancer deaths, and the Hepatitis B vaccine is safe and very effective when given at birth or in early childhood. The vaccine could cost as little as $3.60 per child vaccinated. Spending $122 million to increase vaccine coverage by 25 percent would avert about 150,000 annual deaths from the disease, 40 years into the future. Each dollar spent generates $10 of benefits.
There is a strong argument to increase spending on chronic disease. The burden on poor countries is already high, and will grow considerably. But what priority should these initiatives be given by policymakers and philanthropists? How could limited money best be spent to combat global challenges? Have your say by voting below.
Tomorrow, we look at infectious disease funding. We have seen major breakthroughs in the battles against killer diseases such as malaria and HIV/AIDS. But how can we ramp up our efforts to save more lives?
In this series, Bjorn Lomborg explores the smartest investments to respond to global challenges such as hunger, chronic and infectious disease, sanitation, climate change, and global conflict. See the other articles here. And find out which investments are currently at the top of the Slate readers’ priority list. Have your say by voting at the poll at the end of each article.