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.

One world health: Socioeconomic burden and parasitic disease control priorities

“…Treatment of visceral leishmaniosis cases, such as in a relief programme, is highly cost effective and has been estimated at just US$ 18.40 for each DALY averted (Greikspoor et al, 1999); any intervention that costs less than $25 per DALY averted is considered very good value for money by the World Bank.…”

Reacting to Crisis: The Costs of First Response by the United States Navy

“…However, to date, few published works report or estimate the cost of conducting military support for HADR. Grieskpoor, Sondop, and Vos (1999) examined excess mortality and costs of response by humanitarian organizations to identify cost-effectiveness in terms of Disability Adjusted Life Year. The case study in Sudan for visceral leishmaniasis (Dumdum or Black Fever) treatment was deemed to be 'very good value for money'.…”

“…The money expended in disaster relief in in 2013 was a record US$22 billion. Cost-effectiveness has not been a priority in any decision for responding to disasters ( Grieskpoor, Sondop, and Vos 1999). A "send everything and we will figure out how to pay for it" approach has been the prevailing attitude of the United States Navy (USN) in the past ( Moffat 2014).…”

Barriers to treatment for visceral leishmaniasis in hyperendemic areas: India, Bangladesh, Nepal, Brazil and Sudan

“…In the MSF program, Pentosam ® (sodium stibogluconate) is used as first-line treatment 33 . Patients from Sudan prefer the MSF facilities, as treatment provided is free.…”