The case for investing in the prevention and control of non-communicable diseases in the six countries of the Gulf Cooperation Council: an economic evaluation

Abstract

BackgroundWhile the non-communicable disease (NCD) burden in the countries of the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) has surged over the past decades, the costs and return on investment (ROI) of implementing cost-effective, WHO-recommended NCD interventions have not been established.MethodsWe performed an economic analysis to estimate the ROI from scaling up four sets of NCD interventions over 15 years. We estimated the direct costs of the four main NCDs (cancer, diabetes, cardiovascular diseases and chronic respiratory diseases) using a prevalence-based, bottom-up cost-of-illness approach. We estimated indirect costs based on productivity loss due to absenteeism, presenteeism and premature deaths. We costed the scaling up of interventions using the WHO Costing Tool and assessed the health impact of interventions using the OneHealth Tool. We calculated ROI by comparing productivity and social benefits with the total costs of implementing the interventions.ResultsThe four main NCDs cost the GCC economy nearly US$50 billion in 2019, equal to 3.3% of its gross domestic product. The indirect costs are estimated at US$20 billion or 40% of the total burden. Implementing the four modelled intervention packages in the six GCC countries over 15 years will cost US$14 billion, with an ROI of US$4.9 for every US$1 invested and significant health and social benefits, including 290 000 averted premature deaths.ConclusionBased on the results of these six investment cases, we recommend actions to scale up current WHO-recommended cost-effective interventions, strengthen whole-of-government action, drive the NCD legislative agenda, build out the evidence base, generate additional advocacy material, and increase regional collaboration and data-sharing to establish best practices and monitor impact.

Comparative Performance Evaluation of the Public Health Surveillance Systems in 6 Gulf Cooperation Countries: Cross-sectional Study

“…Only 2 countries used new cutting-edge technologies, resulting in a glaring mismatch among the countries in the use of machine learning, AI, and real-time analytics. 67) 0 (0) 1 ( 17) 1 (17) The system provides estimates of morbidity related to the health-related event under surveillance 1 (17) 5 (83) 0 (0) 0 (0) 0 (0)…”

“…The system provides estimates of mortality related to the health-related event under surveillance 2 (33) 4 (67) 0 (0) 0 (0) 0 (0) The system enables us to identify high-risk populations 3 (50) 3 (50) 0 (0) 0 (0) 0 (0) The system enables us to plan the resources needed for prevention and control 3 (50) 2 (33) 1 ( 17) 0 (0) 0 (0) The system enables us to update and develop national policy strategy 1 ( 17) 5 (83) 0 (0) 0 (0) 0 (0) The system enables us to assess the impact of any prevention and control intervention 2 (33) 0 (0) 0 (0) 4 (67) 0 (0) The system can generate actionable reports and insights immediately about health-related events under surveillance 2 (33) 3 (50) 1 ( 17) 0 (0) 0 (0) The system can detect trends that signal changes in the occurrence of all health-related events under surveillance 1 ( 17) 1 ( 17) 0 (0) 3 (50) 1 (17) The system can predict trends and outcomes using artificial intelligence and machine learning models 3 (50) 3 (50) 0 (0) 0 (0) 0 (0) The system data stimulate research intended for prevention or control 3 (50) 3 (50) 0 (0) 0 (0) 0 (0) Our surveillance system has clear case definitions to detect notifiable diseases 3 (50) 1 ( 17) 2 (33) 0 (0) 0 (0) Our surveillance system uses multiple reporting sources, such as hospitals, laboratories, primary clinics, etc. 2 (33) 1 ( 17) 0 (0) 2 (33) 1 (17) Our surveillance system is integrated with all health information systems in the country 1 (17) 2 (33) 3 (50) 0 (0) 0 (0) We need to perform extensive data analysis to generate disease reports and insights 2 (33) 2 (33) 1 ( 17) 1 ( 17) 0 (0) We have established methods and policies to disseminate surveillance results to relevant stakeholders 3 (50) 3 (50) 0 (0) 0 (0) 0 (0) Our surveillance system allows us to respond quickly to a new demand, that is, diseases, risk factors etc.…”

“…3 (50) 3 (50) 0 (0) 0 (0) 0 (0) Our surveillance system allows us to respond quickly for emerging or re-emerging pandemics 3 (50) 2 (33) 1 ( 17) 0 (0) 0 (0) Our surveillance system can detect events other than notifiable diseases, such as food poisoning, chemical poisoning, environmental events, etc. 0 (0) 3 (50) 2 (33) 1 ( 17) 0 (0) Our surveillance system has high completion rates 0 (0) 3 (33) 2 (33) 1 ( 17) 0 (0) Our surveillance system has high laboratory reporting rates 1 (17) 5 (83) 0 (0) 0 (0) 0 (0) Our surveillance system has high hospital or PHC a reporting rates 1 (17) 5 (83) 0 (0) 0 (0) 0 (0) Our surveillance system can correctly detect a high proportion of disease cases 1 (17) 5 (83) 0 (0) 0 (0) 0 (0) Our surveillance system can correctly detect new epidemics or outbreaks 2 (33) 3 (50) 1 ( 17) 0 (0) 0 (0) The proportion of reported cases that are true cases in our surveillance system is high 2 (33) 4 (67) 0 (0) 0 (0) 0 (0) The proportion of reported epidemics that are true epidemics in our surveillance system is high agree, n (%) Agree, n (%) Neutral, n (%) Disagree, n (%) Strongly disagree, n (%) Question 2 (33) 4 (67) 0 (0) 0 (0) 0 (0) Our surveillance system informs us about the characteristics of the population under surveillance, for example, age, socioeconomic status, geographic location 1 (17) 1 ( 17) 4 (67) 0 (0) 0 (0) Our surveillance system enables us to measure the natural history of disease, for example, latency period, mode of transmission, and fatal outcomes 1 (17) 5 (83) 0 (0) 0 (0) 0 (0) Our surveillance system captures clinical practice data, for example, sites performing diagnostic tests, and physician-referral patterns 2 (33) 2 (33) 2 (33) 0 (0) 0 (0) Our surveillance system captures clinical outcomes of interest, for example, mortality data, hospitalizations, and laboratory data 5 (83) 1 ( 17) 0 (0) 0 (0) 0 (0) The entered data in our surveillance system is accurate 3 (50) 3 (50) 0 (0) 0 (0) 0 (0) Our surveillance system has standardized methods for data entry 2 (33) 4 (67) 0 (0) 0 (0) 0 (0) Our surveillance system can measure what it intends to measure 0 (0) 1 ( 17) 1 ( 17) 3 (50) 1 (17) Our surveillance system has a high number of spontaneous outages and down times 0 (0) 2 (33) 0 (0) 3 (50) 1 (17) We spend a lot of our resources on technical repairs to maintain system functionality 0 (0) 2 (33) 0 (0) 3 (50) 1 (17) Our surveillance system requires a long time for gathering and receiving data 1 ( 17) 1 ( 17) 0 (0) 2 (33) 2 (33) Our surveillance system requires a long time for managing data, such as transfer, entry, modifying, storage, and back-up of data 2 (33) 4 (67) 0 (0) 0 (0) 0 (0) Our surveillance system is able to generate data for immediate disease control 2 (33) 4 (67) 0 (0) 0 (0) 0 (0) Our surveillance system is able to generate data for long-term program planning a PHC: primary health care center. Table 6 shows the correlation coefficients (r) between the global score and each of the attribute scores of the GCC surveillance systems.…”

“…Although NCD monitoring also exists in other GCC countries [14][15][16], these monitoring mechanisms were siloed and operated independently from the original surveillance systems. As NCDs impose a high economic and social burden on GCC countries [17], incorporating NCDs within the original surveillance systems can potentially consolidate surveillance efforts and aid in prioritizing NCD prevention and control to tackle behavioral and system-level risk factors [18]. Several states in the United States have conducted pilot studies on public health surveillance of chronic diseases and risk factors [19].…”

Seasonal Influenza Vaccination among Patients with Comorbidities in the Countries of the GCC: A Responsibility or an Option?

“…The Gulf Corporation Council (GCC) countries have a growing burden of NCDs and have the highest prevalence of diabetes and obesity worldwide. 7 , 8 The region has a sizable population that is more susceptible to severe influenza. In fact, influenza is a leading cause of hospitalizations and mortality among people with comorbidities in the GCC countries.…”