their health systems to deliver adequate care. Other countries are making headway as they and/or donors increase resource allocations to health. In both instances, informed choices about what the available resources will buy can better align needed and realized health improvements.


Economic measurements and analysis are critically important to inform decisions both about allocating resources and choosing among alternative solutions to the problem within and beyond the health sector. The health economics literature relies almost exclusively on cost-effectiveness measures to assess value for money. Cost-effectiveness analysis of interventions can be an important tool for choosing among interventions targeted to the same outcomes, and the first section of this chapter summarizes the available cost-effectiveness evidence for CVD interventions in low and middle income countries. However, cost-effectiveness provides little information about the affordability of given interventions or the actual value to the beneficiaries, and it does not allow for ready comparisons of interventions across different sectors and different health and development priorities. The potential return on investment needs to be assessed within a broad socioeconomic context, and guidance derived from cost-effectiveness analysis may be superseded by broader policy choices for allocating resources across competing priorities within the parameters that society sets for achieving better health and well-being. Economic benefit–cost analysis can be used to balance tradeoffs in choosing among alternatives, such as new technologies or investments in structural and policy changes. However, the analytical and data demands are much higher, and there are almost no cost–benefit studies available from developing countries on CVD interventions. Ultimately, decisions about how to prioritize investments will necessitate carefully defining feasible options for change and determining the willingness of stakeholders to shift resources to implement those changes.

Summary of Cost-Effectiveness Evidence1

The preceding chapters have provided a thorough summary of the relevant CVD interventions under consideration in low and middle income countries. This section discusses the available evidence on their cost-effectiveness, drawing primarily on two rapid reviews commissioned for this report, which built on and updated major recent efforts such as the Disease Control Priorities Project (DCP2) (Musgrove and Fox-Rushby, 2006) and the WHO initia-


This section is based in part on papers written for the committee by Marc Suhrcke et al. and by Stephen Jan and Alison Hayes.

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