Cost-effective interventions to prevent non-communicable diseases: increasing the evidence base in India and other low-
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Cost-effective interventions to prevent noncommunicable diseases: increasing the evidence base in India and other low- and middle-income settings Karen Eggleston*
and Radhika Jain
Keywords: Cost-effectiveness, Diabetes, Non-communicable diseases, India
Background India, as part of its bid to achieve universal health coverage, has expanded government health programs over the last two decades, most notably with the establishment of the National Health Mission and the rollout of public health insurance programs targeting poor households [1]. However, national spending on health remains among the lowest in the world. As the government increasingly takes on the role of purchaser of health care, decisions about the allocation of scarce resources for health will have substantial fiscal and health consequences and must be based on evidence. Additionally, in order to control costs and effectively address the growing chronic disease burden, public programs will need to find ways to integrate curative hospital services with the most cost-effective preventive and primary interventions. Currently, in part because the evidence base on economic evaluations of health interventions in India remains sparse and of low quality [2], decisions about which health care services to cover are typically made by expert committees rather than through systematic This comment refers to the article available at https://doi.org/10.1186/ s12916-020-01704-9. * Correspondence: [email protected] Freeman Spogli Institute for International Studies (FSI), Asia Health Policy Program, Asia-Pacific Research Center (APARC), Stanford University, Stanford, USA
assessments of efficacy and cost-effectiveness. However, in recent years, the government has taken several steps towards establishing the infrastructure for evidence-based priority setting and resource allocation [3], including the establishment of a body for Health Technology Assessment in India (HTAIn) within the Department of Health Research to collate and generate evidence on the clinical efficacy and costeffectiveness of new and existing health technologies and programs [4]. Research evidence on the costeffectiveness of both preventive and curative health interventions in the Indian context is going to be a critical input to the HTAIn.
Evidence of cost-effective prevention of diabetes and non-communicable disease Chronic non-communicable diseases (NCDs) affect more than 20% of the Indian population [5], with incidence and prevalence projected to increase substantially as the population aged 60 and over increases. Levels of several critical risk behaviors, such as alcohol and tobacco use, low physical activity, and unhealthy diet are increasing in socioeconomic status and will require explicit intervention beyond economic development or access to curative care alone. Because the risk factors for chronic diseases are overlapping, the benefits of preventive interventions targeting them are likely to extend beyond preventing diabetes or any other single NCD. Numerous
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