Universal worldwide implementation of 23 proven preventive and therapeutic interventions could avert more than 6 million of the 10 million deaths that occur annually among children younger than age 5 years.1 Investigators from Pakistan and multiple United States locations estimated the additional ongoing annual costs for universal delivery of these interventions in the 42 countries that account for 90% of deaths in this age group. The 7 treatment and 16 prevention interventions were proven effective and considered feasible for universal delivery in low-income countries. The authors assumed interventions would be delivered by trained health care professionals and community workers in outpatient and inpatient facilities and through outreach activities. Only the cost of providing additional services (over year 2000 coverage levels) needed to achieve universal coverage was estimated; the cost of expanding delivery systems was not included. For maximum efficiency in the delivery of preventive services, an integrated delivery timetable was developed, consisting of 18 contacts with a primary care provider over the first 5 years of life. Cost assumptions were based on existing data from international public health organizations. To assess the effect of key baseline assumptions on final cost, sensitivity analyses were performed using variations in the cost of 3 elements: the salary of trained community childbirth attendants, the cost of drugs, and the level of existing coverage (for 2000).
The estimated additional cost of providing the 16 preventive services to all children in the 42 countries was $4.7 billion annually. More than 50% of these funds were for 3 key services: improved water, sanitation and hygiene; delivery with a skilled childbirth attendant; and Haemophilus influenzae type b vaccines. The estimated additional cost of providing the 7 treatment interventions at universal levels was $1 billion annually, although fully implementing the 16 preventive services would reduce that amount by 60% (largely savings through reduced use of antimalarials and antibiotics that would accompany a reduction in cases of malaria, dysentery, and pneumonia). Thus, the total additional running costs for fully implementing universal provision of 16 preventive and 7 treatment services would be $5.1 billion annually. Sensitivity analyses showed that this figure could range from $3.1 billion to $8.1 billion, depending on variations in cost assumptions.
Dr. Aldous has disclosed no financial relationships relevant to this commentary.
These results are striking: a worldwide investment of an additional $5.1 billion could save the lives of 6 million children annually – a cost of $887 per life saved, or $1.23 per person living in the target countries! In contrast, the US spends almost $4,900 per capita annually on health care.2 It is important to stress that the authors estimated only ongoing care delivery costs, not the cost of expanding infrastructure and systems to enable universal coverage. Also, their estimates include only additional costs over current expenditures based on year 2000 coverage...