Can Economic Analysis Contribute to Disease Elimination and Eradication? A Systematic Review

RESEARCH ARTICLE Can Economic Analysis Contribute to Disease Elimination and Eradication? A Systematic Review Elisa Sicuri1, David B. Evans2,3, Fabrizio Tediosi2,3* 1 ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain, 2 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland, 3 University of Basel, P.O. Box, CH-4003 Basel, Switzerland * Abstract a11111 OPEN ACCESS Citation: Sicuri E, Evans DB, Tediosi F (2015) Can Economic Analysis Contribute to Disease Elimination and Eradication? A Systematic Review. PLoS ONE 10(6): e0130603. doi:10.1371/journal.pone.0130603 Academic Editor: Chris T. Bauch, University of Waterloo, CANADA Received: January 12, 2015 Accepted: May 21, 2015 Background Infectious diseases elimination and eradication have become important areas of focus for global health and countries. Due to the substantial up-front investments required to eliminate and eradicate, and the overall shortage of resources for health, economic analysis can inform decision making on whether elimination/eradication makes economic sense and on the costs and benefits of alternative strategies. In order to draw lessons for current and future initiatives, we review the economic literature that has addressed questions related to the elimination and eradication of infectious diseases focusing on: why, how and for whom? Methods A systematic review was performed by searching economic literature (cost-benefit, cost-effectiveness and economic impact analyses) on elimination/eradication of infectious diseases published from 1980 to 2013 from three large bibliographic databases: one general (SCOPUS), one bio-medical (MEDLINE/PUBMED) and one economic (IDEAS/REPEC). Published: June 12, 2015 Copyright: © 2015 Sicuri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Project supported by the Bill and Melinda Gates Foundation – Grant number OPP1037660. Competing Interests: The authors have declared that no competing interests exist. Results A total of 690 non-duplicate papers were identified from which only 43 met the inclusion criteria. In addition, only one paper focusing on equity issues, the “for whom?” question, was found. The literature relating to “why?” is the largest, much of it focusing on how much it would cost. A more limited literature estimates the benefits in terms of impact on economic growth with mixed results. The question of how to eradicate or eliminate was informed by an economic literature highlighting that there will be opportunities for individuals and countries to free-ride and that forms of incentives and/or disincentives will be needed. This requires government involvement at country level and global coordination. While there is little doubt that eliminating infectious diseases will eventually improve equity, it will only happen if active steps to promote equity are followed on the path to elimination and eradication. PLOS ONE | DOI:10.1371/journal.pone.0130603 June 12, 2015 1 / 21 Economics and Disease Elimination and Eradication Conclusion The largest part of the literature has focused on costs and economic benefits of elimination/ eradication. To a lesser extent, challenges associated with achieving elimination/eradication and ensuring equity have also been explored. Although elimination and eradication are, for some diseases, good investments compared with control, countries’ incentives to eliminate do not always align with the global good and the most efficient elimination strategies may not prioritize the poorest populations. For any infectious disease, policy-makers will need to consider realigning contrasting incentives between the individual countries and the global community and to assure that the process towards elimination/eradication considers equity. Introduction The major global health achievements of the last century were possible due to improvements in health technologies and services consequent to advances in knowledge, science and technology, building on improvements in socio-economic conditions [1, 2]. The links between health improvements and socio-economic development are well established and the relationship is complex and bi-directional. For example, increasing incomes, education and other forms of social development improve living conditions and reduce risks to health. They allow people to take more responsibility for, and invest in their own health. On the other hand, improved health also allows people to earn more and improve their own living standards [3–7]. There is no doubt, however, that increased coverage of many types of health interventions—vaccines, safe childbirth delivery, treatment for tuberculosis, malaria and HIV/AIDS and prevention of cardiovascular disease to name a few—have also contributed to worldwide health improvements. Economic analysis has facilitated a better understanding of the relationship between economic growth and health, but has also helped to make the case that investments in health produce excellent returns not just in terms of improved morbidity and mortality but also through their impact on the economic wellbeing. Economic analysis has now been extended to questions surrounding one of the most pressing global health challenges: should countries press for the elimination and eradication of infectious diseases and if so, how? Partly because of the heavy initial investments required, there are a number of areas in which economics can inform these important decisions. We, therefore, undertook a systematic review of the literature to explore how economic analysis has to date contributed to inform the debate about the elimination/eradication of different infectious diseases. We focus particularly on whether there are common strands across diseases in the way this analysis has sought to answer three questions: why eliminate, how, and for whom? [8]. The context: infectious diseases elimination/eradication The proportion of the global burden of disease attributable to infectious diseases has decreased considerably in the last two decades [9]. The reasons for this are beyond the scope of this paper, but are complex and linked to improved socio-economic conditions, disease control technologies, and increased political will to reduce the burden of infectious diseases [10, 11]. Disease elimination has been defined as a reduction to zero of the incidence of infection caused by a pathogen in a defined geographical area, while eradication is a permanent PLOS ONE | DOI:10.1371/journal.pone.0130603 June 12, 2015 2 / 21 Economics and Disease Elimination and Eradication reducti (...truncated)